Serving Substance Abuse Professionals Since 1993

Last Update: 15.06.12

C O R K O N L I N E

powerpoint presentations
CORK database search
resource materials
bibliographies
clinical tools
user services
newsletters
about cork
home

CORK Bibliography: Maternal Drug Use

33 citations. 2009 to present

Prepared: June 2012

Afifi RA; Yeretzian JS; Rouhana A; Nehlawi MT; Mack A. Neighbourhood influences on narghile smoking among youth in Beirut. European Journal of Public Health 20(4): 456-462, 2010. (42 refs.)

Background: Increasingly neighbourhoods are identified as influencing health. Neighbourhood characteristics have been linked to cigarette use. In Lebanon, the water pipe (narghile) use is most frequent among youth. The current study is aimed at identifying differential neighbourhood influences on smoking narghile among youth. Methods: A quantitative interview was completed with 1294 adolescents, 13-20 years, in three urban disadvantaged neighbourhoods of Beirut. Individual and social factors, suggested by the literature, were associated with smoking narghile. The neighbourhood variation in the influence of these factors was then explored. Bivariate and stratified logistic regression analysis were conducted, neighbourhood being the stratification variable. Results: About 60% of respondents had ever tried a narghile, about one-fifth continued to smoke. Several individual-level and social variables predicted narghile smoking bivariately. The influences on narghile smoking varied by neighbourhood. Neighbourhood differences persisted at the multivariate level. Consistently across neighbourhoods, the influence of friends was the predominant predictor of narghile smoking. In one neighbourhood, maternal smoking was a risk factor for narghile smoking of youth, in another paternal smoking. Being female seems to be protective in two of the three neighbourhoods. Other factors also differentially influence narghile use by neighbourhood. Conclusions: The mechanisms of influence of neighbourhoods on health are not clearly understood, but a transactional paradigm seems most fitting with the results found in this research. Interventions to prevent the narghile smoking should address multiple levels of influence; and must be tailored to the particular aspects of neighbourhoods which are influential in the uptake of this behaviour.

Baska T; Warren CW; Hudeckova H; Ochaba R; Stastny P; Lea V et al. The role of family background on cigarette smoking among adolescent school children in Slovakia: Findings from the 2007 Slovakia Global Youth Tobacco Survey. International Journal of Public Health 55(6): 591-597, 2010. (26 refs.)

To analyse Global Youth Tobacco Survey (GYTS) data to determine the role of family background on cigarette smoking among adolescents in Slovakia. The GYTS is a school-based survey of students aged 13-15 years developed by the World Health Organization and the Centers for Disease Control and Prevention. The GYTS was conducted in Slovakia in 2007. Students from families where one or more parents were smokers were significantly more likely to report lifetime smoking, current cigarette smoking and signs of nicotine dependence (only girls). Socioeconomic status of parents as measured by parent educational level and employment status was not statistically associated with students' smoking status. Girls from families with lower socioeconomic status showed more frequently positive attitudes regarding smoking of their peers. Considering family background, parental smoking plays the most important role in smoking of their children regardless of employment status and educational level. The findings suggest that the tobacco control program effort in Slovakia needs to focus on implementation and enforcement for those policies already in place as well as expansion into additional measures.

Bisgaard H; Loland L; Holst KK; Pipper CB. Prenatal determinants of neonatal lung function in high-risk newborns. Journal of Allergy and Clinical Immunology 123(3): 651-657, 2009. (43 refs.)

Background: Neonatal lung function is suspected to be associated with wheezy disorders, but little is known about risk factors for the early lung function. Objectives: To study prenatal determinants of neonatal lung function. Methods: This is a clinical, prospective birth cohort study of 411 newborns, the Copenhagen Prospective Study on Asthma in Childhood, in a single-center research clinic dedicated solely to this longitudinal birth cohort study. Lung function was determined at I month of age by infant spirometry (the raised volume rapid thoraco-abdominal compression technique) and bronchial responsiveness to methacholine by transcutaneous oxygen measurements. Risk factor analyses included anthropometrics; demographics; socioeconomic factors; parental atopic history; previous deliveries; exposures during the third trimester to the mother's smoking, alcohol, and medicines; third trimester pregnancy complications including mother's asthma status; and mode of delivery. Results: Lung function was determined in 404 neonates, age 6 weeks. Neonates with body mass index in the upper quartile had 14% lower baseline forced expiratory volume at 0.5 second, and neonates of mothers smoking during the third trimester had 7% lower baseline forced expiratory volume at 0.5 second. Sex or parental atopic disease did not affect the neonatal lung function and bronchial responsiveness. Maternal intake of paracetamol during the third trimester was associated with doubling of the bronchial responsiveness in the neonates, but the statistical significance may have been driven by outliers. Bronchial responsiveness exhibited a parabola development with tripling of bronchial responsiveness reaching the nadir at 3 months of age, but this needs replication in a study with repetitive measurements within individuals. Conclusion: High body mass index in newborns and mothers smoking is associated with reduced neonatal lung function. This suggests that the association between body proportion and wheezing disorders may be a result of shared genes or prenatal nutrition.

Braillon A; Bewley S; Dubois G. Tobacco harm to the developing child. (editorial). European Journal of Pediatrics 169(12): 1565-1567, 2010. (13 refs.)

Brodsky JL; Viner-Brown S; Handler AS. Changes in maternal cigarette smoking among pregnant WIC participants in Rhode Island. Maternal and Child Health Journal 13(6): 822-831, 2009. (44 refs.)

Objectives: To describe the relationship between the timing of entry into the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) among pregnant women in Rhode Island (RI) and changes in maternal cigarette smoking (MCS) during pregnancy. Methods MCS data gathered by WIC were analyzed for pregnant women who self-identified as smokers at the onset of pregnancy between the years 2001-2005. Bivariate and multivariate analyses were performed to examine the relationship between timing of WIC entry and both increased and decreased/quit MCS during pregnancy. Results Self-reports from smokers indicated that 9.5% quit smoking, 24.6% decreased MCS, 26.8% experienced no change, 33.5% increased MCS, and 5.6% attempted to quit MCS but failed during pregnancy. The adjusted odds ratio for smokers with 1st trimester WIC entry and increased MCS was 0.64 (95% CI 0.52, 0.79). Among smokers with 1st trimester PNC entry, the adjusted odds ratio for smokers with 1st trimester WIC entry and decreased/quit MCS was 1.51 (95% CI 1.17, 1.96). Conclusions Early WIC entry appears to be associated with improvements in MCS. Participants who entered WIC in the first trimester of pregnancy were less likely to increase smoking during pregnancy, and if they also had first trimester prenatal care, were more likely to decrease/quit smoking compared to those who entered WIC later. Programs that increase the rates of first trimester WIC entry may contribute to lower rates of MCS in the WIC population.

Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. The NSDUH Report: Substance Use among Young Mothers. (March 10, 2011). Rockville MD: Substance Abuse and Mental Health Administration, 2011. (7 refs.)

Adolescents are particularly susceptible to substance use, and coupled with teenage motherhood, health risks associated with substance use not only affect these adolescents but also their children. It is well known that prenatal and postnatal tobacco use have negative effects on babies born to mothers who smoke or who are exposed to tobacco smoke. Studies also have shown that teenage mothers who engage in substance use do not "mature out" of substance use as they enter adulthood. Combined 2005 to 2009 data show that an annual average of 528,000 young women aged 15 to 19 were mothers living with at least one of their children. Over one third (35.0%) of young mothers aged 15 to 19 smoked cigarettes, 30.0 percent used alcohol, and 11.7 percent used marijuana in the previous month. Young mothers aged 15 to 19 were more likely than young women who were not mothers to have smoked cigarettes in the past month (35.0 vs. 20.7%). Mothers aged 15 to 17 were more likely than their counterparts who were not mothers to have used marijuana in the past month (17.9 vs. 10.0%) and were just as likely to have used alcohol (25.3 vs. 24.6%).

Public Domain

Crossley IA; Buckner JC. Maternal-related predictors of self-regulation among low-income youth. Journal of Child and Family Studies 21(2): 217-227, 2012. (64 refs.)

The association between self-regulation and various adaptive outcomes has become a topic of growing interest to researchers. Yet, there is not much research on predictors of self-regulation in children. Using a cross-sectional design and an array of psychometrically sound scales and measures from multiple informants, this study examined whether maternal characteristics, namely maternal mental health, substance abuse, parenting practices, and child monitoring predicted self-regulation in children. Participants included a culturally diverse group of 155 youths (ages 8-17) and their mothers, all of whom were part of a larger investigation of low-income families in a mid-sized Northeastern city in the United States. Results showed that maternal substance abuse, parenting practices and parental monitoring independently predicted children's self-regulation, accounting for 23% of the variance. Additional analyses indicated that parenting practices may partly mediate the effect of maternal mental health on children's self-regulation. Implications for intervention and practice, especially those aimed to mitigate the detrimental effects of maternal mental health problems on children's self-regulation, are discussed. Further research, both longitudinal and experimental, is warranted in order to extend this line of investigation.

Dahal GP; Johnson FA; Padmadas SS. Maternal smoking and acute respiratory infection symptoms among young children in Nepal: Multilevel analysis. Journal of Biosocial Science 41(6): 747-761, 2009. (23 refs.)

The association between maternal smoking and adverse child health outcomes has not been systematically explored In less developed countries, especially in Nepal where over a quarter of women of reproductive age smoke tobacco products. This study aims to quantify the effect of maternal smoking on acute respiratory infection (ARI) symptoms among children aged below five years, using the 2001 Nepal Demographic and Health Survey. It is hypothesized that children born to mothers who smoke frequently are at higher risk of developing ARI symptoms. Four-level random intercept logistic regression models were used to disentangle the independent effect of maternal smoking on children's ARI symptoms, controlling for potential biological, socioeconomic, seasonal and spatial variables. Maternal smoking status had a significant effect on children's ARI symptoms; the effects were significantly higher (adjusted OR 1.41; 95% CI 1.02-1.96) among those born to mothers who smoked more frequently than their counterparts. Furthermore, a strong spatial pattern was evident in the prevalence of ARI symptoms, after adjusting for maternal smoking and relevant control variables. The findings underscore the importance of designing exclusive public health intervention measures to prevent tobacco smoking within households, for example through awareness campaigns highlighting the adverse effect of maternal smoking on child health.

De La Rosa M; Dillon FR; Rojas P; Schwartz SJ; Duan R. Latina mother-daughter dyads: Relations between attachment and sexual behavior under the influence of alcohol or drugs. Archives of Sexual Behavior 39(6): 1305-1319, 2010. (61 refs.)

Associations among mother-daughter attachment, mother and daughter substance abuse, and daughter's sexual behavior under the influence of drugs and alcohol were investigated among 158 adult U.S. Latina daughters. Latina daughters were sampled from four mother-daughter dyad types: substance abusing mother and daughter, substance abusing mother only, substance abusing daughter only, and non-substance-abusing mother and daughter. Substance abusing daughters with substance abusing mothers, and daughters who were less strongly attached to their mothers, reported more sex under the influence of drugs. Age, marital status, substance abuse, and mother's substance abuse all influenced the daughter's sex under the influence of alcohol. An unexpected positive association between attachment and sex under the influence of alcohol was found for daughters who were more closely attached to a substance abusing mother. Implications for future research, and HIV/AIDS and drug prevention and treatment programs for Latinas are discussed.

Dubowitz H; Kim J; Black MM; Weisbart C; Semiatin J; Magder LS. Identifying children at high risk for a child maltreatment report. Child Abuse & Neglect 35(2): 96-104, 2011. (46 refs.)

Objective: To help professionals identify factors that place families at risk for future child maltreatment, to facilitate necessary services and to potentially help prevent abuse and neglect. Method: The data are from a prospective, longitudinal study of 332 low-income families recruited from urban pediatric primary care clinics, followed for over 10 years, until the children were approximately 12 years old. Children with prior child protective services involvement (CPS) were excluded. The initial assessment included sociodemographic, child, parent and family level variables. Child maltreatment was assessed via CPS reports. Risk ratios (RRs) and their 95% confidence intervals (CIs) were estimated using Cox regression models. Results: Of the 224 children without a prior CPS report and with complete data who were followed for an average of 10 years, 97 (43%) later had a CPS report. In a multivariate survival analysis, 5 risk factors predicted CPS reports: child's low performance on a standardized developmental assessment (RR = 1.23, 95% CI = 1.01-1.49, p = .04), maternal education <= high school (RR = 1.55, CI = 1.01-2.38, p = .04), maternal drug use (RR = 1.71, Cl = 1.01-2.90, p < .05), maternal depressive symptoms (RR per one standard deviation higher score = 1.28, CI = 1.09-1.51, p < .01), and more children in the family (RR per additional child = 1.26, Cl = 1.07-1.47, p < .01). Conclusions: Five risk factors were associated with an increased risk for later maltreatment. Child health care and other professionals can identify these risk factors and facilitate necessary services to strengthen families, support parents and potentially help prevent child maltreatment.

Durmus B; Kruithof CJ; Gillman MH; Willemsen SP; Hofman A; Raat H et al. Parental smoking during pregnancy, early growth, and risk of obesity in preschool children: The Generation R Study. American Journal of Clinical Nutrition 94(1): 164-171, 2011. (47 refs.)

Background: Maternal smoking during pregnancy seems to be associated with obesity in offspring. Not much is known about the specific critical exposure periods or underlying mechanisms for this association. Objective: We assessed the associations of active maternal and paternal smoking during pregnancy with early growth characteristics and risks of overweight and obesity in preschool children. Design: This study was a population-based, prospective cohort study from early fetal life until the age of 4 y in 5342 mothers and fathers and their children. Growth characteristics [head circumference, length, weight, and body mass index (BMI; in kg/m(2))] and overweight and obesity were repeatedly measured at the ages of 1, 2, 3, and 4 y. Results: In comparison with children from nonsmoking mothers, children from mothers who continued smoking during pregnancy had persistently smaller head circumferences and heights until the age of 4 y, whereas their weights were lower only until the age of 3 mo. This smaller length and normal to higher weight led to an increased BMI [SD score difference: 0.11; 95% CI: 0.02, 0.20; P < 0.05)] and an increased risk of obesity (odds ratio: 1.61; 95% CI: 1.03, 2.53; P < 0.05) at the age of 4 y. In nonsmoking mothers, paternal smoking was not associated with postnatal growth characteristics or risk of obesity in offspring. Maternal smoking during pregnancy was associated with a higher BMI at the age of 4 y in children with a normal birth weight and in those who were small for gestational age at birth. Conclusion: Our findings suggest that direct intrauterine exposure to smoke until late pregnancy leads to different height and weight growth adaptations and increased risks of overweight and obesity in preschool children.

Gilchrist G; Taylor A. Drug-using mothers: Factors associated with retaining care of their children. Drug and Alcohol Review 28(2): 175-185, 2009. (51 refs.)

Introduction and Aims. Research suggests that upwards of 50% of drug users do not live with their children, yet little is known about these children's living arrangements or the variables associated with mothers retaining care of their children. Design and Methods. This cross-sectional study examined the number of pregnancies and children born to female drug users receiving and not receiving treatment, the living arrangements of their children and the variables associated with not living with their children. Results. Data on 185 mothers from a study on psychiatric morbidity among drug users in Glasgow, Scotland were analysed. Participants had given birth to 327 children, 44% (132/297) of children were living with their mother; 26% (78/297) were being cared for by a family member and 20% (59/297) were in local authority care or had been adopted. 49% (87/179) of participants did not live with any of their children. Stepwise multiple forward logistic regression found that current depressive symptoms [odds ratios (OR) 3.90, 95% confidence intervals (CI) 1.78-8.55], lifetime involvement in prostitution (OR 3.12, 95% CI 1.41-6.93), lifetime history of homeless (OR 2.96, 95% CI 1.13-6.39), living with a drug user (OR 2.71, 95% CI 1.30-5.65) and ever being incarcerated (OR 2.47, 95% CI 1.17-5.21) were associated with participants not living with any of their children versus living with at least one of their children. Discussion and Conclusions. Access to drug treatment, mental health treatment and parent craft education should be enhanced for female drug users to assist them retain care of their children where possible.

Goldman GD; Ryan SD. Direct and modifying influences of selected risk factors on children's pre-adoption functioning and post-adoption adjustment. Children and Youth Services Review 33(2): 291-300, 2011. (83 refs.)

Child adoption outcomes are influenced by child's behavior and parents' expectations (Haugaard & Hazan, 2003). Pre-adoption risk factors, such as prenatal alcohol, tobacco and/or other drug (ATOD) exposure, male sex, sexual abuse, and multiple out-of-home placements have been linked to increased externalizing (acting out) behaviors that are difficult to manage and are most closely associated with adoption disruption (Barth, 1991, 2001 Rosenthal & Groze, 1991; Smith & Howard, 1999). However, adoption researchers have found that positive outcomes (fewer externalizing behaviors) are possible for children who have been exposed to pre-adoption risk factors, suggesting that adoptive families provide protective environments that allow healing (Barth, 1991, 1993; Barth & Brooks, 2000). The current study sought to increase understanding of the influence of these pre-adoption risk factors on adoption outcome with attention to the influence of prenatal alcohol, tobacco, and/or other drug (ATOD) exposure. Results indicated that pre-adoption functioning was significantly influenced by prenatal ATOD exposure, but post-adoption adjustment was not. Structural equation modeling then was used to analyze both the direct and moderating influences of the identified risk factors on the relationship between the child's pre-adoption functioning and post-adoption adjustment. Negative influences of the risk factors on the child's externalizing behavior, individually and additively, in both direct effects and moderation analyses, were not found, with one exception. The only model to have a statistically significant effect was the moderation analysis containing the interaction of all four risk factors. Child development, child welfare, addiction professionals, and adoptive families will find this information to be of value in their quest to facilitate successful adoptions and growth of healthy children and families.

Hayatbakhsh MR; Sadasivam S; Mamun AA; Najman JM; Williams GM; O'Callaghan MJ. Maternal smoking during and after pregnancy and lung function in early adulthood: A prospective study. Thorax 64(9): 810-814, 2009. (29 refs.)

Background and aims: There is a paucity of evidence about whether exposure to antenatal smoking impacts on offspring's lung function in early adulthood. This study aimed to examine whether (1) in utero exposure to maternal smoking is related to poorer respiratory functioning in early adulthood; (2) the impact of prenatal smoking is independent of postnatal maternal smoking; and (3) the link between prenatal smoking and a young adult's lung function is explained by the child's birth weight, smoking or history of asthma. Methods: Data were from a 21-year follow-up of mothers and their children recruited into the Mater University of Queensland Study of Pregnancy, a longitudinal prebirth cohort. The study is based on 2409 young adults (1185 males and 1224 females) who had prospective data available on respiratory function at 21 years and maternal smoking during and after pregnancy. A Spirobank G spirometer system was used to measure forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1) and forced expiratory flow between 25% and 75% of FVC (FEF25-75). Results: In utero exposure to maternal smoking was associated with a reduction in FEV1 and FEF25-75 in males (regression coefficient, -0.16; 95% CI, -0.30 to -0.02), after accounting for maternal smoking after pregnancy. At least part of the effect of in utero smoking on young adults' lung function was explained by the child's birth weight and subsequent asthma. Conclusions: Adverse effects of antenatal smoking on development of airway growth may persist into early adulthood. Gender differences noted in this longitudinal cohort need to be explored further.

Kyu HH; Georgiades K; Boyle MH. Maternal smoking, biofuel smoke exposure and child height-for-age in seven developing countries. International Journal of Epidemiology 38(5): 1342-1350, 2009. (36 refs.)

Background: Children are at high risk of exposure to environmental tobacco smoke and biofuel smoke at home in developing countries. This study examines whether exposure to cigarette and biofuel smoke is associated with height-for-age of children (0-59 months) in seven developing countries. Methods: The data are from Demographic and Health Surveys conducted in Cambodia, Dominican Republic, Haiti, Jordan, Moldova, Namibia and Nepal between 2005 and 2007. The respondents were women (15-49 years) and their children in seven countries (n = 28 439), and men (15-59 years) from four countries. The outcome is a physical measurement of child height-for-age in standard deviation units. Results Multilevel regression analysis showed that the country of residence modified the association between maternal smoking and child height-for-age. Exposure to maternal smoking was associated negatively with child height-for-age in Cambodia, Namibia and Nepal, whereas it was not in other countries. Multilevel regression analysis revealed that biofuel smoke exposure was associated with a decrease in child height-for-age [b = -0.13, 95% confidence interval (CI) = -0.19 to -0.07, P < 0.001]. No interaction was found between country of residence and biofuel smoke exposure. Multinomial logistic regression results showed that biofuel smoke exposure was associated with both stunting [odds ratio (OR) = 1.25, 95% CI = 1.08-1.44, P = 0.002) and severe stunting (OR = 1.27, 95% CI = 1.02-1.59, P = 0.04), after controlling for covariates. Conclusion: The findings suggest that exposure to maternal smoking and biofuel smoke may contribute to growth deficiencies in young children. Programmes are needed to ensure smoke-free home environments for children.

Lussier K; Laventure M; Bertrand K. Parenting and maternal substance addiction: Factors affecting utilization of child protective services. Substance Use & Misuse 45(10): 1572-1588, 2010. (58 refs.)

The purpose of this study is to identify which personal, familial, environmental, and social factors are associated with the utilization of child protection services, including parental support programs, by mothers who misuse illicit substances. Participants are 56 mothers with substance use and addiction-related problems, of whom 32 were receiving, voluntarily or otherwise, child protection services while 24 mothers had psychotropic drug use-related problems but were receiving no psychosocial services. Data were collected in the province of Quebec, Canada, between August 1998 and August 1999. Results indicate that mothers who receive services are younger, have fewer interpersonal resources, live in lower socioeconomic conditions, and have greater family dysfunction (less parental supervision and more inconsistent discipline) than mothers who do not receive services from child protection agencies. However, there are no significant differences between groups with regards to maternal childhood trauma, psychological distress, antisocial behavior and the quality of the parent-child bond. The results of this study suggest that although both groups misuse drugs and have personal difficulties, some mothers will not need support from social services to take care of their children. Implications of these findings for prevention are discussed. The study's limitations are noted.

Moller M; Karaskov T; Koren G. Opioid detection in maternal and neonatal hair and meconium: Characterization of an at-risk population and implications to fetal toxicology. Therapeutic Drug Monitoring 32(3): 318-323, 2010. (46 refs.)

Identification of maternal opioid abuse in pregnancy is often difficult to ascertain in the absence of a reliable self-report. We aimed to characterize an at-risk neonatal population for opioid exposures as well as other drugs of abuse and alcohol. From June 2007 to January 2009, 563 neonatal hair and 1318 meconium specimens were assessed for opioids and were positive in 11.4% and 17.0%, respectively. Neonates testing positive for opioids in hair or meconium analysis were also more likely to test positive for other licit and illicit substances (odds ratiohair, 1.75; 95% confidence interval, 1.03-2.97; odds ratiomeconium, 1.61; 95% confidence interval, 1.16-2.22). Specifically, a positive neonatal hair test for opioids also predicted a positive result for oxycodone. In addition, a positive meconium test result for opioids was associated with positive results for cocaine, oxycodone, methadone, benzodiazepines, and fatty acid ethyl esters (alcohol). Finally, there was a significant correlation between maternal and neonatal hair test results for opioids (Spearman rank rho = 0.657, P = 0.03). Understanding the addiction profiles of these women may lead to better clinical and social management and may largely benefit an at-risk population.

Nomura Y; Gilman SE; Buka SL. Maternal smoking during pregnancy and risk of alcohol use disorders among adult offspring. Journal of Studies on Alcohol and Drugs 72(2): 199-209, 2011. (88 refs.)

Objective: The aim of this study was to evaluate the association between maternal smoking during pregnancy (MSP) and lifetime risk for alcohol use disorder (AUD) and to explore possible mechanisms through which MSP may be related to neurobehavioral conditions during infancy and childhood, which could, in turn, lead to increased risk for AUD. Method: A sample of 1,625 individuals was followed from pregnancy for more than 40 years. Capitalizing on the long follow-up time, we used survival analysis to examine lifetime risks of AUD (diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) in relation to levels of MSP (none, < 20 cigarettes/day, and >= 20 cigarettes/day). We then used structural equation modeling to test hypotheses regarding potential mechanisms, including lower birth weight, neurological abnormalities, poorer academic functioning, and behavioral dysregulation. Results: Relative to unexposed offspring, offspring of mothers who smoked 20 cigarettes per day or more exhibited greater risks for AUD (hazard ratio = 1.31, 95% CI [1.08, 1.59]). However, no differences were observed among offspring exposed to fewer than 20 cigarettes per day. In structural equation models, MSP was associated with neurobehavioral problems during infancy and childhood, which, in turn, were associated with an increased risk for adult AUD. Conclusions: MSP was associated with an increased lifetime risk for AUD. Adverse consequences were evident from birth to adulthood. A two-pronged remedial intervention targeted at both the mother (to reduce smoking during pregnancy) and child (to improve academic functioning) may reduce the risk for subsequent AUD.

Office of Applied Studies, Substance Abuse and Mental Health Services Administration. The NSDUH Report: Adolescent Smoking and Maternal Risk Factors. (May 7, 2010). Rockville MD: Substance Abuse and Mental Health Administration, 2010. (6 refs.)

The National Survey on Drug Use and Health (NSDUH) allows an examination of some potential risk factors for adolescent cigarette use and the extent to which exposure to these risk factors is associated with an increased likelihood of adolescents becoming smokers. This report examines mothers' smoking and mothers' depression as possible risk factors for their adolescent children's cigarette use. The key findings in this report are based on combined 2005 to 2007 NSDUH data from the subsample of mothers aged 18 or older and their children aged 12 to 17 who lived in the same households.4 NSDUH asks persons aged 12 or older to report whether they smoked cigarettes. It also asks persons aged 18 or older questions to determine whether they experienced a major depressive episode (MDE) in the past year. Among adolescents living with their mothers, 9.7 percent lived with mothers who had major depressive episode (MDE) in the past year, and 25.6% lived with mothers who used cigarettes in the past month. Adolescents living with mothers who had past year MDE had a higher rate of past month smoking than those living with mothers who did not have MDE (14.3 vs. 7.9%), and adolescents were more likely to smoke if their mothers smoked than if their mothers did not smoke (16.9 vs. 5.8%). The rate of smoking among adolescents living with their mothers was 5.6 percent for adolescents whose mothers neither smoked in the past month nor had a past year MDE, 8.1% for those whose mothers had MDE only, 15.5 percent for those whose mothers smoked only, and 25.3 percent for adolescents exposed to both maternal MDE and maternal smoking.

Public Domain

Ottaviani G. Sudden infant and perinatal unexplained death: are we moving forward yet? (review). Cardiovascular Pathology 20(5): 302-306, 2011. (41 refs.)

Autonomic nervous system and cardiac conducting system dysfunctions have been proposed to be implied in the pathogenesis of sudden infant death syndrome (SIDS). However, most clinicians and even pathologists lack experience with detailed examination of the brainstem and cardiac conducting system and may not recognize lesions within those systems that potentially could be crucial factors in the sudden unexpected perinatal and infant death. Recent anatomical, pathological, and bacteriological studies in SIDS confirm that the multidisciplinary approach provides the best approach to the challenging problems of SIDS and sudden unexplained perinatal death.

Prusakowski MK; Shofer FS; Rhodes KV; Mills AM. Effect of depression and psychosocial stressors on cessation self-efficacy in mothers who smoke. Maternal and Child Health Journal 15(5): 620-626, 2011. (31 refs.)

Motherhood offers factors that may contribute to or confound attempts to quit smoking, including social cues around pregnancy, post partum depression, financial and other pressures of child rearing, being a role model and concern that secondhand smoke might affect their child's health. We sought to characterize a population of tobacco-using mothers in order to identify barriers to quitting that both mirror the general population and are unique to motherhood. A cross-sectional survey collected information in two urban emergency departments from women who smoked and were mothers of small children. The survey asked about tobacco use, including levels of addiction, attempts to quit, readiness and self efficacy for quitting, and other psychosocial risks. We hypothesized that mothers reporting psychosocial stressors and depression would be less motivated to quit and less likely to have attempted quitting. One hundred ninety-two smoking mothers enrolled, representing 433 children exposed to secondhand smoke. Nicotine addiction was moderate. Women reporting at least one form of stress (relationship, financial, work, emotional, family-related) had similar levels of addiction (Fagerstrom score 2.8 vs. 2.9, p = 0.63) and motivation to quit (Ladder of Contemplation 6.4 vs. 6.1, p = 0.26), but reported feeling less confident in their ability to quit than non-stressed counterparts (6.6 vs. 7.6, p = 0.04). Over half (51.3%) of smoking mothers reported symptoms of depression for more than 2 weeks in a row in the last year. Depressed mothers had similar levels of addiction (Fagerstrom score 2.9 vs. 2.8, p = 0.63), and readiness to quit (6.6 vs. 6.5, p = 0.89), and had attempted to quit at similar rates (78% vs. 82%, p = 0.58). However, depressed mothers were less confident in their ability to quit (6.4 vs. 7.4, p = 0.02) and were more than twice as likely to report they are "not at all confident" (22% vs. 9%, p = 0.03). Providers who encourage mothers to quit smoking must identify and be prepared to address psychosocial stressors and co-morbid depression.

Richardson HL; Walker AM; Horne RSC. Maternal smoking impairs arousal patterns in sleeping infants. Sleep 32(4): 515-521, 2009. (39 refs.)

Objective: Impairment of the arousal process from sleep is thought to be involved in the pathogenesis of sudden infant death syndrome (SIDS). We hypothesized that a greater propensity for cortical arousal in the prone position may, in a normal infant, be a protective mechanism to promote complete arousal in a vulnerable sleeping position, a protection that is absent in SIDS victims. We aimed to examine the arousal process in a group of infants exposed to maternal smoking, who are thus at higher risk for SIDS. Design: Twelve healthy, full-term infants born to smoking mothers were studied using daytime polysomnography at 2 to 4 weeks, 2 to 3 months and 5 to 6 months postnatal age. Data were compared with 13 healthy infants born to nonsmoking mothers. Arousal was induced by pulsatile air-jet stimulation to the nostrils during active and quiet sleep, in both supine and prone positions. For each stimulus, physiologic and electroencephalogram changes were visually assessed and arousal responses were classified as sub-cortical activation or cortical arousal. Results: In smoke-exposed infants, the progression from sub-cortical activation to cortical arousal was depressed at 2 to 4 weeks and 5 to 6 months. There was no effect of maternal smoking observed at 2 to 3 months; however, a significant dose-dependent relationship between cortical activation proportions and urinary cotinine levels was present in both supine and prone positions. Conclusion: We have shown that maternal smoking is associated with impaired arousal processes to trigeminal stimulation that may increase the risk for SIDS. This further highlights the importance of public education of the risks of maternal smoking.

Sarfi M; Smith L; Waal H; Sundet JM. Risks and realities: Dyadic interaction between 6-month-old infants and their mothers in opioid maintenance treatment. Infant Behavior & Development 34(4): 578-589, 2011. (83 refs.)

A number of studies point to methadone exposure in utero as a possible risk factor in the developing mother-infant relationship in the first year of life. This study is part of a larger, national follow-up of 38 infants prenatally exposed to methadone or buprenorphine and 36 comparison, low-risk infants. The aim of the present paper is to assess the quality of mother-infant relationship when the infants are 6 months old. Videotaped mother-infant interactions were rated in a global scale (NICHD). Maternal and infant contributions collapsed into the variables "infant style" and "maternal style" showed that the only factor making significant contribution to the outcome measure "dyadic mutuality" was maternal style. The importance of group membership (exposed versus non-exposed), was reduced when controlling for maternal drug use prior to opioid maintenance treatment (OMT), maternal depression and parenting stress as well as infants' developmental status and sensory-integrative functions. This suggests that prediction of dyadic mutuality should be based on individual characteristics rather than group characteristics. These results support previous research findings that methadone and buprenorphine use per se does not have direct influence on the quality of early mother-infant relationship, but tailored follow-up procedures targeting drug-free pregnancies and parenting support are beneficial for women in OMT and their children.

Sbrana E; Suter MA; Abramovici AR; Hawkins HK; Moss JE; Patterson L et al. Maternal tobacco use is associated with increased markers of oxidative stress in the placenta. American Journal of Obstetrics and Gynecology 205(3): 246.e1, 2011. (29 refs.)

OBJECTIVE: We sought to extend our prior observations and histopathologically characterize key metabolic enzymes (CYP1A1) with markers of oxidative damage in the placental sections from smokers. STUDY DESIGN: Placental specimens were collected from term singleton deliveries from smokers (n = 10) and nonsmokers (n = 10) and subjected to a detailed histopathological examination. To quantify the extent of oxidative damage, masked score-graded (0-6) histopathology against 4-hydroxy-2-nonenal (4-HNE) and 8-hydroxydeoxyguanisine (8-OHdG) was performed. Minimal significance (P < .05) was determined with a Fisher's exact and a 2-tailed Student t test as appropriate. RESULTS: We observed a significant increase in the presence of syncytial knots in placentas from smokers (70% vs 10%, P = .02). These gross observations were accompanied by a significant aberrant placental aromatic hydrocarbon metabolism (increased CYP1A1, 4.4 vs 2.1, P = .002) in addition to evidence of oxidative damage (4-HNE 3.4 vs 1.1, P = .00005; 8-OHdG 4.9 vs 3.1, P = .0038). CONCLUSION: We observed a strong association between maternal tobacco use and aberrant placental metabolism, syncytial knot formation, and multiple markers of oxidative damage.

Shrestha A; Nohr EA; Bech BH; Ramlau-Hansen CH; Olsen J. Smoking and alcohol use during pregnancy and age of menarche in daughters. Human Reproduction 26(1): 259-265, 2011. (44 refs.)

BACKGROUND: We assessed whether exposure to prenatal smoking or alcohol accelerates age of menarche (AOM) in offspring. METHODS: We studied a Danish cohort of 3169 singleton females born in April 1984-April 1987. Linear regressions were conducted to examine associations between prenatal smoking or alcohol exposure and offspring's AOM on: (i) the daughters who provided data on both month and the year of menarche (n = 1634) and (ii) the entire sample that provided at least the year of menarche (n = 3169). We also examined associations between only pre-pregnancy smoking or childhood exposure to smoking and AOM. The full model was adjusted for maternal pre-pregnancy body mass index, maternal age at childbirth, parental socio-economic status, parity, consumption of milk products during pregnancy and marital status. RESULTS: Among those who provided both year and month, AOM was accelerated by 2.8 months (95% CI in months: -5.3, -0.4) among those exposed to 10+ cigarettes/day throughout pregnancy and by 4.1 months (95% CI in months: -7.7, -0.5) among those with mothers who quit smoking sometime during pregnancy, compared with the unexposed group after adjustment for covariates. Similar, but much weaker, associations were observed among girls whose mothers smoked 1-9 cigarettes/day throughout pregnancy or whose fathers smoked compared with their unexposed counterparts after adjustment for covariates [-0.8 months (95% CI: -2.6, 1.0)]. No associations were observed between AOM and only pre-pregnancy smoking or only childhood exposure or prenatal alcohol exposure. CONCLUSIONS: Our study indicates that heavy smoking throughout the pregnancy may be important in prenatal programming of AOM.

Simmons LA; Havens JR; Whiting JB; Holz JL; Bada H. Illicit drug use among women with children in the United States: 2002-2003. Annals of Epidemiology 19(3): 187-193, 2009. (40 refs.)

PURPOSE: Given research that shows youth exposed to maternal addiction have increased rates of cognitive, socioemotional, and behavioral problems, we examined the prevalence and correlates of past year illicit drug abuse or dependence among women with children younger than 18 years of age in the home to identify maternal risk factors. METHODS: Data were from the 2002 and 2003 National Survey on Drug Use and Health, a nationally representative sample of the U.S. civilian population. The current analysis utilized a subsample of women (N = 19,300) who reported having children younger than 18 years in the home. Past year abuse or dependence on cocaine, heroin, marijuana, stimulants, and hallucinogens as well as nonmedical use of prescription medications were assessed. RESULTS: The prevalence of illicit drug abuse or dependence was 1.9%. Mothers reporting drug abuse or dependence had increased odds of being unmarried, controlling for other demographics. They also were more likely to report stress, poorer health status, and meet the criteria for serious mental illness (SMI). CONCLUSIONS; Prevention and intervention strategies should focus on developing and testing methods to screen for both risk factors associated with maternal drug abuse and actual substance abuse in primary and emergency care settings to reduce youth exposure and improve child developmental outcomes.

Stavrou EP; Baker DF; Bishop JF. Maternal smoking during pregnancy and childhood cancer in New South Wales: A record linkage investigation. Cancer Causes and Control 20(9): 1551-1558, 2009. (78 refs.)

Following linkage between the NSW Central Cancer Registry (CCR) and the NSW Midwives Data Collection, an investigation of the association between maternal smoking during pregnancy and the risk of childhood cancer in their offspring was undertaken. Children born in NSW between 1994 and 2005, inclusive of 1,045,966 babies, were matched to 948 cancer cases in the CCR. After adjustment for maternal age, gestational age, baby's gender, birth weight, remoteness index, socioeconomic disadvantage and maternal health factors, no association (OR = 0.96, 95% CI 0.81-1.15, p = 0.68) was found with childhood cancer between mothers who smoked (81/100,000) and those who did not smoke during pregnancy (99/100, 000). Maternal smoking was, however, significantly associated with retinoblastoma (OR = 2.20, 95% CI 1.19-4.09, p = 0.01). Association between maternal smoking and preterm birth and low birth weight was significant. Maternal smoking during pregnancy is significantly associated with retinoblastoma and adverse birth outcomes. These results should be highlighted to expectant mothers through antitobacco-smoking campaigns.

Strathearn L; Mayes LC. Cocaine addiction in mothers: Potential effects on maternal care and infant development. Annals of the New York Academy of Sciences. Addiction Reviews 2 1187: 172-183, 2010. (106 refs.)

Maternal cocaine addiction is a significant public health issue particularly affecting children, with high rates of reported abuse, neglect, and foster care placement. This review examines both preclinical and clinical evidence for how cocaine abuse may affect maternal care and infant development, exploring brain, behavioral, and neuroendocrine mechanisms. There is evidence that cocaine affects infant development both directly, via in utero exposure, and indirectly via alterations in maternal care. Two neural systems known to play an important role in both maternal care and cocaine addiction are the oxytocin and dopamine systems, mediating social and reward-related behaviors and stress reactivity. These same neural mechanisms may also be involved in the infant's development of vulnerability to addiction. Understanding the neuroendocrine pathways involved in maternal behavior and addiction may help facilitate earlier, more effective interventions to help substance-abusing mothers provide adequate care for their infant and perhaps prevent the intergenerational transmission of risk.

Sullivan KM; Bottorff J; Reid C. Does mother's smoking influence girls' smoking more than boys' smoking? A 20-year review of the literature using a sex- and gender-based analysis. (review). Substance Use & Misuse 46(5): 656-668, 2011. (72 refs.)

A systematic literature review was conducted to examine whether mother's smoking influences girls' smoking more than boys' smoking. Fifty-seven studies, published between 1989 and 2009, were analyzed using a sex and gender lens. Results indicate that mother's prenatal and postnatal smoking influences girls' smoking more than boys' smoking. Despite evidence that sex and gender are important determinants of smoking among adolescents when examined in relation to mother's smoking, the theoretical understanding of why girls are more likely to smoke if prenatally and postnatally exposed to mother's smoking remains unclear. Implications for future research are discussed.

Suzuki K; Sato M; Tanaka T; Kondo N; Yamagata Z. Recent trends in the prevalence of and factors associated with maternal smoking during pregnancy in Japan. Journal of Obstetrics and Gynaecology Research 36(4): 745-750, 2010. (21 refs.)

Aim: To compare the prevalence of maternal smoking during pregnancy and the correlations between maternal smoking and other maternal lifestyle or pregnancy factors between the years 1996-2001 and 2001-2006. Methods: The participants were pregnant women who responded to questionnaires while registering their pregnancies between 1 April 1996 and 31 March 2001 (Group 1), and between 1 April 2001 and 31 March 2006 (Group 2). The odds ratios were calculated with a 95% confidence interval for maternal smoking during early pregnancy by using a logistic multivariate regression analysis based on maternal factors. Results: In Group 1, 1051 pregnant women responded to the questionnaire administered at pregnancy registration, and 86 (8.2%) mothers reported smoking during early pregnancy. In Group 2, 1022 pregnant women responded, and 91 (8.9%) mothers reported smoking during early pregnancy. There was no significant difference between the groups. In both groups, partner smoking and skipping breakfast were significantly associated with maternal smoking. In Group 2, unintended pregnancy was significantly associated with maternal smoking. Conclusions: To prevent maternal smoking during pregnancy, it is necessary to carefully monitor pregnant women who report partner smoking, skipping breakfast, and unintended pregnancy.

Vennemann MM; Hense HW; Bajanowski T; Blair PS; Complojer C; Moon RY et al. Bed sharing and the risk of sudden infant death syndrome: Can we resolve the debate? Journal of Pediatrics 160(1): 44-U88, 2012. (40 refs.)

Objective: To conduct a meta-analysis on the relationship between bed sharing and sudden infant death syndrome (SIDS) risk. Study design: Data from PubMed and Medline were searched for studies published after Jan 1, 1970. The search strategy included articles with the terms "sudden infant death syndrome," "sudden unexpected death," and "cot death" with "bed sharing" or "co-sleeping." To further specify the potential risk of bed sharing and SIDS, subgroup analyses were performed. Results: Eleven studies met inclusion criteria and were included in the final meta-analysis. The combined OR for SIDS in all bed sharing versus non-bed sharing infants was 2.89 (95% CI, 1.99-4.18). The risk was highest for infants of smoking mothers (OR, 6.27; 95% CI, 3.94-9.99), and infants <12 weeks old (OR, 10.37; 95% CI, 4.44-24.21). Conclusions: Bed sharing is a risk factor for SIDS and is especially enhanced in smoking parents and in very young infants.

Wakschlag LS; Metzger A; Darfler A; Ho J; Mermelstein R; Rathouz PJ. The Family Talk About Smoking (FTAS) Paradigm: New directions for assessing parent-teen communications about smoking. Nicotine & Tobacco Research 13(2): 103-112, 2011. (29 refs.)

Smoking experimentation represents transient risk taking for some youth, whereas for others, it is the onset of a chronic smoking trajectory. However, distinguishing these groups during the experimentation phase has proved challenging. We theorized that variations in parent and teen discourse about smoking might be informative for characterizing this heterogeneity. However, standardized methods for direct assessments of these family processes have been lacking. We examined the predictive utility of directly observed facets of smoking-specific communication for predicting persistence of teen smoking experimentation using a novel method, the Family Talk About Smoking (FTAS) paradigm. The FTAS was tested in a sample of 344 teens with a history of smoking experimentation during interactions with their mothers and fathers. Level of disapproval, smoking expectancies, elaboration of consequences, and quality of personal disclosure were coded during videotaped parent-teen discussions about smoking. Patterns of observed smoking-specific communication varied by teen and parent smoking status. Predictive validity of the FTAS for teen persistent experimentation was demonstrated, net effects of reported smoking-specific socialization, general quality of communication, and parental smoking status. Teen smoking expectancies, disclosure, and disapproval predicted teen persistent experimentation with some differences based on whether interactions were with mothers or fathers. Prediction of persistent experimentation by observed maternal disclosure and elaboration of consequences was moderated by maternal smoking status. Direct observations show promise for generating detailed characterization of individual differences in patterns of family communication about smoking. Implications for targeted prevention and future research are discussed.

Zammit S; Thomas K; Thompson A; Horwood J; Menezes P; Gunnell D et al. Maternal tobacco, cannabis and alcohol use during pregnancy and risk of adolescent psychotic symptoms in offspring. British Journal of Psychiatry 195(4): 294-300, 2009. (52 refs.)

Background: Adverse effects of maternal substance use during pregnancy on fetal development may increase risk of psychopathology. Aims To examine whether maternal use of tobacco, cannabis or alcohol during pregnancy increases risk of offspring psychotic symptoms. Method A longitudinal study of 6356 adolescents, age 12, who completed a semi-structured interview for psychotic symptoms in the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort. Results Frequency of maternal tobacco use during pregnancy was associated with increased risk of suspected or definite psychotic symptoms (adjusted odds ratio 1.20, 95% CI 1.05-1.37, P=0.007). Maternal alcohol use showed a non-linear association with psychotic symptoms, with this effect almost exclusively in the offspring of women drinking >21 units weekly. Maternal cannabis use was not associated with psychotic Symptoms. Results for paternal smoking during pregnancy and maternal smoking post-pregnancy lend some support for a causal effect of tobacco exposure in utero on development of psychotic experiences. Conclusions: These findings indicate that risk factors for development of non-clinical psychotic experiences may operate during early development. Future studies of how in utero exposure to tobacco affects cerebral development and function may lead to increased understanding of the pathogenesis of psychotic phenomena.