Contributors JCC, KLR, KLK, NLD, DR, and RMA designed the study and wrote the protocol. JCC, CLH, JAT enrolled participants and performed the data collection. JCC, CLH, JAT, KLR, and JS performed the qualitative data analysis. JS, MJ, NMD, GAR added insights in understanding and contextualizing the thematic findings within the context of the current field of perinatal marijuana research. JCC wrote the first draft of the manuscript. All authors contributed to and have approved the final manuscript.

In this prospective study, teenager mothers (mean age = 16; range = 12-18; 70% African American) were interviewed about their tobacco use during pregnancy. When their children were ten, mothers reported on their child's behavior and the children completed a neuropsychological battery. We examined the association between prenatal cigarette smoke exposure (PCSE) and offspring neurobehavioral outcomes on data from the ten-year phase (n = 336). Multivariate regression analyses were conducted to test if PCSE predicted neurobehavioral outcomes, adjusting for demographic characteristics, maternal psychological characteristics, prenatal exposure to other substances, and exposure to environmental tobacco smoke. Independent effects of PCSE were found. Exposed offspring had more delinquent, aggressive and externalizing behaviors (CBCL). They were more active (Routh, EAS, SNAP) and impulsive (SNAP), and had more problems with peers (SNAP). On the Stroop test, deficits were observed in both baseline response processing measures and on the more complex interference task that requires both selective attention and response inhibition. The significant effects of PCSE on neurobehavioral outcomes were found for exposure to as few as 10 cigarettes per day. These results are consistent with results from an earlier assessment when the children were age 6, demonstrating that the effects of prenatal tobacco exposure can be identified early and are consistent through middle childhood.

Teenage mothers may not "mature out" of substance use during young adulthood, and this nonnormative trajectory of use may contribute to negative outcomes for teenage mothers and their offspring. Pregnant teenagers (age range = 12-18 years; 68% Black) were recruited from a prenatal clinic and interviewed about their substance use, and subsequently re-interviewed six and ten years later (n = 292). Consistent with the literature, early tobacco and marijuana use were risk factors for young adult use. Other substance use, peer adolescent use and mental health indicators were more important than race and socioeconomic status (SES) in determining which teenage mothers would use tobacco, engage in binge drinking, and use marijuana as young adults. However, race and SES were significant predictors of quitting tobacco use and marijuana use by the 10-year follow-up. Depression was associated with both persistent tobacco use and marijuana use in teenage mothers. These results illustrate the long-term consequences of teenage childbearing and identify modifiable risk factors for later health risks that should be addressed among younger mothers.

Background The purpose of this study was to examine history of pregnancies among women with and without borderline personality disorder (BPD), to determine whether BPD symptoms are associated with teenage pregnancies, unplanned pregnancies, (elective and spontaneous) abortions, and live births. Methods Three hundred seventy-nine women completed the Structured Clinical Interview for DSM-IV Axis I diagnoses (SCID-I), Structured Interview for DSM-IV Personality for Axis II diagnoses (SIDP-IV) and a reproductive health interview. African-American (AA) women were oversampled, because little is known about BPD in AA women and they are at greater risk of teenage pregnancy, unplanned pregnancies and spontaneous abortions. Results BPD symptom severity was associated with a teenage pregnancy, even after controlling for race and socioeconomic status. Symptom severity was also associated with unplanned pregnancies and live births, but only in women without a history of substance use disorder. BPD symptom severity was not associated with abortion. Conclusions Women with BPD become pregnant and have children, often during the period when BPD symptoms emerge and intensify. They are at increased risk of teenage pregnancies and unintended pregnancies, compared to women with Axis I disorders. Treatment planning for this population should include attention to their reproductive health and better integration of physical and mental health services.

In this prospective study, we examined the long-term effects of prenatal cigarette smoke exposure (PCSE) on behavioral dysregulation (BD) in the offspring of adolescent mothers. The adolescent mothers (mean age = 16; range = 12–18; 70% African American) were interviewed about their tobacco use during pregnancy. Offspring were followed to age 14 years (n = 318). Indices of BD outcomes included aggression, rule breaking, externalizing, social problems, attention, distractibility and activity. Multiple measures and multiple informants were used for each construct. Regression analyses were conducted to test if PCSE predicted the BD outcomes, adjusting for demographic and maternal psychological characteristics, and for prenatal exposure to other substances. Independent effects of PCSE were found. Exposed offspring had more aggressive, social, and externalizing problems on both the maternal report and the adolescent self-report measures. They were more active, had more attention problems and greater difficulty with distraction and task orientation. Most PCSE effects were found from first trimester exposure and from exposure to as few as 10 cigarettes per day. These results are consistent with previous findings in this cohort when offspring were 6 and 10 years old, demonstrating that the effects of prenatal cigarette smoke exposure can be identified early and persist into adolescence.