Prenatal drug exposure and the conceptualization of long‐term effects

Abstract

This paper discusses several factors affecting the development of children prenatally exposed to drugs. In the "first generation" of research in this field a main factor model of disease formed the basis for a belief in the feasibility of detecting the direct pharmacological or teratogenic effects of drug exposure on long-term child development. However, the clustering of confounding variables has constituted a major problem in identifying these effects. In the last few years a "second generation" of research in this field has emerged, and investigators have moved beyond simple main-effect models. The importance of controlling for confounding variables has been underscored. However, prenatal substance exposure is still often studied within a teratology model where the main goal is the search for unique effects of a specific drug or substance. Based on this review it is suggested that an appropriate model for understanding the development of drug-exposed children cannot be based on a main-effect perspective. Rather, such a model must evolve from a contextual perspective, and it is suggested that a transactional model, where both potential risk factors and protective factors are considered, should replace the traditional teratology model in this field.

Volumetric cerebral characteristics of children exposed to opiates and other substances in utero

“…The present sample is drawn from a longitudinal project on the development of children born to mothers who used illicit drugs during pregnancy (for details see Moe and Slinning, 2002;Moe 2002;Slinning, 2004). This project initially comprised 78 substance exposed children, and 58 control children born without known biological risk to mothers with no history or evidence of alcohol or illicit drug use.…”

“…As part of previous follow ups, the present sample (and the broader groups from which it is drawn) has been assessed with a number of cognitive and rating scale instruments (see Moe and Slinning 2002;Moe 2002;Slinning, 2004). Data from some of these are presented here.…”

“…Suess et al, 1997;Moe and Slinning, 2002;Moe, 2002;Slinning, 2004). This relationship can partly be explained by environmental correlates of maternal substance-abuse, including higher level of social risk (Hans and Jeremy, 2001), such as effects of poverty, stress, maternal psychopathology, disruptions in maternal care, and poorer interaction with the primary caregiver.…”

“…To date, this is indicated by at least three lines of research: 1) Prenatally exposed children growing up under optimized social conditions, i.e. in carefully chosen foster or adoptive homes, also exhibit on average lower perceptual performance and increased rate of distractibility and hyperactivity (Moe and Slinning, 2002;Moe, 2002, Slinning, 2004, Ornoy et al, 2001). Both Ornoy et al (2001) and Moe (2002) found that adopted substance-exposed children largely scored within normal limits on intellectual tests, but the performance IQ (and in Moe's study, general IQ) was significantly lower than that of the comparison group.…”

Behavioural outcomes of four-year-old children prenatally exposed to methadone or buprenorphine: a test of three risk models

“…However, the evaluation of the effects of prenatal methadone and buprenorphine exposure is complicated by the fact that exposure to methadone or buprenorphine is only one of the factors that can influence child development. Therefore, it has been suggested that prenatal drug exposure should be studied as a risk factor within a developmental perspective (Moe & Slinning, 2002).The environment in which children are raised influences their experiences, which in turn affects brain development (Greenough, Black, & Wallace, 1987). The effects of prenatal drug exposure on children's development should therefore be evaluated in light of possible associations between exposure status and related psychosocial factors.…”