Prenatal substance exposure, adverse childhood experiences and diagnosed mental and behavioral disorders – A longitudinal register-based matched cohort study in Finland

Abstract

Both prenatal substance exposure (PSE, alcohol/drugs) and experiences during the first years of life have powerful effects on brain development. However, only a few studies have investigated the combined effect of PSE and adverse childhood experiences (ACEs) on mental and behavioral disorders among exposed adolescents and adults. This longitudinal register-based cohort study 1) compared the nature and extent of diagnosed mental and behavioral disorders among youth with PSE and matched unexposed controls, and 2) investigated the influence of PSE, health in infancy and ACEs (maternal risk factors and out-of-home care, OHC) on diagnoses of mental and behavioral disorders. The data consisted of 615 exposed youth aged 15–24 years and 1787 matched unexposed controls. Data from hospital medical records and nine registers were merged for the analysis. Descriptive analysis methods and Cox regression were used. The results showed that the prevalence of mental and behavioral disorders was twice as high among exposed compared with controls. The highest levels of mental and behavioral disorders and ACEs were found among exposed with at least one OHC episode. The difference in the risk of mental and behavioral disorders between exposed and controls diminished after controlling for the effect of ACEs. Low birth weight, maternal risk factors, and OHC were the strongest predictors of mental and behavioral disorders. The results suggest that PSE alone does not explain poorer mental health among exposed youth. Risk factors accumulate, and low birth weight and ACEs are strongly associated with increased risk of mental and behavioral disorders.

Completed secondary education among youth with prenatal substance exposure: A longitudinal register‐based matched cohort study

“…The negative association between offspring's mental and/or behavioural disorders and secondary education completion among both exposed and unexposed are supported by previous research indicating that mental and/or behavioural disorders can impair educational performance and be associated with inferior educational outcomes, due to difficulties with behaviour, self‐regulation, concentration, attention, and executive functioning and cognitive abilities (Brännlund et al, 2017; Howell et al, 2006; Jangmo et al, 2019; Polderman, Boomsma, Bartels, Verhulst, & Huizink, 2010). We have recently shown that childhood adversities and low birth weight are linked with offspring's mental and/or behavioural disorders (Koponen et al, 2020) similar to other studies (Aarnoudse‐Moens, Weisglas‐Kuperus, van Goudoever, & Oosteriaan, 2009; Björkenstam et al, 2017; Kambeitz, Klug, Greenmyer, Popova, & Burd, 2019). The results of the present study and prior research suggest then that the time lag in completed secondary education may not be a direct cause of prenatal substance exposure but rather reflect the impact of evolving offspring's mental and/or behavioural disorders influenced by adverse experiences during childhood.…”

“…In the present study, the different domains of offspring's mental and/or behavioural disorders were more common among the exposed offspring compared with the unexposed. The common mental and/or behavioural disorders, deficits in neuropsychological functioning, in particular, and the association between prenatal substance exposure have been previously reported (Irner, 2012; Koponen et al, 2020 Sandtorv, Hysing, Rognlid, Nilsen, & Elgen, 2017). The negative association between offspring's mental and/or behavioural disorders and secondary education completion among both exposed and unexposed are supported by previous research indicating that mental and/or behavioural disorders can impair educational performance and be associated with inferior educational outcomes, due to difficulties with behaviour, self‐regulation, concentration, attention, and executive functioning and cognitive abilities (Brännlund et al, 2017; Howell et al, 2006; Jangmo et al, 2019; Polderman, Boomsma, Bartels, Verhulst, & Huizink, 2010).…”

“…Childhood adversities (e.g. neglect, abuse, parental substance abuse, parental mental health disorders, family stress and poverty) can influence child's health, behaviour, and social functioning long‐term (Anda et al, 2006; Hughes et al, 2017; Koponen et al, 2020; Norman et al, 2012). Childhood adversities have also been associated with poorer educational outcomes (Berg, Bäck, Vinnerljung, & Hjern, 2016; Erola, Jalonen, & Lehti, 2016; Kääriälä, Berlin, Lausten, Hiilamo, & Ristikari, 2018; Sirin, 2016; Vinnerljung, Bo, Öman, & Gunnarson, 2005).…”

Epigenetic Impacts of Early Life Stress in Fetal Alcohol Spectrum Disorders Shape the Neurodevelopmental Continuum

“…While an FASD diagnosis is associated with increased risk for the development of comorbid neurodevelopmental disorders, additional adverse childhood events further increased the rates of neurodevelopmental disorders in people born with FASD (Kambeitz et al, 2019). PAE alone does not sufficiently predict the rate of later disorders and youth with adverse childhood experiences, specifically out-of-home care, have the highest risk of mental health problems (Koponen et al, 2020). Additionally, children with PAE and subsequent postnatal adversity have different brain structures and symptom profiles than children without added postnatal adversity (Andre et al, 2020).…”

The role of mother's prenatal substance use disorder and early parenting on child social cognition at school age

“…Although deficits in social cognition often underlie adult substance use disorders (SUDs) (Castellano et al, 2015; Sanvicente‐Vieira et al, 2017), little is known about the development of social cognition in the children of mothers with SUDs. Maternal prenatal SUD is accompanied by a variety of biological and psychosocial risks that may also predispose children to mental health and substance use problems (Koponen et al, 2020; Minnes et al, 2014). Deficits in social cognition are an important topic of study because they may precede the development of mental health and substance use problems.…”