Suchergebnisse

Researchers are referring to polysubstance use as the "fourth wave" of the opioid epidemic. Prenatal polysubstance exposure is on the rise, leading to increased health and safety complications among infants and caregivers. This study examined the co-occurrence of polysubstance exposures and child maltreatment concerns using Child Abuse and Prevention Treatment Act (CAPTA) notifications made in Connecticut. Sixteen percent of notifications included polysubstance exposures. The average total number of substances identified among polysubstance cases was 2.39 (range: 2–7). Each additional substance identified was shown to have 2.5 times higher odds of maltreatment report controlling for maternal age, infant race/ethnicity, and toxicology test type. Findings from this study suggest that the total number of substances is a primary factor contributing to maltreatment reports among infants with prenatal substance exposure.

A basic problem encountered by investigations of prenatal cocaine effects has been the valid identification and quantification of exposure. Based on a combination of sources: (a) medical record review, (b) maternal urine toxicology screen, (c) meconium analysis, and (d) maternal postpartum interview, drug exposure status of 415 infants was established. Using this combination as a benchmark, maternal postpartum interview was found most sensitive, while medical record review was slightly less accurate. Meconium analysis and urine screens both demonstrated miss rates greater than the interview or record review methods. Meconium analysis and postpartum interview, however, each detected cases of cocaine exposure that the other had missed. Correlations between the amount of cocaine found in meconium and in maternal report indicated that the cocaine metabolite benzoylecgonine was the best biological marker. Quantifying heavy versus light exposure required a combination of both meconium analysis and maternal postpartum interview techniques.

The current state of knowledge about the neurodevelopmental sequelae of prenatal cocaine exposure is reviewed. Maternal cocaine use is associated with a number of other factors such as poor nutrition, inadequate prenatal care, and exposure to other substances, including alcohol and tobacco, that also affect neurodevelopmental outcome. The effects of postnatal maternal cocaine use on the mother's capacity to care for the infant as well as the association of cocaine use with more general environmental factors—for example, poverty, violence, neglect, and abuse—are discussed as important factors to consider when attempting to define whether or not prenatal cocaine exposure has specific and unique effects on the developing fetal brain. Six methodological problems commonly found in the literature on prenatal cocaine exposure are cited as issues to consider when attempting to evaluate the validity of currently available findings.

This study examines the relationship between prenatal cocaine exposure and child welfare outcomes. Seventy-six infants positive for cocaine at birth were matched to 76 negative infants. With prenatal care and maternal use of alcohol and tobacco controlled, cocaine-exposed infants had significant decrements in birth weight, length, head circumference, and depressed 5-min Apgar scores. This confirmed the health risk of prenatal cocaine exposure for the sample. Three-year follow-up data were obtained from the State Central Register and foster care records. Adjusting for prior maternal involvement with child welfare services the study groups did not differ in incidents of child maltreatment or foster care placement. These findings suggest that prenatal cocaine exposure is not a marker for abusive parenting. However, from the perspective of a cumulative risk model, the identification of cocaine-exposed infants at birth can form the starting point for the development of appropriate diagnostic and follow-up services for mother and child.