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FETAL ALCOHOL EFFECTS (FAS PROJECT) COCAINE AND PREGNANCY (MSA PROJECT) FETAL GROWTH AND DEVELOPMENT (LBW PROJECT) Physician Education Addressing the Impact of Maternal High Risk Behaviors on Child Development
Studies of infants exposed to alcohol were begun in 1980 and continued through 1986. These studies were funded by the Georgia Department of Human Resources, the State Legislature and the March of Dimes. Six hundred and nine mothers were enrolled in these studies prenatally and 435 infants were born at Grady Memorial Hospital and were available for the research study. Scientific results of these studies include: Women drinking in pregnancy have immune system alterations. Counseling in the prenatal clinic helps many women stop drinking Neonatal Withdrawal Syndrome can be found in alcohol exposed infants. Alcohol exposure in pregnancy affects birthweight and behavior in newborns. Behavioral differences seen at birth persist to 28 days. The cries of alcohol affected infants are different from those of other babies Developmental effects can be measured at 12 months. Bibliography Coles, C.D. (1993). Impact of Prenatal Alcohol Exposure on the Newborn and the Child. Clinical Obstetrics and Gynecology, 36(2), 255-266. Coles, C.D., Smith, I.E., & Falek, A. (1987). Prenatal alcohol exposure and infant behavior: Immediate effects and implications for later development. Advances in Alcohol and Substance Abuse, 6(4), 87-104. Coles, C.D., Smith, I.E., Fernhoff, P.M., & Falek, A. (1985). Neonatal neurobehavioral characteristics as correlates of maternal alcohol use during gestation. Alcoholism, 9(5), 454-460. Coles, C.D., Smith, I.E., Fernhoff, P.M., & Falek, A. (1984). Neonatal ethanol withdrawal: Characteristics in clinically normal, nondysmorphic neonates. Journal of Pediatrics, 105, 445-451. Coles, C.D., Smith, I.E., Lancaster, J., & Falek, A. (1987). Persistence over the first month of neurobehavioral deficits in infants exposed to alcohol prenatally. Infant Behavior and Development10, 23-37. Smith, I.E., Coles, C.D., Lancaster, J.S., Fernhoff, P.M., & Falek, A. (1986). The effect of volume and duration of prenatal ethanol exposure on neonatal physical and behavioral development. Neurobehavioral Toxicology and Teratology, 8, 375-381. Smith, I.E., Lancaster, J.S., Moss-Wells, S.,Coles, C.D., and Falek, A. (1987). Identifying high-risk pregnant drinkers: Biological and behavioral correlates of continuous heavy drinking during pregnancy. Journal of Studies on Alcohol 48, 304-309. Zeskind, P.S., Platzman, K.A., Coles, C.D., and Schuetze, P.A. (1996) Brief Report: Cry analysis detects subclinical effects of prenatal alcohol exposure in newborn infants. Infant Behavior and Development, 19, 497-500. Studies of the development of alcohol-exposed children were begun in 1987 and continued until 1994. We were supported by the National Institute on Alcoholism and Alcohol Abuse (NIAAA), by the Georgia Department of Human Resources, and by the March of Dimes. During that time, we examined the developmental outcome for children whose mothers stopped and continued to drink. We also compared alcohol-affected children to those with a diagnosis of attention deficit, hyperactivity disorder (ADHD) since ADHD is frequently diagnosed in those with FAS and partial FAS (pFAS). From these studies we found: Children whose mothers quit drinking by the second trimester had more positive outcomes than those whose mothers continued even if mothers drank the same amount. Children with alcohol-related dysmorphic features (FAS/E) were not more likely than control children from the same social class and ethnic group to have ADHD. They were more likely to have academic problems and difficulties with learning. School aged children prenatally exposed to alcohol have specific learning problems including mathematics and visual/spatial skills. Bibliography Brown, R.T., Coles, C.D., Smith, I.E., Platzman, K.A., Silverstein, J., Erickson, S., & Falek, A. (1991). Effects of prenatal alcohol exposure at school age: II. Attention and Behavior. Neurotoxicology and Teratology 13 (4), 369-376. Coles, C.D. (1998) Going beyond ADHD to understand behavior and learning problems in FAS. Iceberg, 8 (1), 1-2. Coles, C.D., Brown, R.T., Smith, I.E., Platzman, K.A., Erickson, S., & Falek, A. (1991). Effects of prenatal alcohol exposure at school age: I. Physical and cognitive development. Neurotoxicology and Teratology, 13(4), 357-367. Coles, C.D., Platzman, K.A., Raskind-Hood, C.L., Brown, R.T., Falek, A., & Smith, IE. (1997) A comparison of children affected by prenatal alcohol exposure and attention deficit, hyperactivity disorder. Alcoholism: Clinical and Experimental Research, 21 (1), 150-161. Platzman, K.A., Stoy, M.R., Brown, R.T., Coles, C.D., Smith, I.E., & Falek, A. (1992). Review of observational methods in attention deficit hyperactivity disorder (ADHD): Implications for Diagnosis. School Psychology Quarterly, 7 (3),155-177. Robinson, M.K., Myrick, J.E., Henderson, L.O., Coles, C.D., Powell, M.K., & Lemkin, P.F. (1995) Two-dimensional protein electrophoresis and multiple hypothesis testing to detect potential serum protein biomarkers in children with Fetal Alcohol Syndrome. Journal of Electrophoresis, 16, 1176-1183. Starting in 1995, with funds from the National Institute on Alcoholism and Alcohol Abuse (NIAAA), we revisited the parents and children we first saw in the early 1980’s to examine how prenatal alcohol exposure affected development during the teen years. Young people were seen at 14 ½ years old and asked about school performance, alcohol and drug use, social adjustment and other aspects of development during this critical period. We also looked at immune system functioning and response to stress. To be sure that the results we got were the result of prenatal alcohol exposure, we compared them to a group of teens from Special Education programs in the Atlanta area. We are still analyzing the data from this study but preliminary results suggest: Prenatal alcohol exposure may affect immune response Alcohol-affected young people feel more anxious and depressed than other teens Alcohol-exposed and affected youth do not have more behavior problems and delinquency than those in the Special Education Group. Bibliography Coles, C.D., & Lynch, M.E. (1999, in press) Adolescents with disabilities: Insights for alcohol-affected individuals. In J. Kleinfield and B. Morse (Eds.) Fantastic Antone Grows Up, Fairbanks, AK: University of Alaska Press. Olsen, D.R., Magee, R.M., Donahoe, R.M., Falek, A., & Coles, C.D. (1997). Immunity and prenatal alcohol exposure: A pilot study in human adolescents. In, Advances in Experimental Medical Biology: Drugs of Abuse, Immunomodulation and AIDS. New York: Plenum Press. In a previous study, we found that alcohol use altered pregnant women's immune response and we thought that was possible that prenatal exposure to alcohol affects the body's ability to respond to stress and fight disease in their children as well. To investigate these possibilities, we asked the teens in the follow-up research sample to contribute some samples of blood, urine and saliva and we are analyzing these to see if there are differences in immune functioning and stress response in those whose mothers used alcohol during pregnancy. In a pilot study conducted by Dorthey Olsen, Ph.D., we found that adolescents with the physical effects of alcohol also: Showed changes in T-cell functioning. Reported more allergy symptoms. We were somewhat surprised that these effects were found so many years after the exposure to alcohol. With a supplemental grant from the National Institute on Alcoholism and Alcohol Abuse (NIAAA), we are investigating this issue further. We are now including information about the teens' response to stress since there is a link between stress response and immune functioning which might account for our earlier findings. To investigate stress, we are measuring salivary cortisol, a hormone which measure the body's reaction to novelty and is often altered in individuals who are experiencing stressful situations. The results of this research will be available in 2000. Bibliography Madden, J.J., Donahoe, R.M., Smith, I.E., Martinson, D.E., Moss-Wells, S., Klein, L., & Falek, A. (1984) Increased rate of E-rosette formation by T Lymphocytes of pregnant women who drink ethanol. Clinical Immunology and Immunopathology, 33, 67-79. Olsen, D.R., Magee, R.M., Donahoe,
R.M., Falek, A., & Coles, C.D. (1998). Immunity and prenatal
alcohol exposure: A pilot study in human adolescents.Advances
in Experimental Medicine and Biology, 437:255-64. Maternal Substance Abuse Project We have done two studies of newborns exposed to cocaine and other drugs. Both were funded by the National Institute on Drug Abuse (NIDA). In the first, begun in 1989, we just studied full term babies and in the second, begun in 1992, we looked at premature babies as well. Because the early reports of the effects of prenatal cocaine exposure were so negative, we were interested in learning more about their physical status, growth and early behavior. In doing these studies we found: Cocaine exposure is associated with lower birth weight but only for full term infants. This suggests that the grown retardation associated with cocaine occurs in the last part of pregnancy. There is no evidence for Neonatal Withdrawal as a result of cocaine exposure There was no increased rate of birth defects in this group Cocaine exposed infants had no differences in heart rate but their respiratory rates were different. Women using drugs and alcohol in pregnancy are more likely to enter treatment if they are experience emotional distress. Preterm cocaine-exposed infants were not more affected than full term. Bibliography Brown, J.V., Bakeman, R., Coles, C.D., Sexson, W.R., & Demi, A. (1998). Maternal drug use, fetal growth and newborn behavior: Are preterms and fullterms affected differently? Developmental Psychology, 34 (3), 540-554. Coles, C.D. (1993). Saying "Goodbye" to the "Crack Baby". Neurotoxiocology and Teratology,5, 290-292. Coles, C.D., Platzman, K.A., Smith, I.E., James, M. E. & Falek, A. (1992). Effects of cocaine and alcohol use in pregnancy on neonatal growth and neurobehavioral status. Neurotoxicology and Teratology14, 23-33. James, M.E., & Coles, C.D. (1991). Cocaine abuse during pregnancy: Psychiatric considerations. General Hospital Psychiatry 13, 399-409. Smith, I.E., Dent, D.Z., Coles, C.D., & Falek, A. (1992). A comparison study of treated and untreated pregnant and postpartum cocaine abusing women. Journal of Substance Abuse Treatment, 9, 343-348. From 1993 to 1997, we followed infants exposed to drugs and alcohol and looked at their social and emotional development. This study was supported by the National Institute on Drug Abuse (NIDA). We were interested both in the effect of the prenatal exposure and the postnatal care giving environment since both of these are impacted by maternal substance abuse. We saw 200 babies and their mothers or other caregivers at 8 weeks, 6 months, 12 month, 18 months and 24 months. Half of the families were affected by substance abuse and half were "controls" who volunteered to help in understanding this problem. Some of the scientific findings from this study include: Growth, mental and physical development are not different in the drug exposed group from 8 weeks to 24 months Drug-exposed infants have much less favorable caregiving environments and are more likely not to be living with their biological parents. By 2 years, only 54% are with birth mothers. At 8 weeks, drug-exposed babies show alterations in arousal regulation (heart rate and respiration). At 8 weeks, cocaine and the quality of caregiving affect the infants’ attention to social stimuli. At 24 months, drug-exposed infants show more problems with feeding, sleeping and self control. They are more likely to be aggressive. At 24 months, cocaine had specific effects on sleep and on negative emotional reactions to social situations. Bibliography Bard, KA., Coles, CD, Platzman, KA, Brown, JV, & Lynch, ME (2000, in press) The effects of prenatal drug exposure, term status, and caregiving on arousal and arousal modulation in 8-week-old infants. Submitted to Developmental Psychobiology. Coles, C.D, Bard, K.A., Platzman, K.A., & Lynch, M.E. (1999, in press) Attentional Response at 8 weeks in prenatally drug-exposed and preterm infants. Neurotoxicology and Teratology. Platzman, KA., Bard, KA, Coles, CD, Brown, JV, & Lynch, ME (1999, submitted) Assessment of the Caregiving Environment and Infant Functioning in Polydrug Families: We are excited to be starting an 8-year follow-up of the children exposed to cocaine and other drugs. This study was funded in June 1999 by the National Institute on Drug Abuse (NIDA) and data collection will begin in January 2000. This study will focus on 100 drug-exposed children and their current caregivers and compare them to 100 unexposed children who were also identified when they were born. In addition we will recruit 50 8-year old children who were exposed to cocaine and other drugs prenatally who were adopted early in infancy and who have had a stable home environment. We are also looking for 50 8-year old children who have been diagnosed with externalizing disorders (that is, conduct disorder, ADHD, oppositional disorders). Volunteers for this part of the study can call us at 404 894-8288 and ask for Mary Ellen Lynch or Sharron Paige-Whitaker. If you want more information about volunteering, please contact: Mary Ellen Lynch: mlynch@emory.edu. We will be collecting data for about
3 years and hope to understand much more about social and emotional
development in cocaine-exposed school aged children when we finish
the study. Fetal Growth and Development Project (Low Birth Weight Project) In 1992, we began a collaborative project with the Rollins School of Public Health and the Centers for Disease Control and Prevention (CDC) to find methods for identifying alcohol-affected children during infancy. This project has three parts: 1) Surveillance in the Nursery; 2) Follow-up in the First Year and 3) Preschool Follow-up (FUDGE). Under the supervision of Caroline Drews-Botsch, Ph.D., from the Rollins School of Public Health, information was collected on all infants born at Northside Hospital and Grady Memorial Hospital during a 22 month period in 1993 and 1994. From all infants born during that time, 1009 were recruited for this study and information collected from their mothers about drug and alcohol use as well as many other factors. Some of the findings from this phase of the study include: Most women reduce drinking early in pregnancy. At the suburban hospital, women were more likely to resume drinking in the 3rd trimester. Binge drinking (>7 drinks/wk) is associated with lower birthweight. Bibliography Drews, C.D., Coles, C.D., Floyd, R.L., & Falek, A. (in preparation) The prevalence of prenatal drinking at a public and a private hospital. Drews, C.D., Boyle, C., Coles, C.D.,
& Falek, A. (in preparation) The effect of moderate drinking
in pregnancy on the risk of delivery of an infant that is small
for gestational age. Early identification of the cognitive and behavioral effects of alcohol exposure would help to prevent secondary disabilities in children and might allow earlier treatment for their mothers. To test methods for early identification, we used three methods to identify children who were at high risk and tested them at six and 12 months using standardized tests (e.g. Bayley Scales of Infant Development) as well as experimental measures of attention (e.g., heart rate). We selected children who: 1) had a small head size; 2) had mothers who drank >5 drinks per occasion (binged), or 3) had mothers who scored high on a Maternal Substance Abuse Checklist. We have found that: It is possible to identify newborns who will perform poorly at 12 months. The Maternal Checklist is most effective in identifying high risk children. Alcohol exposure affects attention at 6 months. Bibliography Coles, C.D. (1999) Intervening with children with FAS and ARND: Where do we start? In, Centers for Disease Control and Prevention (Eds). Intervening With Children Affected by Prenatal Alcohol Exposure. Proceedings of a Special Focus Session of the Interagency Coordinating Committee on Fetal Alcohol Syndrome; 1998, September 10-11; Chevy Chase, MD. Bethesda, MD: National Institute of Alcohol Abuse and Alcoholism. Coles, C.D., Kable, J.A., Drew-Botsch, C., & Falek, A. (2000, in press). Early identification of risk for effects of prenatal alcohol exposure. Journal of Studies on Alcohol. Kable, J.A. (1995) Auditory vs. general information processing deficits in infants of mothers who smoked during their pregnancy. Dissertation sumitted to Purdue University. Understanding the long-term effects
of prenatal exposure as well as low birth weight means that children
have to be followed over time. The children in the Fetal Growth
and Development Study were revisited when they were 4 1/2 years
old and given a physical examination and a battery of tests. This
study was carried out through the Rollins School of Public Health
with Caroline Drews, Ph.D. as the principal investigator. Developmental
testing was done at the Marcus Institute with the cooperation of
Claire D. Coles, Ph.D. and Julie Kable, Ph.D. The outcome data from
this study is just being analyzed and results will be available
soon.
The Maternal Substance Abuse and Child Development Project is funded in part by the Georgia Department of Human Resources Division of Public Health. The Maternal Substance Abuse and Child Development Study is under the direction of Claire D. Coles Ph.D., with the Department of Psychiatry and Behavioral Science, Emory University School of Medicine. For more information, please contact: Claire D. Coles: ccoles@emory.edu ; Karen K. Howell: khowell@emory.edu |
