June/July 2002 Article 1 Article 2

Maternal Cocaine Use and Infant Behavior Rina Das Eiden, Ph.D. Research Institute on Addictions, University at Buffalo, The State University of New York Audra Lewis, M.S. Research Institute on Addictions and Department of Psychology, Vanderbilt University Stacy Croff, M.S. and Elizabeth Young, B.S. Research Institute on Addictions University at Buffalo, The State University of New York Abstracted from Infancy, 3, 77-96, 2002. Maternal cocaine use during pregnancy has been described as a significant problem affecting large numbers of children. It also is associated with increased use of other substances such as alcohol, nicotine, and marijuana. Apart from other substance use, two primary risk factors associated with cocaine use during pregnancy are negative maternal functioning (e.g. higher antisocial behavior and psychological distress) and an inadequate caregiving environment. The purpose of this preliminary study was to examine the influence of maternal cocaine use on affect regulation during infancy. The effects of associated risk factors such as multiple substance use, maternal functioning, and the caregiving environment were also investigated. Regulatory Problems Regulatory problems are problems with physiology, emotions, and behavior that are necessary to cope adequately with different environmental demands. For example, some infants react with high negative emotion in a novel situation and take a relatively long time to get back to a neutral state. This reaction may be evident in their physiology (e.g., changes in heart rate) and behavior (e.g., expressions of negative affect). Of additional interest is how well such infants are able to use different strategies (e.g., distraction, moving attention toward caregiver) in order to reduce or regulate their arousal or reaction to a new situation that is emotionally challenging.. The Participants Mothers and newborns were recruited from two inner-city hospitals, just following delivery. The final sample consisted of 45 mothers and infants – 19 cocaine-exposed infants and 26 control infants – who completed one-month, two-month, and seven-month assessments. The mothers ranged in age from 19 to 43. Ninety-two percent of the mothers were African-American and 72 percent were single. The infants totaled 26 boys and 19 girls. Prenatal cocaine-exposure status was determined by a combination of maternal report and medical chart review. Urine toxicologies from the prenatal or immediate postpartum period were available through chart review for all mothers in the study. Infants were considered cocaine-exposed if maternal self-reports for cocaine use were positive regardless of urine toxicology results. Infants also were considered exposed if mothers reported that they did not use cocaine, but the urine toxicology results were positive. All screenings included drug level or metabolites of cocaine, opiates, benzodiazepines, and tetrahydrocannabinol (THC). Approximately 39 percent of mothers and infants in the cocaine group had positive urine toxicologies at delivery; the remainder of the mothers admitted having used cocaine prenatally in the self-report screening instrument administered after delivery. Mothers were recruited into the control group if their urine toxicologies and self-reported substance use were negative for cocaine, they reported not using any illicit substances, and did not drink heavily during pregnancy (defined as more than one drink a day or seven drinks a week). Assessments About two weeks after delivery, mothers were contacted and scheduled for their first laboratory visit. Mothers and infants were initially assessed at one and two months of infant age, with a follow-up visit at seven months of age. Infant height, weight, dysmorphia (a cluster of facial and other physical characteristics) assessment, and assessment of behavioral asymmetries were conducted at one month of age. At the same time, mothers were interviewed regarding prenatal substance use, sensation seeking, and antisocial behavior. A developmental assessment and observations of mother-infant feeding interactions were conducted at two months of infant age. Mothers were interviewed regarding postnatal substance use, psychological symptoms, and reports of infant behavior. The visit at seven months included measures of infant behavior in novel situations, developmental evaluations, mother-infant interactions, and maternal reports of infant behavior, postnatal substance use, and the caregiving environment. Results The results of this study indicate that maternal cocaine use has direct and indirect implications for infant regulatory behavior. Maternal cocaine use was associated with a variety of prenatal and perinatal risk factors such as higher alcohol use and cigarette smoking during pregnancy, higher frequency of marijuana use, lower gestational age, baby's length, duration of delivery, greater number of obstetrical complications, higher maternal age, and greater number of previous pregnancies. Moreover, cocaine- using mothers were more antisocial and infants of these mothers experienced greater caregiving instability. Thus, maternal cocaine use is a marker variable for increased prenatal and postnatal risk. When group differences in infant behavior at two and seven months were examined, cocaine-using mothers reported their infants to have lower positive affect and greater distress in response to novel situations at two months. Infants of these mothers displayed lower arousal and less coordinated motor behavior during developmental testing. At seven months, the infants displayed lower engagement and/or orientation during developmental testing and higher negative affect in response to stress during behavioral testing. Additionally, a number of these associations were a function of other substance use or mediated through other postnatal risk factors. For instance, while prenatal maternal cocaine use had unique associations with infant positive affect and distress to novelty at two months after controlling for other substance use, it was not associated with infant arousal at two months. Higher quantity/frequency of maternal alcohol use during pregnancy was associated with lower infant arousal. At seven months, lower engagement/orientation was associated with higher frequency of other substance use. These results are consistent with previous studies reporting that cocaine-exposed infants are more likely to experience exposure to multiple substances and higher caregiving instability. These risk factors are directly associated with regulatory problems in early infancy and behavior problems in later childhood (Coles et al, 1999; Eiden, 1999; Eiden et al., 1999).. Areas for Future Study This study provides further support to the small body of literature suggesting that the impact of prenatal maternal cocaine use in the context of multiple drug use may have subtle effects on mental development. However, maternal cocaine use may have a more significant impact on infant regulatory behavior. Differences in behavior may be a function of both initial regulatory problems as well as the quality of the postnatal environment. Results in this study should be interpreted with caution given the small sample size. The results require replication with a much larger sample of cocaine-using mothers. Future studies with larger sample sizes and longer follow-ups are needed to examine these questions in more detail. Article 1

William R. Greiner, President

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