ReviewMaternal smoking, drinking or cannabis use during pregnancy and neurobehavioral and cognitive functioning in human offspring
Section snippets
Background and theoretical framework
Studies of behavioral and cognitive effects of in-pregnancy exposures, such as stress and undernutrition, often treat prenatal substance use as a confounding variable without addressing the role of these lifestyle factors, such as smoking, drinking, or cannabis use, on the offspring as a direct or interactive agent. However, drug abuse during pregnancy has also been related to postnatal consequences, manifested as alterations in behavior and cognition.
Research into these mostly subtle
Perturbations in neurodevelopment
During fetal development, every area, system, and circuit of the brain has its growth spurts. If the area does not fully develop in those assigned periods, the developing brain does not compensate; the area is left with a deficit. Genetic expression moves on to develop the next scheduled area (Watson et al., 1999). Thus, the timing of the perturbation in neurodevelopment may be critical in determining if a neurobehavioral or cognitive deficit results, and the timing of the disruption in
Methodological issues
Several methodological aspects should be considered when reviewing human studies on the association of prenatal maternal teratogenic factors and child and adolescent neurobehavioral and cognitive outcomes.
Smoking during human pregnancy
In the United Kingdom, over a quarter of pregnant women who smoke continue to do so during pregnancy (Coleman, 2004). Also in the United States, despite abundant adverse publicity, tobacco use occurs in about 25% of all pregnancies (Bardy et al., 1993, DiFranza and Lew, 1995). Most of these women are young, unmarried and from low socioeconomic strata (Kvale et al., 2000).
Several reports have established that maternal smoking during pregnancy is adversely associated with neurobehavioral and
Alcohol use during human pregnancy
Alcohol is widely recognized as a teratogenic agent causing CNS dysfunction and impaired mental functioning. The most serious consequence of maternal drinking during pregnancy is fetal alcohol syndrome (FAS), the diagnosis of which is based on three criteria: (1) growth deficiency manifested by small overall height and small head size; (2) central nervous system disorders, including mental retardation and (3) a distinctive pattern of abnormal facial features. Alcohol exposure during pregnancy
Cannabis use in human pregnancy
Cannabis is the most commonly used illicit drug among women of reproductive age and in the United States the self-reported use of this substance is 2.9% during pregnancy (National Pregnancy and Health Survey, 1996, Ebrahim and Gfroerer, 2003).
Fried (2002) has reviewed the studies on behavioral teratologic consequences of prenatal exposure to cannabis. Only two longitudinal cohorts with very different sample characteristics were found that examined the possible impact of cannabis exposure in
Discussion
Most studies included in this review indicate that low to moderate maternal smoking, or drinking and (heavy) cannabis use during pregnancy may contribute to neurobehavioral and cognitive deficits in human offspring. However, because of several methodological limitations no causal conclusions can be drawn. One of the most fundamental issues regarding interpretation of these results of human studies is the inability to manipulate a range of factors that potentially influence outcomes in the
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