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Prenatal Drug Exposure & Child Outcome: Time for Policy to Catch up with Research. Barry M. Lester, PhD Brown Center for the Study of Children at Risk. The Warren Alpert Medical School of Brown University. Women, Pregnancy and Drug Use:

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slide1
Prenatal Drug Exposure & Child Outcome: Time for Policy to Catch up with Research

Barry M. Lester, PhD

Brown Center for the Study of Children at Risk

The Warren Alpert Medical School

of Brown University

Women, Pregnancy and Drug Use:

Medical Facts, Practical Responses and the Well-Being of Children and Families

Oklahoma City, November 14, 2007

slide2
Science and Prenatal

Drug Exposure

Are There Drug Effects?

YES, BUT:

They are smaller than initially thought

Not all drug exposed children are affected

They can be treated

slide3
History and Headlines

COCAINE

HURTS BABIES

When drug babies reach school age

Mothers Turned

Into Monsters

Pregnant cocaine user guilty of abuse

Crack

A Disaster of Historic Dimension, Still Growing

Studies: Future bleak for crack babies

Cocaine: a vicious

assault on a child

Crack’s Toll Among Babies: A Joyless View, Even of Toys

In the 1980s, early reports on prenatal cocaine effects created a public frenzy about “unfit to parent” women and their damaged “crack babies."

slide4
History and Headlines

COCAINE

HURTS BABIES

When drug babies reach school age

Mothers Turned

Into Monsters

Pregnant cocaine user guilty of abuse

Crack

A Disaster of Historic Dimension, Still Growing

Studies: Future bleak for crack babies

Cocaine: a vicious

assault on a child

Crack’s Toll Among Babies: A Joyless View, Even of Toys

Based on insufficient and inaccurate information, society over-reacted.

Women were prosecuted, children were removed from their birth mothers, families were split up.

slide5
History and Headlines

COCAINE

HURTS BABIES

When drug babies reach school age

Mothers Turned

Into Monsters

Pregnant cocaine user guilty of abuse

Crack

A Disaster of Historic Dimension, Still Growing

Studies: Future bleak for crack babies

Cocaine: a vicious

assault on a child

Crack’s Toll Among Babies: A Joyless View, Even of Toys

By the mid 1990s, the number of children in foster care reached an all-time high of over 500,000.

Many of these children suffered emotional problems from multiple foster care placements.

slide6
History and Headlines

Prenatal cocaine exposure has subtle effects on children’s ability to focus their attention

Major Trial Finds Only Subtle Fetal Injury From Cocaine

A mother’s cocaine use may not doom her childafter all

“Crack Kids”: Not Broken

A Rush toJudgment

Hope for ‘SnowBabies’

Researchers debunk myth of the ‘crack baby’

But, later studies did not find that prenatal cocaine exposure was related to serious defects or medical complications in the newborn.

slide7
U. Tenn

Memphis

Wayne State

U. Miami

Brown U.

MLS

Cocaine: The Maternal

Lifestyle Study

medical conditions n 8 000
Medical Conditions(N>8,000)
  • Previously reportedmedical problems in the mothers were rare (<5%) and not related to cocaine
  • Previously reported physical damage to the infant was rare (<5%) and not related to cocaine
medical findings at birth
Medical Findings at Birth
  • Cocaine effects were found on infant gestational age (8.4 days), birthweight (536 grams) head circumference (1.5 cm), small for gestational age (29% vs 13%)
  • Cocaine exposed infants showed more “soft signs” and behavioral effects
mental development ages 1 7
Mental Development Ages 1-7

110

COMP

EXP

100

90

80

IQ

70

4.4 IQ Pts

60

50

1

2

3

4

5

6

7

Age (Years)

(Lester et al 2004)

slide11
70

No Cocaine

Mod Cocaine

Hi Cocaine

65

60

Predicted CBCL Externalizing Score

55

50

45

40

3

4

5

6

7

8

9

Age (Years)

Behavior Problems Ages 3-9

behavior problems at age 7
Behavior Problems at Age 7

MLS CBCL Externalizing >63

what is the cost to society
What is the Cost to Society?

120,000 drug exposed infants/year

X 5%

(extra 6000 drug exposed children per year needing special education services)

X $9204

(cost special education services per child)

= $55,224,000

per year additional funds

slide15
Brown

Oklahoma

California

Hawaii

IDEAL

Iowa

Methamphetamine: Infant Development Environment And Lifestyle Study

slide16
Research Is Just Beginning

According to an NIH Expert Panel Report: in terms of the potential adverse reproductive and developmental effects of meth exposure

“studies that focused upon humans were uninterpretable” …

…due to such factors as a lack of control of potential confounding factors and the issue of the purity and contaminants of the methamphetamine used by the drug abusers” (p.191).

NTP-CERHR, Monograph on the Potential Human Reproductive and Developmental Effects of Amphetamines, July 2005

ideal medical conditions n 408
IDEAL: Medical Conditions(N=408)
  • No increase in maternal medical problems in mothers who used Meth during pregnancy (e.g. placental abruption)
  • No increase in physical damage in Meth exposed infants
medical findings at birth18
Medical Findings at Birth
  • Meth effects were found on infant gestational age (1.4 weeks), birthweight (200 grams) and small for gestational age (19% vs 8.5%)
slide19
Newborn Behavior
  • Lower arousal
  • More stress signs
  • Similar to cocaine
behavior problems at age 3
Behavior Problems at Age 3

IDEAL CBCL Externalizing>63

slide23
Policy Responses

2 parallel policy responses towards

drug use by women

Punitive Treatment

slide24
Punitive
  • Drug use by mothers as legal/criminal issue
  • Criminal justice system - Child welfare system
  • Harming child by using drugs
  • Child abuse in its most destructive form
  • Favors imprisonment, child removal
slide25
Treatment
  • Drug use by pregnant women viewed as a mental health (medical) issue
  • Harm reduction
  • Reproductive health care, substance abuse and mental health treatment,

relationship with child

slide26
Problems With Punitive Approach
  • Fear of being reported drives women away from health care system (e.g. prenatal care)
  • Denies the opportunity to parent for those who can/want to parent
slide27
Problems With Punitive Approach
  • Overburdens foster care system
  • Child’s ability to form attachments is jeopardized by multiple foster placements
slide28
Addiction Can Be Treated

3

0

ml/gm

METH Abuser

(1 month detox)

Normal Control

METH Abuser

(24 months detox)

slide29
50 to 70%

50 to 70%

40 to 60%

30 to 50%

Similar Relapse Rates for Drug and Other Medical Problems

100

90

80

70

60

Percent of Patients Who Relapse

50

40

30

20

10

0

Drug

Dependence

Type I

Diabetes

Hypertension

Asthma

slide30
Model Programs
  • Family centered
  • Comprehensive
  • Interdisciplinary staff
  • Nonjudgmental, nonpunitive, nurturing, culturally appropriate
  • Parenting programs
  • Mental health and women’s issues
  • Child care
  • Transportation
slide31
What Have We Learned?
  • Addiction is a disease – a medical condition that can be treated
  • Mothers don’t use drugs because they are evil people who don’t care about their baby
  • They use drugs because they have a mental disorder
slide32
What Have We Learned?

Community Violence

Violent Friends

A bad environment can worsen drug effects

Domestic Violence

slide33
What Have We Learned?
  • Environment is key

A good environment can overcome drug effects

the brain is the ultimate use it or lose it machine
The Brain is the Ultimate “Use-It or Lose-It” Machine

Synapses

  • At birth – 50 trillion
  • At 1 year – 1000 trillion
  • At age 20 – 500 trillion
slide35
The human brain is shaped by experience

Experience, in turn, leads to neural changes in the brain

The remolded brain facilitates taking in new experiences

slide36
Current Headlines

The Meth Epidemic: Hype vs Reality

New drug wave delivers 'crank babies'

Crack Then, Meth Now

Generation of Meth Babies

We are in a similar situation today with methamphetamine as we were 20 years ago with cocaine

slide37
Current Headlines

meth babies” “could make the crack baby look like a walk in the nursery”

Children of meth users are filling foster homes

Meth Infants Called the New “Crack Babies”

Only Future Will Tell Full Damage

Speed Wreaks on Kids

slide38
Avoid Labeling

Top Medical Doctors, Scientists & Specialists Urge Major Media Outlets Not to Create “Meth Baby” Myth

Signatories from Leading Hospitals and Research Institutes In US and Abroad Agree That Term Lacks Scientific Basis as Does the Claim That Treatment Does Not Work

  July 25, 2005

slide39
Avoid Labeling

“The use of stigmatizing terms, such as ice babies and meth babies, lack scientific validity and should not be used. Experience with similar labels applied to children exposed parentally to cocaine demonstrates that such labels harm the children to which they are applied, lowering expectations for their academic and life achievements, discouraging investigation into other causes for physical and social problems the child might encounter, and leading to policies that ignore factors, including poverty, that may play a much more significant role in their lives.”

slide40
Final Thought…

We have made tremendous strides in the past 20 years when it comes to our understanding drug addiction and treatment.

The effects of prenatal drug exposure are milder than initially thought. A good environment can help overcome drug effects.

slide41
Final Thought…

While there are drug users who are inadequate mothers, there are also drug users who are competent mothers who, with treatment, can care for their children. Families can be preserved.

Failure to take advantage of what we have learned is not only a missed opportunity but a giant step backward.

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