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EPIDEMIOLOGIC TRENDS IN DRUG ABUSE—Panel on Methamphetamine Abuse: NIDA-Supported Research Studies evaluate specialized treatment approaches for this population. Because of the health problems associated with longterm MA use, early interventions could decrease the high medical and social costs of MA use. For inquiries concerning this report, please contact Mary-Lynn Brecht, Ph.D., UCLA ISAP, 1640 S. Sepulveda Blvd., Suite 200, Los Angeles, CA 90025, Phone: 310-445-0874 ext. 270, E-mail: lbrecht@ucla.edu. Prenatal Exposure to Methamphetamine and Child Development Barry Lester, Ph.D., Linda LaGasse, Ph.D., Lynne M. Smith, M.D., Chris Derauf, M.D., Penny Grant, M.D., Rizwan Shah, M.D., Amelia Arria, Ph.D., Marilyn Huestis, Ph.D., and Jing Liu, Ph.D. Preliminary findings on infants exposed prenatally to methamphetamine (MA) and nonexposed infants suggest… • Prenatal exposure to MA is associated with an increase in SGA (small for gestational size). • Neurobehavioral deficits at birth were identified in NNNS (Neonatal Intensive Care Unit Network Neurobehavioral Scale) neurobehavior, including dose response relationships and acoustical analysis of the infant’s cry. These preliminary findings are from the IDEAL (Infant Development, Environment, and Lifestyle) clinical network study supported by NIDA (RO1DA- 01498-01). The final sample will be comprised of 204 exposed and 208 nonexposed infants and their caretakers. STUDY SAMPLE AND METHODS The sample for these preliminary findings is based on infants who were exposed to MA prenatally and infants who were not exposed to MA. Exposure was determined through mothers’ self-reports and/or GC/MS (Gas Chromatography/Mass Spectroscopy) confirmation of MA in meconium. Subjects in both groups were ineligible for the study if the mothers used lysergic acid diethylamide (LSD), phencyclidine (PCP), opiates, or cocaine only during pregnancy. Other maternal exclusion criteria were non-English speaking, mental confusion or psychotic symptoms, low cognitive function, and being younger than 18. Infant exclusion criteria were multiple gestation, 320 congenital anomalies or chromosomal abnormalities, unlikely to survive, and overt TORCH (Toxoplasmosis, Other Agents, Rubella, Cytomegalovirus, Herpes Simplex) infections. Mothers who used alcohol, tobacco, or marijuana during pregnancy were included in both the exposed or nonexposed groups. The subjects were recruited from seven hospitals at four clinical research sites (Tulsa, OK; Des Moines, IA; Los Angeles, CA; and Honolulu, HI) from September 1, 2002, through August 31, 2003. The figures below show the number of mothers who were screened and ineligible, and the final number of eligibles who consented to participating in the study. 13,808 Screened → 10,510 Available → 7,119 Eligible → 1,632 Consented Subjects with MA exposure and matched comparisons were enrolled in the followup phase (84 exposed and 92 comparison). In the comparison group, mothers denied MA use and the infants had a negative meconium screen. The comparison group was matched to the exposed group by race, infants’ birthweight, type of medical insurance, and maternal education. Data were collected soon after the infants’ birth and at a 1-month followup. Mothers were interviewed at both time points for demographic information, drug use during pregnancy, and psychological characteristics. SGA was determined from physical growth parameters from hospital medical charts. The NNNS was used to test infant neurobehavior at birth. The NNNS includes measures of arousal, stress and abstinence signs, self-regulation, and quality of movement. Statistical analyses on NNNS scores included comparison between groups, trimester effects of MA use, and dose response relationships between the amphetamine metabolite in meconium and newborn neurobehavior. Following the NNNS exam, the infant’s cry was elicited and tape-recorded for subsequent computer acoustical analysis. The SASSI (Substance Abuse Subtle Screening Inventory) was used to determine substance dependence disorder in the mothers at 1 month. FINDINGS Based on self-reports of 1,632 eligible mothers who consented to participation, it was found that 6 percent used MA during pregnancy. Findings from this recruitment sample showed that MA-exposed infants were significantly more likely than their comparison counterparts to have lower birthweight and were more likely to be SGA. However, only the SGA effect remained with adjustment for covariates. Proceedings of the Community Epidemiology Work Group, Vol. II, January 2005
EPIDEMIOLOGIC TRENDS IN DRUG ABUSE—Panel on Methamphetamine Abuse: NIDA-Supported Research Studies Findings below are based on the initial followup sample of 84 subjects in the methamphetamine group and 92 subjects in the comparison group. MA use was higher in the first trimester (3 days a week) than in the second or third trimesters (2 days a week). Maternal use of alcohol, marijuana, and tobacco was higher in the MA group than in the comparison group (e.g., 79 percent of the MA mothers used tobacco compared with 26 percent of the comparison group). Most mothers in the MA group had more than one prenatal care visit (89 percent), while almost all (99 percent) in the comparison group had more than one visit. However, the number of visits was somewhat lower in the MA group (11 vs. 14 in the comparison group), and the first prenatal visit took place later in the pregnancy in the exposed group (exposed 15 weeks vs. comparison 9 weeks gestational age). At hospital discharge, 26 percent of the MA infants were not placed with their biological mothers, compared with 2 percent of the nonexposed infants. Child protection service (CPS) referrals were also higher (51 vs. 6 percent), as was CPS supervision at discharge (48 vs. 3 percent). On the SASSI, 74 percent of mothers in the MA group had a substance use disorder, compared with 11 percent in the comparison group. This effect remained after adjustment for covariates. Among infants, NNNS arousal scores were significantly lower and stress abstinence scores (with covariates) were higher in MA-exposed infants. The amount of MA use during the first and third trimester was related to more stress/abstinence signs; MA use during the third trimester was also related to a poorer quality of movement. There were dose response relationships between the amount of MA metabolite in the infant’s meconium and quality of movement, stress/abstinence signs, and regulation scores. Acoustic cry analysis showed that with covariates, more MA- exposed infants cried to the first stimulus, they had more dysphonation (turbulence), changes in voice pitch, variability in amplitude (loudness), and changes in voicing patterns than infants in the comparison group. There were no differences in maternal or newborn infant medical factors between the two groups. CONCLUSIONS According to the 1999 National Survey on Drug Use and Health, MA was the only substance with the same percentage of use by pregnant and non-pregnant women. In the 2002 Treatment Episode Data Set, it was found that 21 percent of those pregnant reported use of MA, in contrast to 13 percent of the nonpregnant women. Few studies have been conducted on the in utero effects of MA. These studies do suggest birth abnormalities (e.g., placental abruption, premature delivery, fetal growth retardation) and later learning disabilities, aggressive behavior, and increased rates of attention deficit disorder. However, these findings on humans have been based on small sample sizes and lack of controls for confounding variables (including use of other drugs), lack of a control group, and examiners not being blinded to exposure status. The IDEAL study has been undertaken to provide greater knowledge of the effects of MA use during pregnancy on infants. The preliminary findings reported here found an increase in SGA, neurobehavioral and cry deficits in MAexposed infants. It is possible that this is “déjà vu,” reminiscent of the effects of cocaine use on human development. The findings point to the following needs: • There is a need for well-designed studies to determine the effects of MA on child outcome. • There is a need for caution in not over interpreting findings that can lead to unwarranted stigmatizing of drug-exposed infants and their families. • There is a need for effective intervention programs that meet the special needs of female MA users and their children to reduce potential MArelated deficits. REFERENCES Arria, A.; Derauf, C.; LaGasse, L.; Grant, P.; Shah, R.; Smith, L.; Haning W.; Huestis, M.; Strauss, A.; DellaGrotta, S.; Liu, J.; and Lester, B. Methamphetamine and other substance use during pregnancy: Preliminary estimates from the Infant Development, Environment, and Lifestyle (IDEAL) Study. Maternal and Child Health Journal (submitted for publication). Arria, A.M.; Derauf, C.; LaGasse, L.; Grant, P.; Shah, R.; Smith, L.; Haning, W.; Huestis, M.; Strauss, A.; DellaGrotta, S.; Liu, J.; and Lester, B. Alcohol, tobacco and illicit drug use during pregnancy: Preliminary results from the Infant Development, Environment, and Lifestyle Study (IDEAL). Pediatric Research 55, No. 4. Part 2, 168A (2004). Derauf, C.; LaGasse, L.; Grant, P.; Shah, R.; Smith, L.; Arria, A.; Huestis, M.; Haning, W.; Strauss, A.; DellaGrotta, S.; Liu, J.; and Lester, B. Demographic and psychosocial characteristics of mothers who used methamphetamine during pregnancy: Preliminary results from the Infant Development, Environment, and Lifestyle Study Proceedings of the Community Epidemiology Work Group, Vol. II, January 2005 321
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NATIONAL INSTITUTE ON DRUG ABUSE EP
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Foreword This publication includes
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EPIDEMIOLOGIC TRENDS IN DRUG ABUSE
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2 EPIDEMIOLOGIC TRENDS IN DRUG ABUS
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Epidemiology of Drug Abuse: CEWG Ar
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• The city of Atlanta has become
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In the first 6 months of 2004, trea
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eports (exhibit 2), while African-A
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population) than in 2002 (17.2 per
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16 EPIDEMIOLOGIC TRENDS IN DRUG ABU
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data from the Drug Abuse Warning Ne
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than age 18, compared to 4 percent
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More often than not, marijuana use
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Solomon, L.; Flynn, C.; Muck, K.; e
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• Logan International Airport and
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In 2002, heroin/morphine was indica
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The FY 2004 racial distribution for
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• Emergency department (ED) drug
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monly mentioned secondary drug amon
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Between 2001 and 2003, the Illinois
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In the NIHU Study, 20 percent of pa
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Ecstasy remained available in most
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66 and analyzed by the Division of
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ounce in the Denver metropolitan ar
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18 at the time of admission to trea
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Injecting had been the most common
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alcohol; 651 involved alcohol-in-co
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The economy in Hawai'i, after a dec
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Methamphetamine remains the leading
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methamphetamine, representing 76.5
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Of interest in this chart is the ag
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98 weighted DAWN data released by S
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A total of 5,425 cocaine arrests wa
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data, however, rising from 1.5 perc
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According to NDIC, California and M
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and 15 items were identified as pse
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most frequently reported secondary
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esidents are living with advanced H
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112 EPIDEMIOLOGIC TRENDS IN DRUG AB
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(DAWN) that monitors emergency depa
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Beginning in 2003, SAMHSA’s natio
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65 percent were older than 34. The
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the 1,198 drug abuse ED reports in
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“Crystal” or smokeable methamph
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tion was injection (62.9 percent),
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included reports of ED cases involv
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From November 10 to 16, 2004, 18 me
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NFLIS between October 2003 and Sept
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from 12.2 percent in the first half
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156 2003. Anecdotal information on
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Brownsville, and El Paso. African-A
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ground economy, it was estimated th
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According to street interviews, mos
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that crack sells for about $28,000-
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Benloton, X-man, 911, Lean Back, Se
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DAWN ME mentions for marijuana-invo
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ecstasy. MDMA ED mentions may be st
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the deaths, while Whites constitute
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2000 reported that the average hero
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for this drug, making olanzapine th
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ADHS/DBHS reported that more than o
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Marijuana is widely available in Ar
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212 2004. Data from 2000-2002 DAWN
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purity dropped to 14.4 percent in 2
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No recent GHB incidents or deaths w
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correspond to decreases in total ad
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228 reports in drug-related visits;
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Marijuana Arrests for marijuana-rel
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positivity. UHS staff believe, on t
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236 are not estimates for the repor
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were evident. Excluding missing dat
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The characteristics of other opiate
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June 2004 (exhibit 6c). A minority
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Deaths involving depressants were a
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imipramine) are an older class of m
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The term “lag” refers to the pe
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costs $1,200-$1,500, compared with
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ties. In the DFW area, Mexican mari
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The 2004 secondary school survey re
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Page 296 and 297: York and Miami (Pach et al. 2002).
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Page 341 and 342: Janie B. Dargan, M.S.W. Policy Anal
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