General Information - Prenatal Meth Exposure
Prenatal Methamphetamine Exposure
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Because methamphetamine is such a potent neurotoxin the adult userís brain, there are serious concerns about the impact of a motherís methamphetamine use on her unborn child. Many of these children are being raised by relatives and adoptive parents who are concerned about the impact of prenatal methamphetamine exposure on their childís mental and emotional health. A realistic assessment of the challenges and needs of these children is essential to helping them realize their full potential.
Some methamphetamine affected children show no outward signs of a problem in early infancy, but as a group, they are more likely to be premature or under weight at birth. Methamphetamine affects the blood flow through the placenta restricting oxygen and nutrient delivery. Drug addicted mothers typically have poor nutrition which also affects their children with anemia or growth restriction. Children of IV drug users are more likely to have serious infectious diseases like hepatitis and AIDS. They may test positive for AIDS only because the mother was positive, and they may clear the antibodies acquired from their mothers by 1 year of age without having AIDS themselves.
The newborn infant exposed to methamphetamine may be acutely intoxicated if the mother has used recently before birth. Signs include a rapid heart rate and high blood pressure, irritability and rigidity, even seizures or a stroke. If the mother has not used methamphetamine immediately before birth, the child may be in withdrawal, with symptoms of lethargy, poor muscle tone and poor feeding. Concurrent use of heroin of alcohol can complicate the picture and drug testing the child may be necessary to determine what he has been exposed to.
The major concern for the child with prenatal exposure to methamphetamine is the effect it will have on mental and emotional development. Methamphetamine is a potent neurotoxin the adult and so would be expected to cause some developmental problems for exposed children. It is important to understand the exact nature of these problems so interventions can be planned and much of the damage reversed. Studies have shown that if effective intervention is not offered, drug exposed children are more likely to fail in school and have delinquency problems in adolescence.
The earliest studies on human response to fetal methamphetamine exposure were grim indeed. Dixon and Bejar at UCSD (1989) found that 35% of neonates exposed to cocaine and /or methamphetamine in utero had abnormalities in brain structure at birth, including intraventricular hemorrhage, necrotic echodensities and cavitary lesions. These lesions were thought to be due to the severe vaso-constrictive effects of methamphetamine. A significant number of stimulant exposed infants (10%) had ventricular dilation reflecting diffuse atrophy of cortical tissue.
But the human brain continues to develop over the first 21 years of life, and especially in the first three years of life. The developmental window that extends from birth to age three is a time of explosive growth in cognitive, emotional, verbal and social development. Given adequate interaction, stimulation and nutrition, the human brain increases in size by more than double. If the meth exposed child is sent home with responsible parents, much of the brain injury sustained before birth could be compensated for and its impact diminished. Early intervention in methamphetamine exposed children could be extremely important to the long term prognosis for human cognitive and social development.
And indeed that is what the studies demonstrate. When methamphetamine exposed children are studied at age eight to ten, the cavitary lesions and ventricular dilation are no longer seen (Smith 2001) . All of the children in this study had been exposed to methamphetamine with very low levels of exposure to other drugs of abuse, including alcohol. Children with developmental delay, impaired growth, seizure disorders or ADHD were excluded. Only those children who looked perfectly normal were studied. There are no scientific studies to indicate what percentage of methamphetamine exposed children have developmental delays, learning disabilities or ADHD.
In a follow-up study by the same group, again excluding children with developmental delays or ADHD, significant changes were seen in the deeper areas of the brain the have to do with information processing, memory, and hand eye coordination. These areas were 17-26% smaller than in unexposed children of the same age. These children also scored lower on measures of visual-motor integration (hand Ė eye coordination), attention, verbal memory and long term spatial memory. Again, these were children who had not been identified as having a developmental delay or ADHD by teachers or caregivers. These children looked perfectly normal and were in performing normally in school, but they were challenged by the effects of their prenatal methamphetamine exposure.
Long term follow-up of methamphetamine exposed children over a period of up to fifteen years shows the impact of these challenges. Children exposed to methamphetamine who received no special intervention and were not screened or treated for learning disabilities demonstrated increased aggressive behavior and poor adjustment at eight to ten years old (Billings 1994). The same children followed up to fifteen years of age (Cernerud 1996 and Eriksson 2000) showed higher rates of academic failure and poor social adjustment. These methamphetamine exposed children were three times more likely to be behind in school (15% were one year or more behind) and had lower grades than non-exposed peers.
These long term studies did not attempt to control for alcohol exposure. Indeed 81% of these children were also exposed to alcohol prenatally. Fetal Alcohol Syndrome has clearly been linked to significant neurobehavioral abnormalities including ADHD and mental retardation. Most of these children (80%) were also exposed to nicotine, which has been linked to abnormalities of the auditory association area. The majority (78%) of these children did not live with their birth mothers throughout childhood. Many were wards of the state and had moved from foster home to foster home, a condition that is strongly linked academic failure and delinquency.
Methamphetamine exposed children are vulnerable to the effects of their motherís drug use. If these fragile children are raised in a drug abusing or unstable home, if they are not cared for, fed well, interacted with, read to, and talked to by a caring parent, they will not do well. They are at high risk for academic and social failure, and at high risk of delinquency. Rapid brain development in the first three years of life requires consistent parenting during this crucial phase of development.
On the other hand, methamphetamine exposed children who are properly cared for have only a minimal degree of brain injury. Their learning disabilities are easily recognized and treated. With proper nurture and early childhood education, methamphetamine exposed children can have a normal life. But no school or agency can offer them the love and nurture they need. Methamphetamine exposed children have a special need for competent parenting by caring adults. The consequences of neglecting these children are profound.
Billings L et al 1994 The influence of environmental factors on behavioral problems in eight year old children exposed to amphetamine during fetal life. Child Abuse and Neglect 15:3-9
Cernarud L et al 1996 Amphetamine addiction during pregnancy: 14 year follow-up of growth and school performance. Acta Pediatr 85:204-8
Chang L et al 2004 Smaller subcortical volumes and cognitive deficits in children with prenatal methamphetamine exposure. Psychiatry Research Neuroimaging 132:95-106
Dixon SD, Bejar R 1989 Echoencephalographic findings in neonates associated with maternal cocaine and methamphetamine use: incidence and clinical correlates. J of Pediatrics 115:770-8
Erickson M 2000 Amphetamine abuse during pregnancy: Environmental factors and outcome after 14-15 years. Scan J Public Health 28:154-157.
Smith L M et al 2001 Brain proton magnetic resonance spectroscopy in children exposed to methamphetamine in utero. Neurology 57:255-60.
Smith L et al 2003 Effects of prenatal methamphetamine exposure on fetal growth and drug withdrawal symptoms in infants born at term. J Dev Behav Pediatr 24:17-23