Prenatal tobacco exposure is related to neurobehavioral modifications in infants of adolescent mothers

INTRODUCTION: Prenatal tobacco exposure interferes with neonatal outcomes. OBJECTIVE: To determine the neonatal neurobehavioral effects of in utero tobacco exposure. METHODS: This prospective cross-sectional study included healthy, term, with birth weight appropriate for gestacional age neonates without exposure to alcohol, drugs, or infections, born to adolescent mothers without psychiatric disorders or post-traumatic stress. Infants were classified according to in utero tobacco exposure, as identified by the Composite International Diagnostic Interview administered to mothers. Neurobehavior was assessed by the Neonatal Intensive Care Unit Network Neurobehavioral Scale. Both tools were administered between 24 and 72 hours after birth. Neurobehavioral outcomes were compared between exposed and nonexposed infants by ANOVA. The associations between neurobehavioral scores and number of cigarettes smoked were studied by linear correlation. RESULTS: During the study, 928 newborns of adolescent mothers were born, and 388 were included in the study. Of these, 23 were exposed to tobacco, and 365 neonates were not exposed. There were no differences between the groups in gestational age, birth weight, post-natal age at the exam, or time between last feeding and exam. Exposed neonates showed higher scores on arousal (p = 0.004), excitability (p = 0.003), and stress/abstinence signals (p = 0.019) and a lower score on regulation (p = 0.025). After adjusting for the type of anesthesia, mode of delivery, gender, age at neurologic exam, exam duration and time between last feeding and exam, differences in arousal and excitability remained significant. The mean number of cigarettes consumed daily was positively correlated with lethargy (p = 0.013) and inversely with attention (p = 0.043). CONCLUSIONS: Neonates exposed in utero to tobacco showed worse neurobehavioral performance between 24 and 48 hours of life

Depression during gestation in adolescent mothers interferes with neonatal neurobehavior

Objective: To compare the neurobehavior of neonates born to adolescent mothers with and without depression during gestation. Methods: This prospective cross-sectional study included healthy term neonates born to adolescent mothers with untreated depression during gestation, without exposure to legal or illicit drugs, and compared them with infants born to adolescent mothers without psychiatric disorders. Maternal psychiatric diagnoses were assessed by the Composite International Diagnostic Interview (CIDI 2.1) and neonatal neurobehavior by the Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS) at 24 to 72 hours of life. Neurobehavioral outcomes were analyzed by ANOVA adjusted for confounders. Results: 37 infants born to mothers with depression during gestation were compared to 332 infants born to mothers without psychiatric disorders. Infants of mothers with depression had smaller head circumferences. Significant interactions of maternal depression and male gender, gestational age > 40 weeks, regional anesthesia during delivery, vaginal delivery, and infant head circumference ≥ 34 cm were found. Worse performance was noted in the following neonatal neurobehavioral parameters: arousal, excitability, lethargy, hypotonicity, and signs of stress and abstinence. Conclusion: Infants born to adolescent mothers with depression exhibit some behavioral changes in the first days of life. These changes are associated with infant sex, gestational age, type of anesthesia, mode of delivery, and head circumference.Universidade Federal de São Paulo (UNIFESP) - Escola Paulista de Medicina (UNIFESP-EPM) Department of Pediatrics Division of Neonatal MedicineUNIFESP and Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) National Science and Technology Institute for Policies on Alcohol and Drugs (INPAD)UNIFESP-EPM Research Unit on Alcohol and Other DrugsUNIFESP-EPM Department of PsychiatryUNIFESP, - Escola Paulista de Medicina (UNIFESP-EPM) Department of Pediatrics Division of Neonatal MedicineUNIFESP, and Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) National Science and Technology Institute for Policies on Alcohol and Drugs (INPAD)UNIFESP, EPM Research Unit on Alcohol and Other DrugsUNIFESP, EPM Department of PsychiatrySciEL

Neurobehavior of Late Preterm Infants of Adolescent Mothers

Background: Late preterm infants have higher morbidity in the neonatal period and difficulties at school age. There are few data about neonatal neurobehavior performance that may interfere in their development. Objectives: To compare the neurobehavior of healthy late preterm and full-term neonates born to adolescent mothers. Methods: This prospective cross-sectional study included infants with a gestational age of 40(0/7)-40(6/7) weeks (full term) and 34(0/7)-36(6/7) weeks (late preterm) aged 24-72 h without exposure to alcohol, tobacco, drugs or infections and free of clinical problems during the first 3 days of life. Infants were assessed with the Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS). Outcomes were analyzed by ANOVA. Results: From July 2001 to November 2002, 3,685 infants were born, 928 of adolescent mothers. After exclusion, 36 late preterm and 96 term infants were enrolled. Adjusted for anesthesia type, delivery mode, gender, age at NNNS examination, time between last feeding and examination, and examination duration, late preterm, compared to term neonates, presented lower scores for attention (p = 0.041), arousal (p = 0.011), regulation (p < 0.001), quality of movements (p < 0.001) and higher scores for non-optimal reflexes (p < 0.001) and hypotonicity (p = 0.029). Conclusion: Late preterm infants of adolescent mothers have a more immature neurobehavioral performance at 24-72 h of life in multiple areas compared to term neonates suggesting a need for careful follow-up. Copyright (C) 2010 S. Karger AG, BaselFundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo, Div Neonatal Med, Dept Pediat, BR-01410020 São Paulo, BrazilUniversidade Federal de São Paulo, Res Unit Alcohol & Drugs, BR-01410020 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychiat, BR-01410020 São Paulo, BrazilUniversidade Federal de São Paulo, Div Neonatal Med, Dept Pediat, BR-01410020 São Paulo, BrazilUniversidade Federal de São Paulo, Res Unit Alcohol & Drugs, BR-01410020 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychiat, BR-01410020 São Paulo, BrazilFAPESP: 2000/10293-5Web of Scienc

Brief report: Prevalence of psychiatric disorders in pregnant teenagers

Purpose: To evaluate the prevalence of ICD-10 psychiatric disorders in a population of pregnant teenage women from a Brazilian public hospital.Method: 1000 pregnant teenage women were evaluated using the Composite International Diagnostic Interview, a Structured interview which establishes diagnoses according to the International Classification of Diseases.Results: 325 of the 1000 patients were found to have at least one psychiatric disorder; 33.2% of them had a second psychiatric diagnosis. the most prevalent, disorders were depression (12.9%), post-traumatic stress disorder (10%), and tobacco dependence/harmful use (10.30%). the most prevalent co-morbidity was ICD-10 Affective Disorders versus Neurotic, Stress-related, and Somatoform Disorders. Substance-related disorders are significantly correlated with all of the ICD-10 psychiatric diagnoses but Psychotic Disorders.Conclusion: the prevalence of psychiatric disorders in this Population is high, and one third of them had co-morbidities, a condition usually associated with a more serious course of illness. This finding has important implications for clinical management and prognosis, and demands preventive public policies. (C) 2008 Published by Elsevier Ltd on behalf of the Association for Professionals in Services for Adolescents.Universidade Federal de São Paulo, Dept Psychiat, Alcohol & Drug Res Unit Uniad, BR-04023061 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Pediat, BR-04023061 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychiat, Alcohol & Drug Res Unit Uniad, BR-04023061 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Pediat, BR-04023061 São Paulo, BrazilWeb of Scienc

Neurocomportamento de recém-nascidos a termo, pequenos para a idade gestacional, filhos de mães adolescentes Neurobehavior of full-term small for gestational age newborn infants of adolescent mothers

OBJETIVO: Comparar o neurocomportamento de recém-nascidos a termo pequenos (PIG) e adequados (AIG) para a idade gestacional, filhos de mães adolescentes. MÉTODOS: Estudo transversal prospectivo de nascidos a termo AIG e PIG, com 24-72 horas de vida, sem afecções do sistema nervoso central. Os neonatos foram avaliados por meio da Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS) para: habituação, atenção, despertar, controle, manobras para a orientação, qualidade dos movimentos, excitabilidade, letargia, reflexos não ótimos, assimetria, hipertonia, hipotonia e sinais de estresse e abstinência. A comparação dos grupos AIG e PIG foi feita por análise de variância e teste do qui-quadrado. Aplicou-se a regressão multivariada para analisar os fatores associados ao escore de cada variável do NNNS. RESULTADOS: Dos 3.685 nascidos no local do estudo, 928 (25%) eram de mães adolescentes. Desses, 477 satisfizeram os critérios de inclusão, sendo 419 (88%) AIG e 58 (12%) PIG. A análise univariada não mostrou diferença em nenhuma das variáveis da NNNS entre os PIG e os AIG. Na análise multivariada, os PIG nascidos de parto vaginal apresentaram menor escore na variável qualidade de movimentos do que os nascidos por cesárea. Os PIG nascidos com anestesia local ou sem anestesia apresentaram maior escore na variável excitabilidade do que os nascidos sob anestesia loco-regional. Os PIG femininos tiveram menor escore na variável sinais de estresse/abstinência que os masculinos. CONCLUSÃO: Os recém-nascidos PIG de mães adolescentes mostraram menor qualidade de movimento, mais excitabilidade e mais sinais de estresse, em associação com o sexo do neonato e com variáveis relacionadas ao parto.<br>OBJECTIVE: To compare the neurobehavior of small (SGA) and adequate (AGA) for gestational age full-term neonates born to adolescent mothers. METHODS: This prospective cross-sectional study included full-term newborn infants aged 24-72 hours, free from central nervous system malformations and born to adolescent mothers at a single center in Brazil. Infants were assessed with the Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS) for: habituation, attention, arousal, regulation, handling, quality of movement, excitability, lethargy, nonoptimal reflexes, asymmetry, hypertonia, hypotonia, and stress/abstinence signals. The chi-square test and analysis of variance were used to compare SGA and AGA infants. Multivariate regression was used to analyze factors associated with the score of each NNNS variable. RESULTS: Of 3,685 infants born in the study hospital, 928 (25%) had adolescent mothers. Of these, 477 infants met the inclusion criteria: 419 (88%) were AGA and 58 (12%) were SGA. Univariate analysis did not show any differences between AGA and SGA neonates in terms of NNNS variables. Multivariate analysis showed that SGA neonates born by vaginal delivery had lower scores for quality of movements than those born by caesarean section. The SGA neonates born with local or without anesthesia had higher scores for excitability than those born with spinal anesthesia. Additionally, female SGA neonates had lower scores for stress/abstinence signals than males. CONCLUSION: SGA neonates born to adolescent mothers showed poorer quality of movements, more excitability and more signals of stress in association with sex of infant and variables related to delivery

Underreporting of use of cocaine and marijuana during the third trimester of gestation among pregnant adolescents

Objective: the aim of this study is to check the validity of the self-report of drug use by pregnant adolescents, by comparing their responses to a structured interview about their use of cocaine and marijuana during the pregnancy with an analysis of their hair.Results: Hair analysis detected the use of cocaine and/or marijuana in the third trimester of pregnancy in 60 (6%) patients.40 (4%) patients used only marijuana, 17 (1.7%) used only cocaine. and 3 (0.3%) used both drugs. None of the patients had reported the use of these substances in their interviews with healthcare professionals.Conclusion: Although the prevalence of the use of drugs during pregnancy is significant despite consistent evidence about the compromise of the neurobehavioral development of the newborns that are exposed to drugs during the prenatal period, drug use is frequently not reported. Therefore, more sensitive methods of detection should be used so that appropriate medical and psychosocial interventions can be implemented for the mothers as well as for their children. (C) 2009 Elsevier B.V. All rights reserved.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo, Dept Psychiat, Alcohol & Drugs Res Unit Uniad, BR-04023061 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Pediat, BR-04038001 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychiat, Alcohol & Drugs Res Unit Uniad, BR-04023061 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Pediat, BR-04038001 São Paulo, BrazilFAPESP: 00/10.293-5Web of Scienc

Underdetection of Psychiatric Disorders During Prenatal Care: A Survey of Adolescents in Sao Paulo, Brazil

Purpose: This study estimates the prevalence of common mental disorders and the proportion and potential determinants of detection among adolescents attending prenatal care.Methods: We recruited 930 consecutive adolescents admitted for obstetric care, of which 457 participants had attended the hospital's prenatal care unit. Common mental disorders were assessed using the Composite International Diagnostic Interview (version 2.1). A detailed review of prenatal care records was used to identify detection of psychiatric disorders by prenatal healthcare professionals.Results: A total of 103 adolescents (22.5%) had some mental disorder but only one-fifth of them had had their psychiatric disorder detected during prenatal care. the most frequent diagnosis using the Composite International Diagnostic Interview (version 2.1) was depression (13.5% or 62), but only 21% had been detected. Alcohol and drug dependence were the least common mental disorders (2.4%), but they were the most commonly detected (45.5%). Physical chronic condition increased the likelihood of detecting psychiatric disorder.Conclusion: Mental health is not yet recognized as an integral component of practice in prenatal care. Given the potential effect of antenatal psychiatric morbidity on maternal and child outcomes, especially among adolescents, practice needs to be changed and prenatal care professionals trained in the recognition and basic treatment of common mental disorders. (C) 2012 Society for Adolescent Health and Medicine. All rights reserved.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo, Dept Psychiat, BR-05086010 São Paulo, BrazilHosp Mario de Moraes Altenfelder, Sch Matern & Publ, Dept Psychol, São Paulo, BrazilUniv Fed Rio Grande do Sul, Sch Med, Grad Studies Program Epidemiol, BR-90046900 Porto Alegre, RS, BrazilKings Coll London, Inst Psychiat Hlth Serv & Populat Res, London WC2R 2LS, EnglandUniversidade Federal de São Paulo, Dept Pediat, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Obstet, São Paulo, BrazilHosp Dr Mario Moraes Altenfelder, Sch Matern & Publ, Dept Obstet, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychiat, BR-05086010 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Pediat, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Obstet, São Paulo, BrazilFAPESP: 00/10293-5Web of Scienc