A collaborative research effort led by Sarah Maylott, PhD of Duke University, suggests that prenatal exposure to substances may increase a child’s risk for displaying problem behaviors in middle childhood. Specifically, children exposed to prenatal tobacco and alcohol were more likely to display rule-breaking or aggressive behaviors, while children exposed to illegal drugs, such as cocaine, methamphetamine, or heroin, were more likely to have higher rates of anxiety, depression, or withdrawn behaviors. However, not all children exposed to substances had behavioral problems, suggesting that some children may be more resilient than others.
This research, titled “Latent Class Analysis of Prenatal Substance Exposure and Child Behavioral Outcomes” is published in the Journal of Pediatrics.
The results outlined in Dr. Maylott’s work are particularly important, as approximately 1 in 5 women in the United States report use of legal or illegal substances while pregnant, varying from tobacco and alcohol to psychoactive drugs, such as opioids and cocaine. Previous studies have investigated how prenatal exposure to multiple substances may affect the health of young children, but less is understood about how polysubstance exposures may affect the neurodevelopment of older children.
Leveraging data from approximately 2,000 women from 10 ECHO cohorts across the country from 2000-2020, the research team used a statistical analysis technique to group women based on the types of substances used during pregnancy and compared these groups based on their child’s behaviors. On average, pregnant women were 28 years old when they gave birth, and child behaviors were assessed between ages 6 to 11 using the Child Behavior Checklist. The team hypothesized that children with prenatal polysubstance exposure would have more instances of problem behavior in middle childhood than those children with little to no prenatal substance exposure.
“Our work shows that it could be possible to identify children with certain behavioral challenges based on their mothers’ prenatal substance use profiles,” said Dr. Maylott. “With further research, clinicians and researchers may be able to use these results to identify and support children at higher risk for behavior problems.”
Subsequent large-scale studies are needed that look at how the quantity and timing of substance use during pregnancy affect children’s risk for behavioral problems and how the home environment may contribute to that risk. Researchers also need to find factors that may lead to resilient outcomes for children with prenatal substance exposure.
In a study investigating how per- and polyfluoroalkyl substances (PFAS) exposures affected pregnant mothers and their babies, ECHO researchers Amy Padula, PhD, MSc, and Tracey Woodruff, PhD, MPH, from the University of California, San Francisco found that higher levels of prenatal exposure to PFAS are associated with lower birthweights. The PFAS were detected in all participating mothers, suggesting some level of PFAS exposure from the environment. 
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