Maternal cocaine use and caregiving status: Group differences in caregiver and infant risk variables

doi:10.1016/j.addbeh.2006.05.013

Addictive Behaviors

Volume 32, Issue 3, March 2007, Pages 465-476

https://doi.org/10.1016/j.addbeh.2006.05.013 Get rights and content

Abstract

This study examined differences between cocaine and non-cocaine-using mothers, and between parental and non-parental caregivers of cocaine-exposed infants on caregiver childhood trauma, psychiatric symptoms, demographic, and perinatal risks. Participants included 115 cocaine and 105 non-cocaine mother–infant dyads recruited at delivery. Approximately 19% of cocaine mothers lost custody of their infants by 1 month of infant age compared to 0.02% of non-cocaine mothers. Mothers who used cocaine during pregnancy had higher demographic and obstetric risks. Their infants had higher perinatal risks. Birth mothers who retained custody of their infants had higher demographic risks and perinatal risks, higher childhood trauma, and higher psychiatric symptoms compared to birth mothers who did not use cocaine and non-parental caregivers of cocaine-exposed infants. Results highlight the importance of addressing childhood trauma issues and current psychiatric symptoms in substance abuse treatment with women who engaged in substance use during pregnancy.

Section snippets

Participants

Participants consisted of 220 mother–infant dyads (115 cocaine-exposed and 105 non-cocaine-exposed) recruited into an ongoing longitudinal study of maternal substance use and child development. By 4–8 weeks of infant age, 22 infants (19.1% of those exposed to cocaine) had been removed from parental care. Approximately 72% of these infants were in non-kin care, with the remainder being cared for by a grandmother or maternal aunt. Only 1 infant in the non-cocaine group was placed in non-parental

Demographics and infant growth outcomes

Results from MANOVA with the demographic variables as the dependent measures and group status (non-cocaine, cocaine parental care, cocaine non-parental care) yielded a significant multivariate effect of group status, F(10,428.67) = 5.63, p < .001. Results from univariate analyses followed by simple contrasts indicated that biological mothers in the control group were younger and had lower parity compared to biological mothers in the cocaine group who did not retain custody of their children. Both

Discussion

The major purpose of this study was to examine potential differences in maternal and infant characteristics between cocaine and non-cocaine-using mothers, and within the cocaine group, between infants in parental and non-parental care and caregivers of these infants As expected, cocaine-exposed infants were more likely to be cared for by a primary caregiver other than their biological mothers. Although there is some variability in the definition of a primary caregiver (see Bandstra et al., 2002

Acknowledgements

The authors thank parents and infants who participated in this study and the research staff who were responsible for conducting numerous assessments with these families. Special thanks to Drs. Claire Coles and Phillip S. Zeskind for their collaboration on this study, to Drs. Amol Lele and Luther Robinson for collaboration on data collection at Women of Children's Hospital of Buffalo, and to Dr. Michael Ray for his collaboration on data collection at Sisters of Charity Hospital of Buffalo. This

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In addition, prenatal substance use is a marker of continued or increased use in the postnatal period (e.g., Shisler, Homish, Molnar, & Eiden, 2016), and continued substance use may pose significant risks for children's environments (e.g., Johnson et al., 2002). Similarly, there is a well-established link between substance use and maternal psychological distress as well as antisocial behavior (Eiden, Foote, & Schuetze, 2007; Prevatt, Desmarais, & Janssen, 2017), and between maternal psychological distress and child aggression (Connell & Goodman, 2002; Vera, Granero, & Ezpeleta, 2012). Children whose parents use substances are more likely to experience caregiving instability, such as short-and long-term separation from primary caregiver(s), custody changes, and disrupted feeding and sleeping routines (Adam, 2004; Platzman, Coles, Lynch, & Bard, 2001); caregiving instability is related to child maladjustment (e.g., Howard, Martin, Berlin, & Brooks-Gunn, 2011).
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Children experiencing prenatal substance exposure also often live in contexts that are at high risk for violence (Bada et al., 2011; Conners-Burrow, Johnson, & Whiteside-Mansell, 2009). In addition to these risks associated with the broader caregiving context, substance-using mothers experience higher psychiatric symptoms, and these have significant implications for developmental outcomes related to self-regulation (Eiden, Foote, & Schuetze, 2007). These aspects of environmental risks often co-occur (Rutter, 1987; Seifer, 1995).
A conceptual model of the association between prenatal cocaine exposure (PCE) and child self-regulation via maternal harshness and language development was examined. Specifically, the model tested whether PCE was associated with self-regulation either directly or indirectly via high maternal harshness and poor language development. The role of child sex, autonomic reactivity, and cumulative environmental risk as potential moderators was also explored. The sample was 216 mother–child dyads recruited at birth and assessed at 2, 7, 13, 24, 36, and 48 months of child ages. Participating mothers were primarily African American (72%). Results indicated a significant indirect association between PCE and child effortful control at 36 months via higher maternal harshness. Autonomic reactivity moderated the association between maternal harshness and self-regulation such that among children with poor autonomic reactivity, high maternal harshness was associated with lower conscience at 3 years. Child sex and environmental risk did not moderate the association between PCE and self-regulation. Thus, the quality of caregiving experience played a significant role in the development of self-regulation among PCE children, especially those at higher autonomic risk. In particular, PCE children who also exhibit poor autonomic reactivity may be particularly susceptible to environmental influences such as parenting.
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This cumulative environmental risk could be conceptualized as a mediator or intervening variable between the association between prenatal CE and internalizing behavior problems or alternatively as moderating the association between CE and internalizing behavior problems. With respect to mediation, the literature on maternal substance use indicates that these women are at particularly high risk for experiencing greater psychological distress (Eiden et al., 2007) and violent encounters due to vulnerability to victimization (Eiden et al., 1999), unstable relationships (Lynch and Cicchetti, 1998), and residence in high-risk neighborhoods (Osofsky et al., 1993). Child exposure to violence is subsequently associated with higher risk for internalizing behavior problems across multiple studies (Huang et al., 2010; Oravecz et al., 2011).
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Maternal cocaine use and caregiving status: Group differences in caregiver and infant risk variables

Abstract

Section snippets

Participants

Demographics and infant growth outcomes

Discussion

Acknowledgements

Neurotoxicology and Teratology

Child Abuse and Neglect

Neurotoxicology and Teratology

Neurotoxicology and Teratology

Neurotoxicology and Teratology

Child Abuse and Neglect

Journal of Substance Abuse

Neurotoxicology and Teratology

Infant Behavior & Development

Dose–response effect of cocaine on newborn head circumference

Pediatrics

Hair analysis for drugs of abuse

Journal of Forensic Sciences

The determinants of parenting: A process model

Child Development

Characteristics of pregnant substance abusers in two cities in the northeast

American Journal of Drug and Alcohol Abuse

Programmed therapeutic messages as a smoking treatment adjunct: Reducing the impact of negative affect

Health Psychology

Psychological assessment of adult posttraumatic states

Maternal drug use during pregnancy: Are preterm and full-term infants affected differently?

Developmental Psychology

Prenatal cocaine exposure: A comparison of 2-year-old children in parental and nonparental care

Child Development

The aggression questionnaire

Journal of Personality and Social Psychology

The Brief Symptom Inventory (BSI) administration, scoring, and procedures manual

Symptom Checklist-90-R (SCL-90-R) administration, scoring and procedures manual

Maternal cocaine use and infant behavior

Infancy