Elsevier

The Journal of Pediatrics

Volume 157, Issue 2, August 2010, Pages 288-295.e1
The Journal of Pediatrics

Original Article
Prenatal Cocaine Exposure Related to Cortisol Stress Reactivity in 11-Year-Old Children

https://doi.org/10.1016/j.jpeds.2010.02.039Get rights and content

Objective

Determine the association between prenatal cocaine exposure and postnatal environmental adversity on salivary cortisol stress reactivity in school-aged children.

Study design

Subjects included 743 11-year-old children (n = 320 cocaine-exposed; 423 comparison) followed since birth in a longitudinal prospective multisite study. Saliva samples were collected to measure cortisol at baseline and after a standardized procedure to induce psychological stress. Children were divided into those who showed an increase in cortisol from baseline to post stress and those who showed a decrease or blunted cortisol response. Covariates measured included site, birthweight, maternal pre and postnatal use of alcohol, tobacco or marijuana, social class, changes in caretakers, maternal depression and psychological symptoms, domestic and community violence, child abuse, and quality of the home.

Results

With adjustment for confounding variables, cortisol reactivity to stress was more likely to be blunted in children with prenatal cocaine exposure. Children exposed to cocaine and who experienced domestic violence showed the strongest effects.

Conclusions

The combination of prenatal cocaine exposure and an adverse postnatal environment could downregulate the hypothalamic-pituitary-adrenal axis resulting in the blunted cortisol response to stress possibly increasing risk for later psychopathology and adult disease.

Section snippets

Methods

Enrollment and exclusion criteria for the MLS have been described in detail.21, 22 The study had approval from the institutional review board at each site. Each site also had a certificate of confidentiality from the National Institute on Drug Abuse. Informed consent was obtained from all participants. Infants in the longitudinal study were selected to be in the exposed group (maternal report of cocaine or opiate use during pregnancy or gas chromatography–mass spectrometry confirmation of

Results

Of the 1388 children enrolled at the one month visit, 115 were excluded because they were exposed to opiates, 388 did not participate in the 11-year visit. Of the 885 attending the 11-year visit, 115 did not participate in the cortisol reactivity task due to chronic disability (n = 57), child or parent unable or refusal (n = 14), or technical problems or resource limitations (n = 44). Of the 770 who participated in the cortisol reactivity task; 22 had an incomplete procedure or saliva

Discussion

We report cortisol stress reactivity in school-aged children with prenatal cocaine exposure. We found that cortisol reactivity to stress was more likely to be blunted in children with prenatal cocaine exposure. These effects were also related to domestic violence but they were independent of other covariates including other prenatal and postnatal drug exposures. Thus, more children with prenatal cocaine exposure and exposure to domestic violence showed the blunted cortisol response than

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  • Cited by (0)

    Supported by the National Institute of Child Health and Human Development (NICHD) Neonatal Research Network and an interinstitute agreement with the National Institute on Drug Abuse (NIDA) through cooperative agreements: U10-DA-024117-01, U10-HD-21385 (S.S.), U10-DA-024128-06, U10-HD-2786 (H.B.), U10-DA-024119-01, U10-HD-27904 (B.L.), and U10-DA-024118-01, U10-HD-21397 (C.B.); and NICHD contract N01-HD-2-3159 (B.L.). The authors declare no conflicts of interest.

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