Prenatal

产前
  • 文章类型: Journal Article
    Preeclampsia (PE), caused by multiple factors, is one of the most serious complications of pregnancy. Cadmium (Cd) is a heavy metal environmental pollutant, reproductive toxicant, and endocrine disruptor, which can increase the risk of PE. Cd toxicity due to occupational, diet, and environmental factors has worsened the risk. Studies showed elevated Cd concentration in maternal blood and placenta of PE women. However, the implicit association between Cd associated PE is still not highlighted. We systematically reviewed Cd-associated PE and its effect on pregnancy and birth outcomes. Based on \"Preferred reporting items for systematic reviews and meta-analyses (PRISMA)\" guidelines, eighty-six studies were identified by PubMed, Web of Science (WOS), and Scopus databases. Publications were included until October 2023 and articles screened based on our inclusion criteria. Our study identified that the exposure of controlled and uncontrolled Cd induces PE, which negatively affects pregnancy and birth outcomes. Given the serious nature of this finding, Cd is a potential adverse agent that impacts pregnancy and future neonatal health. Further comprehensive studies covering the whole trimesters of pregnancy and neonatal developments are warranted. Data on the molecular mechanisms behind Cd-induced PE is also essential for potential preventive, diagnostic, or therapeutic targets.
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  • 文章类型: Case Reports
    WDR44基因中的功能增益变体最近与X连锁的纤毛病相关的神经发育表型相关。这里,我们报道了一个WDR44功能缺失(LOF)变异,该变异在一个男性胎儿的基因组序列中被鉴定,该男性胎儿参与了通过基因组测序进行的产前遗传学诊断(PrenatalSEQ)多中心研究.表型与所描述的X连锁纤毛病一致,包括发育迟缓,小头畸形,先天性心脏缺陷,肾脏异常,隐睾,肌肉骨骼异常,颅面畸形,和渗出。这是WDR44LOF变体在患有产前表现的受影响个体中的首次报道,并支持LOF作为X连锁WDR44纤毛病相关表型的机制。
    Gain-of-function variants in the WDR44 gene have recently been associated with an X-linked ciliopathy-related neurodevelopmental phenotype. Here, we report on a WDR44 loss-of-function (LOF) variant identified in the genome sequence from a male fetus enrolled in the Prenatal Genetic Diagnosis by Genomic Sequencing (PrenatalSEQ) multicenter study. The phenotype is consistent with the described X-linked ciliopathy that includes developmental delay, microcephaly, congenital heart defects, kidney abnormalities, cryptorchidism, musculoskeletal abnormalities, craniofacial dysmorphism, and effusions. This is the first report of a WDR44 LOF variant in an affected individual with a prenatal presentation and supports LOF as a mechanism for the X-linked WDR44 ciliopathy-related phenotype.
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  • 文章类型: Case Reports
    MNS1(减数分裂特异性核结构蛋白1基因)编码一种与活动纤毛功能和精子鞭毛组装有关的结构蛋白。迄今为止,两种不同的纯合MNS1变异与常染色体隐性遗传内脏异位相关(MIM#618948)。在MNS1基因中鉴定出具有复合杂合变体的法国个体。通过GeneMatcher提出了一个协作电话来描述这种罕见综合征的新病例,导致另一个家庭的身份。第一位患者是一名女性,表现出完整的位置倒置和不寻常的症状,包括10颗恒牙的严重近视和牙齿发育不全。发现她在MNS1中携带复合杂合移码和无义变体。第二和第三名患者是在MNS1中具有纯合框内缺失变体和在GLDN中具有纯合错义变体的同胞胎儿。尸体解剖显示复杂的产前畸形综合征。我们在此添加超罕见MNS1相关疾病的新病例,并对所有已发表的个体进行综述。
    MNS1 (meiosis-specific nuclear structural protein-1 gene) encodes a structural protein implicated in motile ciliary function and sperm flagella assembly. To date, two different homozygous MNS1 variants have been associated with autosomal recessive visceral heterotaxy (MIM#618948). A French individual was identified with compound heterozygous variants in the MNS1 gene. A collaborative call was proposed via GeneMatcher to describe new cases with this rare syndrome, leading to the identification of another family. The first patient was a female presenting complete situs inversus and unusual symptoms, including severe myopia and dental agenesis of 10 permanent teeth. She was found to carry compound heterozygous frameshift and nonsense variants in MNS1. The second and third patients were sibling fetuses with homozygous in-frame deletion variants in MNS1 and homozygous missense variants in GLDN. Autopsies revealed a complex prenatal malformation syndrome. We add here new cases with the ultra-rare MNS1-related disorder and provide a review of all published individuals.
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  • 文章类型: Journal Article
    环境纳米塑料(NPl)颗粒和微塑料(MPl)颗粒污染问题日益严重,显着影响生态系统和生物健康。研究表明,NPl/MPl可以穿透胎盘屏障进入胎儿体内,导致跨代效应。这篇综述整合了现有的关于产前NPl/MPl暴露对哺乳动物后代的影响的文献,特别关注它对中枢神经系统的负面影响,肝脏,肠道健康,生殖功能,和骨骼肌。关于哺乳动物中的产前NPl/MPl的绝大多数先前研究使用聚苯乙烯材料。未来的研究应该探索其他产前NPl/MPl材料对后代的影响,以更好地反映人类环境的现实。还必须更深入地调查与产前NPl/MPl暴露于后代相关的潜在危害和潜在机制。这将有助于在未来制定适当的预防和治疗策略。
    The issue of environmental nanoplastic (NPl) particle and microplastic (MPl) particle pollution is becoming increasingly severe, significantly impacting ecosystems and biological health. Research shows that NPl/MPl can penetrate the placental barrier and enter the fetus, leading to transgenerational effects. This review integrates the existing literature on the effects of prenatal NPl/MPl exposure on mammalian offspring, focusing particularly on its negative impacts on the central nervous system, liver, intestinal health, reproductive function, and skeletal muscles. The vast majority of previous studies on prenatal NPl/MPl in mammals have used polystyrene material. Future research should explore the effects of other prenatal NPl/MPl materials on offspring to better reflect the realities of the human environment. It is also essential to investigate the potential harm and underlying mechanisms associated with prenatal NPl/MPl exposure to offspring in greater depth. This will aid in developing appropriate prevention and treatment strategies in the future.
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  • 文章类型: Journal Article
    这项研究检查了妊娠暴露(第6-21天)对内分泌干扰化学物质如双酚A(BPA)的性别特异性影响。邻苯二甲酸二乙基己酯(DEHP),或它们对大脑单胺水平的组合,在调节行为中起着重要作用。怀孕的Sprague-Dawley大鼠口服生理盐水,低剂量(5µg/kgBW/天)的BPA或DEHP,和它们的组合或单独的DEHP高剂量(7.5mg/kgBW/天)或在怀孕期间与BPA组合。对后代进行行为测试,并在成年后牺牲,并分析大脑的神经递质水平。在室旁核,BPA的雄性后代的多巴胺水平显着降低(p<0.01),DEHP,B+D(HD)组,这与他们的休克探针防御埋葬时间密切相关。所有脑区的神经递质变化在雌性后代中是显著的,DEHP(HD)女性受影响最大,其次是B+D组。BPA和/或DEHP(LD)在雄性后代中以区域特异性方式增加了单胺周转(p<0.05)。总的来说,产前暴露于BPA,DEHP,或者它们的组合改变了大脑特定区域的单胺水平,性别特异性,和剂量依赖性方式,这可能对他们的行为和神经内分泌影响有影响。
    This study examines the sex-specific effects of gestational exposure (days 6-21) to endocrine-disrupting chemicals such as bisphenol A (BPA), diethylhexyl phthalate (DEHP), or their combination on brain monoamine levels that play an important role in regulating behavior. Pregnant Sprague-Dawley rats were orally administered saline, low doses (5 µg/kg BW/day) of BPA or DEHP, and their combination or a high dose (7.5 mg/kg BW/day) of DEHP alone or in combination with BPA during pregnancy. The offspring were subjected to a behavioral test and sacrificed in adulthood, and the brains were analyzed for neurotransmitter levels. In the paraventricular nucleus, there was a marked reduction in dopamine levels (p < 0.01) in male offspring from the BPA, DEHP, and B + D (HD) groups, which correlated well with their shock probe defensive burying times. Neurotransmitter changes in all brain regions examined were significant in female offspring, with DEHP (HD) females being affected the most, followed by the B + D groups. BPA and/or DEHP (LD) increased monoamine turnover in a region-specific manner in male offspring (p < 0.05). Overall, prenatal exposure to BPA, DEHP, or their combination alters monoamine levels in a brain region-specific, sex-specific, and dose-dependent manner, which could have implications for their behavioral and neuroendocrine effects.
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  • 文章类型: Journal Article
    这项研究利用了早期生长和发育研究(N=561名收养儿童;57.2%的男性,55.3%白色),对出生时被收养的孩子的研究,检查遗传性(出生父母的心理病理学)和产前风险(产前产妇困扰和怀孕期间吸烟),婴儿消极情感,养父母过度反应和温暖是儿童外化症状的独立预测因素。当前的研究评估了是否:(1)婴儿负面情感和过度反应的父母教养是遗传和产前风险对外化症状的影响的候选介体,以及(2)父母的温暖削弱了遗传风险的影响,产前风险,消极情感,以及对外化症状的过度反应。遗传风险有主要影响,婴儿消极情感,以及对儿童外化症状的过度反应。这项研究没有发现对假设的调解和调节作用的支持,这表明针对父母的过度反应性而不是温暖会更有效地降低儿童外化症状的风险。
    This study utilized the Early Growth and Development Study (N = 561 adoptive children; 57.2% male, 55.3% White), a study of children adopted at birth, to examine heritable (birth parent psychopathology) and prenatal risk (prenatal maternal distress and smoking during pregnancy), infant negative affectivity, adoptive parent over-reactivity and warmth as independent predictors of childhood externalizing symptoms. The current study evaluated if: (1) infant negative affectivity and over-reactive parenting are candidate mediators for the effects of heritable and prenatal risk on externalizing symptoms and (2) parental warmth weakens the influence of heritable risk, prenatal risk, negative affectivity, and over-reactive parenting on externalizing symptoms. There were main effects of heritable risk, infant negative affectivity, and over-reactive parenting on child externalizing symptoms. The study found no support for the hypothesized mediation and moderation effects, suggesting that targeting parental over-reactivity rather than warmth would be more effective in reducing risk for childhood externalizing symptoms.
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  • 文章类型: Journal Article
    最近,在美国,自闭症谱系障碍(ASD)的诊断从150名儿童中的1名增加到每36名儿童中的1名,保证需要新的预防和治疗策略。广谱大麻二酚油,不含δ-9-四氢大麻酚,大麻的精神活性成分,可能是一个这样的治疗。它具有很高的安全性,经常被有焦虑症状的人用作补充和综合干预措施,压力,和炎症。使用ASD的神经发育大鼠模型(基于出生前和出生后的应激和特布他林暴露引起的神经炎症),我们试图通过在整个怀孕期间对水坝施用广谱大麻二酚油来防止男性后代发生ASD样行为(10mg/kg,i.p.,daily,胚胎天3-16)。为了评估后代的ASD样表型,我们使用了与三个核心ASD症状相关的三个行为测量指标:1)社交交流(独处时发声的时间);2)重复行为(大理石掩埋测试期间掩埋的大理石);和3)社交互动(在三室社交互动测试期间与新对象交互的时间).怀孕期间给予广谱大麻二酚油降低了所有三种ASD相关行为反应的得分,导致ASD样表型的整体显著预防。这些发现强调了广谱大麻二酚油作为预防与ASD样表型发展相关的应激源诱导后遗症的补充和综合方法的潜力。
    Recently, the diagnosis of autism spectrum disorder (ASD) has increased from 1 in 150 to every 1 in 36 children in the United States, warranting a need for novel prevention and therapeutic strategies. Broad-spectrum cannabidiol oil, free from delta-9-tetrahydrocannabinol, the psychoactive component of cannabis, may be one such therapeutic. It has a high safety profile and is frequently used as a complementary and integrative intervention by persons experiencing symptoms of anxiety, stress, and inflammation. Using a neurodevelopmental rat model of ASD (based on neuroinflammation induced by stress and terbutaline exposure during pre- and postnatal development), we sought to prevent the development of ASD-like behaviors in male offspring by administering broad-spectrum cannabidiol oil to dams throughout pregnancy (10 mg/kg, i.p., daily, embryonic days 3-16). To assess an ASD-like phenotype in the offspring, we used three behavioral measures relevant to three core ASD symptoms: 1) social communication (time spent vocalizing when alone); 2) repetitive behavior (marbles buried during a marble burying test); and 3) social interaction (time spent interacting with a novel conspecific during the three-chamber social interaction test). Broad-spectrum cannabidiol oil given during pregnancy decreased scores for all three ASD-related behavioral responses, resulting in an overall significant prevention of the ASD-like phenotype. These findings highlight the potential of broad-spectrum cannabidiol oil as a complementary and integrative approach for prevention of stressor-induced sequelae relevant to development of an ASD-like phenotype.
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  • 文章类型: Journal Article
    关于可接受性的系统审查,可行性,公平和资源利用是加拿大公共卫生署关于沙眼衣原体(CT)和淋病奈瑟菌(NG)产前筛查的最新建议的一部分.
    信息来源,包括MEDLINE®All,搜索Embase和CochraneCENTRAL(2003年1月至2021年1月)电子数据库,以获取评估可接受性的研究,可行性,≥12岁孕妇CT或NG筛查的公平性和资源使用。非随机研究的偏差风险评估工具用于质量评估,并准备了叙述性综合。
    在确定的1,386条记录中,9项观察性研究(约5,000名参与者)和3项经济评估符合纳入标准.总的来说,孕妇和医疗保健提供者接受筛查。大多数孕妇和伴侣支持对CT进行普遍检查。孕妇首选非侵入性取样方法。在某些人群中存在可行性(筛查的可及性)的不平等。研究表明,有针对性的筛查可能会错过病例。与不进行筛查相比,对所有孕妇进行CT筛查可以节省净成本。局限性包括没有确定有关孕妇伴侣之间产前筛查NG的可接受性的合格文献,以及一些风险人群增加的研究,这些研究限制了研究结果的普遍性,突出了未来研究的领域。
    产前检查CT和NG在孕妇和医疗保健提供者中通常是可以接受的。有证据表明,有针对性的筛查可能会错过病例。在更新PHAC关于CT和NG的产前筛查建议时,包括了这些发现。这项工作在埃德蒙顿举行的加拿大妇产科医师协会2024年度临床和科学会议上发表,艾伯塔省.
    UNASSIGNED: A systematic review on acceptability, feasibility, equity and resource use was conducted as part of updating recommendations from the Public Health Agency of Canada on prenatal screening for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG).
    UNASSIGNED: Information sources, including MEDLINE® All, Embase and Cochrane CENTRAL (January 2003-January 2021) electronic databases were searched for studies that assessed acceptability, feasibility, equity and resource use of screening for CT or NG in pregnant persons aged ≥12 years. The Risk of Bias Assessment Tool for Non-Randomized Studies was used for quality assessment and a narrative synthesis was prepared.
    UNASSIGNED: Of the 1,386 records identified, nine observational studies (approximately 5,000 participants) and three economic evaluations met the inclusion criteria. In general, pregnant persons and healthcare providers accepted screening. Most pregnant persons and partners supported universal testing for CT. Pregnant persons preferred non-invasive sampling methods. Inequities in feasibility (accessibility to screening) exist in certain populations. Studies have shown that targeted screening can miss cases. Screening all pregnant persons for CT has net cost savings compared to no screening. Limitations include not identifying eligible literature on acceptability of prenatal screening for NG among partners of pregnant persons and some studies with increased risk populations that restrict the generalizability of the findings highlighting areas for future research.
    UNASSIGNED: Prenatal screening for CT and NG is generally acceptable among pregnant persons and healthcare providers. Evidence has shown that targeted screening can miss cases. The findings were included when updating PHAC\'s recommendations on prenatal screening for CT and NG. This work was presented at the Society of Obstetricians and Gynaecologists of Canada\'s 2024 Annual Clinical and Scientific Conference in Edmonton, Alberta.
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  • 文章类型: Journal Article
    怀孕期间的维生素D状态可能会影响后代的神经发育。
    目的是研究5岁后代脐带血血清25-羟维生素D与妊娠和注意力缺陷多动障碍症状之间的关系。
    在欧登塞儿童队列中,丹麦,944对母子对有关于妊娠或脐带血25-羟维生素D的数据,并通过儿童行为清单评估了父母对1.5-5岁儿童的注意力缺陷多动障碍症状评分。对血清25-羟维生素D与注意缺陷多动障碍症状评分的相关性进行了校正多元线性回归和两阶段暴露分析。
    脐带血中血清25-羟维生素D的平均值(标准偏差)为48.0(21.8)nmol/L;妊娠早期为65.5(20.2)nmol/L,妊娠晚期为79.3(25.7)nmol/L。检查时儿童的中位(四分位范围)年龄为5.2(5.1-5.4)岁,中位(四分位范围)注意缺陷多动障碍症状评分为2(0-3)分。在调整后的分析中,脐带血中<25nmol/L和<32nmol/L以及妊娠早期<25nmol/L的血清25-羟维生素D与0.9相关[95%置信区间:0.4,1.3],0.5[0.1,0.9]和2.1[0.8,3.4]指出注意缺陷多动障碍症状评分高于参考。在两阶段暴露分析中,注意缺陷多动障碍症状评分每增加25nmol/L血清25-羟维生素D下降0.4分。妊娠早期和脐带中<25nmol/L的血清25-羟维生素D与注意缺陷多动障碍症状评分90百分位数的五倍和两倍风险相关,调整后的比值比[95%置信区间]=4.9[1.3,19.0]和2.2[1.2,3.9]。
    在此队列中,脐带血25-羟维生素D<25nmol/L和妊娠早期是5岁儿童注意力缺陷多动障碍症状评分较高的危险因素,提示维生素D对学龄前注意缺陷多动障碍特征的保护作用。
    UNASSIGNED: Vitamin D status in pregnancy may affect offspring neurodevelopment.
    UNASSIGNED: The objective was to investigate the association between serum 25-hydroxyvitamin D in cord blood and pregnancy and symptoms of attention-deficit hyperactivity disorder in 5-year-old offspring.
    UNASSIGNED: In Odense Child Cohort, Denmark, 944 mother-child pairs had data on pregnancy or cord serum 25-hydroxyvitamin D and parent-rated attention-deficit hyperactivity disorder symptom score by Child Behavior Checklist for ages 1.5-5 years. Adjusted multiple linear regression and two-stage exposure analyses were performed for serum 25-hydroxyvitamin D associations to the attention-deficit hyperactivity disorder symptom score.
    UNASSIGNED: The mean (standard deviation) serum 25-hydroxyvitamin D in cord blood was 48.0 (21.8) nmol/L; early pregnancy was 65.5 (20.2) nmol/L and late pregnancy was 79.3 (25.7) nmol/L. The median (interquartile range) age of child at examination was 5.2 (5.1-5.4) years and median (interquartile range) attention-deficit hyperactivity disorder symptom score was 2 (0-3) points. In adjusted analyses, serum 25-hydroxyvitamin D of <25 nmol/L and <32 nmol/L in cord blood and <25 nmol/L in early pregnancy was associated with 0.9 [95% confidence interval: 0.4, 1.3], 0.5 [0.1, 0.9] and 2.1 [0.8, 3.4] points higher attention-deficit hyperactivity disorder symptom score vs reference. In the two-stage exposure analysis, attention-deficit hyperactivity disorder symptom score decreased by 0.4 points per 25 nmol/L increase in serum 25-hydroxyvitamin D. Moreover, serum 25-hydroxyvitamin D of <25 nmol/L in early pregnancy and cord was associated with a five-fold and a two-fold risk of attention-deficit hyperactivity disorder symptom score ⩾90th percentile, adjusted odds ratio [95% confidence interval] = 4.9 [1.3, 19.0] and 2.2 [1.2, 3.9].
    UNASSIGNED: In this cohort, serum 25-hydroxyvitamin D <25 nmol/L in cord blood and early pregnancy were risk factors for higher attention-deficit hyperactivity disorder symptom score in 5-year-old children, suggesting a protective effect of vitamin D on attention-deficit hyperactivity disorder traits at preschool age.
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  • 文章类型: Journal Article
    目的:大麻合法化引发了产前大麻使用的增加。鉴于烟草通常与大麻共同使用,确定与产前大麻和烟草共同暴露相关的结局至关重要.虽然有关于产前大麻和烟草暴露对儿童行为的个体影响的文献,它们的组合使用存在差距,可能会产生互动效果。因此,我们调查了产前大麻和烟草共同暴露与产前单独暴露或不暴露两种物质相比,在儿童中期,产前大麻和烟草共同暴露是否与更大的外在化和内在化问题相关.
    方法:来自青少年脑认知发育(ABCD)研究(在9-11岁儿童中收集)的基线数据用于探索从儿童行为清单得出的外化和内化得分的差异四组:产前大麻和烟草共同暴露的儿童(CT,n=290),产前只接触大麻的儿童(CAN,n=225),产前只接触烟草的儿童(TOB,n=966),和未暴露的儿童(CTL,n=8,311)。我们还检查了每日烟草暴露量是否调节了大麻暴露对结果的影响。
    结果:调整协变量,一个2×2的ANCOVA显示出产前大麻(p=0.03)和烟草暴露(p<0.001)的显着主要影响,并且对外部化分数有显着的交互影响(p=0.032);内在化分数没有发现显着的主要影响或交互。然而,每日大麻量和烟草暴露量之间的相互作用显着预测了外部化和内部化得分(p<0.01)。
    结论:这些发现表明,与单独暴露于任何一种物质相比,共同暴露与更大的外部化问题相关,它们彼此没有区别。Further,更多的烟草暴露可能会放大大麻暴露对儿童外化和内化行为的负面影响。这些发现强调了针对孕妇共同使用大麻和烟草的干预措施的必要性,以避免其对中年儿童行为的不利影响。
    产前大麻和烟草的共同暴露及其与儿童中期行为的关联我们探讨了与单独使用药物或不使用药物相比,在10岁儿童中,它们的联合使用是否与更大的问题行为相关.我们发现,产前共同暴露的儿童有更大的外化行为,如注意力问题和侵略,与产前接触其中一种物质或不接触的儿童相比。产前共同暴露,仅接触大麻和仅接触烟草对儿童内在化行为没有影响(例如,抑郁症,焦虑)。然而,母亲消费的烟草量放大了大麻对儿童外化和内化行为的负面影响。这些发现强调,需要对孕妇的大麻和烟草共同使用进行专门治疗,以避免这些物质对儿童中期外化行为的不利影响。
    OBJECTIVE: Cannabis legalization has triggered an increase in prenatal cannabis use. Given that tobacco is commonly co-used with cannabis, determining outcomes associated with prenatal cannabis and tobacco co-exposure is crucial. While literature exists regarding the individual effects of prenatal cannabis and tobacco exposure on childhood behaviour, there is a gap regarding their combined use, which may have interactive effects. Therefore, we investigated whether prenatal cannabis and tobacco co-exposure was associated with greater externalizing and internalizing problems in middle childhood compared to prenatal exposure to either substance alone or no exposure.
    METHODS: Baseline data from the Adolescent Brain Cognitive Development (ABCD) Study (collected in children ages 9-11) were used to explore differences in externalizing and internalizing scores derived from the Childhood Behavior Checklist across four groups: children with prenatal cannabis and tobacco co-exposure (CT, n = 290), children with prenatal cannabis-only exposure (CAN, n = 225), children with prenatal tobacco-only exposure (TOB, n = 966), and unexposed children (CTL, n = 8,311). We also examined if the daily quantity of tobacco exposure modulated the effect of cannabis exposure on outcomes.
    RESULTS: Adjusting for covariates, a 2 × 2 ANCOVA revealed significant main effects for prenatal cannabis (p = 0.03) and tobacco exposure (p < 0.001), and a significant interaction effect on externalizing scores (p = 0.032); no significant main effects or interactions were found for internalizing scores. However, interactions between daily quantity of cannabis and tobacco exposure significantly predicted both externalizing and internalizing scores (p < 0.01).
    CONCLUSIONS: These findings indicate that co-exposure is associated with greater externalizing problems than exposure to either substance alone, which did not differ from each other. Further, greater tobacco exposure may amplify the negative effect of cannabis exposure on both externalizing and internalizing behaviours in children. These findings underscore the need for interventions that target cannabis and tobacco co-use in pregnant women to circumvent their adverse impact on middle childhood behaviour.
    Prenatal Cannabis and Tobacco Co-exposure and its Association with Middle Childhood BehavioursPlain Language SummaryGiven the high rates of both cannabis and tobacco use during pregnancy, we explored if their combined use was associated with greater problematic behaviour in 10-year-old children compared to either substance alone or no substance use. We found that children with prenatal co-exposure had greater externalizing behaviours, such as attention problems and aggression, compared to children with prenatal exposure to one of the substances or no exposure. Prenatal co-exposure, cannabis-only exposure and tobacco-only exposure had no effect on childhood internalizing behaviours (e.g., depression, anxiety). However, the amount of tobacco consumed by the mother amplified the negative effect of cannabis on both childhood externalizing and internalizing behaviours. These findings emphasize the need for specialized treatment for cannabis and tobacco co-use in pregnant women to circumvent the adverse impact of these substances on externalizing behaviours in middle childhood.
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