Prenatal cocaine exposure related to cortisol stress reactivity in 11-year-old children.
OBJECTIVE
Determine the association between prenatal cocaine exposure and postnatal environmental adversity on salivary cortisol stress reactivity in school-aged children.


METHODS
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.
Lester
Barry M
BM
Department of Pediatrics, Brown Center for the Study of Children at Risk, Warren Alpert Medical School of Brown University, Women & Infants Hospital of Rhode Island, Providence, RI 02905, USA. Barry_Lester@Brown.edu
Lagasse
Linda L
LL
Shankaran
Seetha
S
Bada
Henrietta S
HS
Bauer
Charles R
CR
Lin
Richard
R
Das
Abhik
A
Higgins
Rosemary
R
D002648:Child; D003042:Cocaine / Q000009:adverse effects*; D017579:Domestic Violence; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D008137:Longitudinal Studies; D008297:Male; D018811:Maternal Exposure; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects; D011446:Prospective Studies; D012463:Saliva / Q000378:metabolism*; D012923:Social Class; D013315:Stress, Psychological / Q000209:etiology; D019966:Substance-Related Disorders
D003042:Cocaine; D006854:Hydrocortisone
Neuropsychobiology. 1989;22(3):150-69
2485862
JAMA. 2001 Mar 28;285(12):1613-25
11268270
J Child Psychol Psychiatry. 2000 Jan;41(1):97-116
10763678
Pediatrics. 2007 Feb;119(2):e348-59
17272597
J Psychosom Res. 1979;23(3):181-92
573796
Placenta. 1981 Oct-Dec;2(4):279-85
6946410
Child Dev. 2009 Mar-Apr;80(2):528-43
19467009
Dev Psychobiol. 1992 Mar;25(2):93-103
1577206
Psychiatry. 1993 Feb;56(1):22-35
8488209
Arch Gen Psychiatry. 1987 Apr;44(4):328-36
3566455
Int J Dev Neurosci. 1994 Nov;12(7):651-9
7900547
Psychoneuroendocrinology. 2009 Nov;34(10):1437-48
19632788
Psychophysiology. 1997 May;34(3):329-39
9175447
Psychiatry. 1993 Feb;56(1):7-21
8488215
Psychoneuroendocrinology. 2006 Sep;31(8):948-57
16831519
Pediatrics. 2009 Nov;124(5):1355-62
19822596
Child Dev. 2002 Jul-Aug;73(4):1238-48
12146745
Dev Psychopathol. 2001 Summer;13(3):677-93
11523854
Psychoneuroendocrinology. 2005 Nov;30(10):1010-6
15950390
Pediatrics. 2002 Dec;110(6):1182-92
12456917
Ann N Y Acad Sci. 1997 Jan 15;807:419-28
9071367
Psychoneuroendocrinology. 2000 Jan;25(1):1-35
10633533
Biol Neonate. 1997;71(2):102-10
9057993
Pediatrics. 2008 Jul;122(1):e83-91
18541617
Horm Behav. 2009 Feb;55(2):292-8
19084531
Psychoneuroendocrinology. 1994;19(4):313-33
8047637
JAMA. 2000 Aug 2;284(5):592-7
10918705
Dev Neurosci. 2009;31(1-2):23-35
19372684
Psychoneuroendocrinology. 2006 Jan;31(1):59-68
16005570
Neuro Endocrinol Lett. 2002 Feb;23(1):45-8
11880861
Psychosom Med. 2005 Mar-Apr;67(2):211-6
15784785
J Nerv Ment Dis. 1986 Mar;174(3):145-9
3950596
Am J Psychiatry. 2003 Sep;160(9):1554-65
12944327
Arch Gen Psychiatry. 1967 Jul;17(1):104-10
4952155
J Clin Endocrinol Metab. 1991 Dec;73(6):1224-34
1659582
Arch Gen Psychiatry. 1973 Jan;28(1):19-24
4683141
Psychosom Med. 1963 Jul-Aug;25:364-76
13959816
Dev Psychopathol. 2001 Summer;13(3):653-76
11523853
Biol Psychiatry. 2000 Nov 15;48(10):976-80
11082471
Am J Obstet Gynecol. 2002 Mar;186(3):487-95
11904612
Dev Psychopathol. 2001 Summer;13(3):515-38
11523846
Ann N Y Acad Sci. 2006 Dec;1094:215-25
17347353
Arthritis Rheum. 1994 Nov;37(11):1583-92
7980669
J Am Acad Child Adolesc Psychiatry. 1991 Mar;30(2):257-65
2016230
Psychosom Med. 1998 May-Jun;60(3):309-18
9625218
Dev Psychopathol. 1999 Spring;11(2):195-208
16506530
Pediatrics. 1996 Jun;97(6 Pt 1):851-5
8657526
Arch Gen Psychiatry. 2001 Mar;58(3):297-302
11231837
Psychoneuroendocrinology. 2007 Feb;32(2):183-91
17289279
Dev Psychol. 2007 Jul;43(4):811-22
17605516
Ann N Y Acad Sci. 1998 May 1;840:33-44
9629234
Brain Res. 1993 Oct 8;624(1-2):209-15
8252393
Psychoneuroendocrinology. 2007 Sep-Nov;32(8-10):892-905
17656028
Child Psychiatry Hum Dev. 2008 Mar;39(1):27-38
17564829
Am J Phys Anthropol. 1997 Jan;102(1):33-53
9034037
Dev Psychopathol. 2008 Spring;20(2):423-36
18423087
Pneumologie. 1994 Nov;48(11):793-8
7824500
Ann N Y Acad Sci. 1997 Jun 21;821:57-75
9238194
Psychiatry Res. 1993 Jan;46(1):9-17
8464960
Arch Intern Med. 1993 Sep 27;153(18):2093-101
8379800
Clin Perinatol. 1999 Mar;26(1):55-74
10214543
Neurosci Biobehav Rev. 2004 Jan;27(8):751-64
15019425
Am J Psychiatry. 1996 Jul;153(7):929-34
8659616
Dev Psychopathol. 1999 Fall;11(4):685-714
10624721
N Engl J Med. 1998 Jan 15;338(3):171-9
9428819
Biol Psychiatry. 2008 Oct 1;64(7):599-606
18620338
Arch Oral Biol. 2004 Dec;49(12):963-8
15485637
Eur J Appl Physiol. 2009 Nov;107(4):455-61
19669787
Neuropsychobiology. 1993;28(1-2):76-81
8255414
N Engl J Med. 1988 Aug 11;319(6):348-53
3292920
J Am Acad Child Adolesc Psychiatry. 2000 Nov;39(11):1438-45
11068900
Dev Psychopathol. 2002 Spring;14(2):333-49
12030695
Psychiatry Res. 2005 Mar 30;134(1):1-10
15808285
JAMA. 2009 Jun 3;301(21):2252-9
19491187
Biol Psychiatry. 2004 Apr 1;55(7):745-51
15039004
J Am Acad Child Adolesc Psychiatry. 2003 Sep;42(9):1101-7
12960710
Arch Gen Psychiatry. 2000 Jan;57(1):38-43
10632231
Behav Sleep Med. 2005;3(4):177-92
16190809
Psychosom Med. 1997 Jul-Aug;59(4):419-26
9251162
J Am Acad Child Adolesc Psychiatry. 1994 Mar-Apr;33(3):320-7
8169176