title: Motor delays in MDMA (ecstasy) exposed infants persist to 2 years.
abstract: BACKGROUND
  Recreational use of 3,4 methylenedioxymethamphetamine (ecstasy, MDMA) is increasing worldwide. Its use by pregnant women causes concern due to potentially harmful effects on the developing fetus. MDMA, an indirect monoaminergic agonist and reuptake inhibitor, affects the serotonin and dopamine systems. Preclinical studies of fetal exposure demonstrate effects on learning, motor behavior, and memory. In the first human studies, we found prenatal MDMA exposure related to poorer motor development in the first year of life. In the present study we assessed the effects of prenatal exposure to MDMA on the trajectory of child development through 2 years of age. We hypothesized that exposure would be associated with poorer mental and motor outcomes.
  
  
  METHODS
  The DAISY (Drugs and Infancy Study, 2003-2008) employed a prospective longitudinal cohort design to assess recreational drug use during pregnancy and child outcomes in the United Kingdom. Examiners masked to drug exposures followed infants from birth to 4, 12, 18, and 24 months of age. MDMA, cocaine, alcohol, tobacco, cannabis, and other drugs were quantified through a standardized clinical interview. The Bayley Scales (III) of Mental (MDI) and Motor (PDI) Development and the Behavior Rating Scales (BRS) were primary outcome measures. Statistical analyses included a repeated measures mixed model approach controlling for multiple confounders.
  
  
  RESULTS
  Participants were pregnant women volunteers, primarily white, of middle class socioeconomic status, average IQ, with some college education, in stable partner relationships. Of 96 women enrolled, children of 93 had at least one follow-up assessment and 81 (87%) had ≥ two assessments. Heavier MDMA exposure (M=1.3±1.4 tablets per week) predicted lower PDI (p<.002), and poorer BRS motor quality from 4 to 24 months of age, but did not affect MDI, orientation, or emotional regulation. Children with heavier exposure were twice as likely to demonstrate poorer motor quality as lighter and non-exposed children (O.R.=2.2, 95%, CI=1.02-4.70, p<.05).
  
  
  CONCLUSIONS
  Infants whose mothers reported heavier MDMA use during pregnancy had motor delays from 4 months to two years of age that were not attributable to other drug or lifestyle factors. Women of child bearing age should be cautioned about the use of MDMA and MDMA-exposed infants should be screened for motor delays and possible intervention.
authors.affiliation: Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, United States. Electronic address: Lynn.Singer@case.edu.
authors.forename: Lynn T
authors.initials: LT
authors.lastname: Singer
authors.affiliation: The University of East London, Docklands Campus, University Way, London E16 2RD, United Kingdom. Electronic address: D.G.Moore@uel.ac.uk.
authors.forename: Derek G
authors.initials: DG
authors.lastname: Moore
authors.affiliation: Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, United States. Electronic address: Meeyoung.Min@case.edu.
authors.forename: Meeyoung O
authors.initials: MO
authors.lastname: Min
authors.affiliation: The University of East London, Docklands Campus, University Way, London E16 2RD, United Kingdom. Electronic address: J.E.Goodwin@uel.ac.uk.
authors.forename: Julia
authors.initials: J
authors.lastname: Goodwin
authors.affiliation: The University of East London, Docklands Campus, University Way, London E16 2RD, United Kingdom. Electronic address: J.J.D.Turner@uel.ac.uk.
authors.forename: John J D
authors.initials: JJ
authors.lastname: Turner
authors.affiliation: Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, United States. Electronic address: Sarah.Fulton@case.edu.
authors.forename: Sarah
authors.initials: S
authors.lastname: Fulton
authors.affiliation: Swansea University, Singleton Park, Swansea, Wales SA2 8PP, United Kingdom,. Electronic address: a.c.parrott@swansea.ac.uk.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Parrott
mesh_terms: D002675:Child, Preschool; D002658:Developmental Disabilities / Q000209:etiology*; D005260:Female; D006213:Hallucinogens / Q000009:adverse effects*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D000068079:Motor Disorders / Q000209:etiology*; D018817:N-Methyl-3,4-methylenedioxyamphetamine / Q000009:adverse effects*; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000139:chemically induced* / Q000503:physiopathology; D011596:Psychomotor Disorders / Q000209:etiology*; D019966:Substance-Related Disorders / Q000150:complications
chemical_list: D006213:Hallucinogens; D018817:N-Methyl-3,4-methylenedioxyamphetamine
keywords: 3,4-Methylenedioxymethamphetamine; Alcohol; Behavior; Cocaine; Infant development; Motor; Prenatal; Teratology; “Ecstasy”