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Published on: December 14, 2014
Characterizing adverse prenatal and postnatal experiences in children
Catherine A Lebel1,2,3, Carly A McMorris2,4, Preeti Kar2,3
1Department of Radiology, University of Calgary, Calgary, Alberta, Canada.
Insights
Adverse prenatal and postnatal exposures often co-occur, impacting children cumulatively. A new framework quantifies these exposures, revealing complex patterns and informing interventions for better child outcomes.
Area of Science:
- Child Development
- Public Health
- Toxicology
Background:
- Prenatal and postnatal adversities frequently co-occur, potentially leading to cumulative negative effects.
- Characterizing complex and heterogeneous exposures like prenatal alcohol exposure (PAE) and toxic stress is challenging.
- Clinical practice and research often oversimplify adverse exposures, attributing outcomes to single factors.
Purpose of the Study:
- To propose and apply a novel framework for comprehensively characterizing adverse prenatal and postnatal exposures.
- To quantify the type, timing, and frequency of various adversities in a cohort of children.
- To understand the co-occurrence patterns between different types of prenatal and postnatal exposures.
Main Methods:
- Developed a framework to quantify prenatal alcohol exposure (PAE), other prenatal substance exposure, prenatal toxic stress, postnatal threat, and postnatal deprivation.
- Utilized a 4-point Likert-type scale to assess exposure severity and categorized postnatal adversities by early (<24 months) and late (≥24 months) periods.
- Ascertained exposures through health records, child welfare records, and interviews with parents and caregivers.
Main Results:
- Nearly all children in the cohort experienced co-occurring prenatal exposures.
- Two-thirds of children faced both prenatal and postnatal adversities.
- High PAE correlated with late postnatal adversities, while other prenatal substance exposure linked to early postnatal deprivation; postnatal adversities frequently co-occurred.
Conclusions:
- The proposed framework offers a holistic view of a child's adverse exposure landscape.
- This comprehensive assessment can guide clinical interventions, policy development, and future research.
- Understanding complex exposure patterns is crucial for effective support and improved child outcomes.
Background:
Prenatal and postnatal adversities, including prenatal alcohol exposure (PAE), prenatal exposure to other substances, toxic stress, lack of adequate resources, and postnatal abuse or neglect, often co-occur. These exposures can have cumulative effects, or interact with each other, leading to worse outcomes than single exposures. However, given their complexity and heterogeneity, exposures can be difficult to characterize. Clinical services and research often overlook additional exposures and attribute outcomes solely to one factor.
Methods:
We propose a framework for characterizing adverse prenatal and postnatal exposures and apply it to a cohort of 77 children. Our approach considers type, timing, and frequency to quantify PAE, other prenatal substance exposure, prenatal toxic stress, postnatal threat (harm or threat of harm), and postnatal deprivation (failure to meet basic needs) using a 4-point Likert-type scale. Postnatal deprivation and harm were separated into early (<24 months of age) and late (≥24 months) time periods, giving seven exposure variables. Exposures were ascertained via health records, child welfare records, interviews with birth parents, caregivers, and/or close family/friends.
Results:
Nearly all children had co-occurring prenatal exposures, and two-thirds had both prenatal and postnatal adversities. Children with high PAE were more likely to experience late postnatal adversities, and children with other prenatal substance exposure were more likely to have early postnatal deprivation. Postnatal adversities were more likely to co-occur.
Conclusion:
This framework provides a comprehensive picture of a child's adverse exposures, which can inform assessment and intervention approaches and policy and will be useful for future research.
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