Prenatal Drug Exposure and Adolescent Cortisol Reactivity: Association with Behavioral Concerns.
Stacy Buckingham-Howes, Dayna Mazza, Yan Wang and 2 others
PMID 27541579WHAT IT FOUND
The proposed link from prenatal drug exposure to behavior through cortisol response did not hold after accounting for age and other factors.
Prenatal drug exposure was associated with lower cortisol response, and cortisol response was associated with lower drug experimentation and aggression and externalizing scores.
Key findings
01Adolescents with prenatal drug exposure were less likely to show a cortisol response to mild stress than non-exposed adolescents (12% versus 26%).
02A cortisol response was associated with lower likelihood of drug experimentation (OR=0.31, 95% CI=0.12-0.81, p=0.02) and lower caregiver-reported aggression (b=-4.63, 95% CI=-8.67 to -0.58, p=0.03) and externalizing scores (b=-4.53, 95% CI=-8.88 to -0.18, p=0.04).
03Prenatal drug exposure was not directly associated with behavioral problems or drug experimentation, and the cortisol pathway was significant only in unadjusted models, becoming non-significant when age or other covariates were included.
STILL TO COME
How it was doneWhat they found
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What it does not show
The sample was small and racially homogeneous, so the findings cannot be generalized to other populations. All measures were taken at one adolescent time point, so the study cannot show how cortisol response developed or changed over time. Prenatal drug exposure was linked to lower cortisol response, but the proposed pathway to behavior did not hold after adjusting for age and other covariates, so the associations may not be independent. The exposed and non-exposed groups differed in caregiving status and prenatal alcohol and tobacco exposure, which may influence both cortisol and behavior. Medication use was not available, and only one baseline cortisol sample was collected, which limits precision.
Declared interests
The supplied metadata lists NIH extramural research support. The supplied article text does not include an author conflict-of-interest declaration.
The easy way to misread this
Do not conclude that prenatal drug exposure causes adolescent behavioral problems or drug experimentation through a blunted cortisol response. The direct association between exposure and behavior was null, and the proposed pathway became non-significant after adjustment.