Article Summary #4: Characterizing adverse prenatal and postnatal experiences

This Article Summary is part of our new CanFASD Connect Top Articles Summary Series. Over the next several months, we will be bringing you summaries of all the recent research papers from our list of the Top FASD Articles of 2019. This is a summary of a recent research paper called Characterizing adverse prenatal and postnatal experiences in children.


Background

Prenatal alcohol exposure (PAE) is known to cause negative outcomes for individuals exposed. However, the majority of people with prenatal alcohol exposure (PAE) are also exposed to other prenatal or postnatal factors that may negatively impact their physical and mental health, including exposure to other substances, toxic stress, lack of resources, abuse, and neglect. These factors can interact with one another, leading to unexpected or cumulative negative effects on health outcomes. Yet, clinicians and researchers often do not include these factors in patient reports or treatment recommendations and they are commonly left out of research.

This study created a framework to help future researchers and diagnosticians identify and characterize adverse prenatal and postnatal factors. The framework has researchers and diagnosticians rank exposure in the following 7 areas on a scale from 1 (no exposure) to 4 (high exposure):

  • Prenatal alcohol exposure
  • Other prenatal substance exposure
  • Other prenatal toxic stress
  • Early postnatal deprivation (<24 months)
  • Late postnatal deprivation (≥24 months)
  • Early postnatal threat
  • Late postnatal threat (≥24 months)

By developing this framework, researchers are able to study what prenatal and postnatal factors beyond PAE impacted health, and how those risk factors interacted with one another.  

Main Findings

  • All participants had confirmed prenatal alcohol exposure, with 99% also experiencing exposure to other prenatal substances and/or prenatal toxic stress
  • 70% of cases co-occurred with at least one postnatal adversity
  • 8% of participants had at least some confirmed exposure in each of the seven categories
  • Children exposed to high levels of alcohol during fetal development were more likely to experience late postnatal threat and/or deprivation
  • The presence of one postnatal adversity increases the risk for other postnatal adversities. However, fewer children experience postnatal adversities because of factors such as adoption or placement in stable homes.

Recommendations

  • Implement a common framework across child-serving sectors, specifically child welfare and health to accurately document levels of exposure for each child
  • Provide increased support as early as possible (including prenatally) and continue these supports throughout the lifespan to encourage healthy child and family development
  • Implement an individualized approach to treatment and interventions that takes into consideration each individual’s the unique experiences and risk factors.

Take home message
It is important to implement a common framework across multiple disciplines in order to consider all factors of a child’s prenatal and postnatal histories to determine effective interventions and treatment based on the child’s individual needs and promote positive outcomes.

Authors: Catherine A. Lebel, Carly A. McMorris, Preeti Kar, Chantel Ritter, Quinn Andre, Christina Tortorelli, W. Ben Gibbard

Journal: Birth Defects Research

Date: January 28th 2019

Read the full article (not available open access)

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