Beeghly Marjorie, Frank Deborah A, Rose-Jacobs Ruth, Cabral Howard, Tronick Edward
Department of Pediatrics, Harvard Medical School, Children's Hospital, Boston, MA 02215, USA.
Neurotoxicol Teratol. 2003 Jan-Feb;25(1):23-38. doi: 10.1016/s0892-0362(02)00323-9.
The objective of this longitudinal prospective cohort study was to determine whether level of prenatal cocaine exposure, or the interaction between level of prenatal cocaine exposure and contextual risk variables, was associated with a higher rate of infant-caregiver insecure attachment and disorganized attachment, or with alterations in infant crying or avoidant behavior, after controlling for prenatal exposure to alcohol, tobacco, and marijuana, the quality of the proximal caregiving environment, and other covariates. Subjects were 154 full-term 12-month-old infants (64 unexposed, 61 with lighter cocaine exposure, 29 with heavier cocaine exposure) and their primary caregivers from low-income, urban backgrounds. Exposure status was determined in the maternity ward by biologic assay (infant meconium and/or maternal or infant urine) and maternal self-report. At the 12-month follow-up visit, infants were videotaped with their primary caregiver in Ainsworth's Strange Situation. Reliable coders masked to exposure status scored videotapes for attachment variables, amount of crying, and level of avoidance. Contrary to popular perceptions, level of prenatal cocaine exposure was not significantly related to secure/insecure attachment status, disorganized attachment status, or rated level of felt security. Foster care status also was not associated with attachment status. However, heavier prenatal cocaine exposure, in interaction with maternal contextual variables (public assistance or multiparity) was associated with alterations in infant socio-affective behavior, including a higher level of behavioral disorganization, more avoidance of the caregiver, and less crying.
这项纵向前瞻性队列研究的目的是，在控制了产前酒精、烟草和大麻暴露、近端照料环境质量及其他协变量之后，确定产前可卡因暴露水平，或产前可卡因暴露水平与情境风险变量之间的相互作用，是否与婴儿-照料者不安全依恋和紊乱依恋的较高发生率相关，或与婴儿哭闹或回避行为的改变相关。研究对象为154名足月12个月大的婴儿（64名未暴露、61名轻度可卡因暴露、29名重度可卡因暴露）及其来自低收入城市背景的主要照料者。在产科病房通过生物学检测（婴儿胎粪和/或母亲或婴儿尿液）和母亲自我报告来确定暴露状态。在12个月的随访中，婴儿与其主要照料者在安斯沃思陌生情境中被录像。对暴露状态不知情的可靠编码员对录像带的依恋变量、哭闹量和回避程度进行评分。与普遍看法相反，产前可卡因暴露水平与安全/不安全依恋状态、紊乱依恋状态或感觉安全的评分水平无显著关联。寄养状态也与依恋状态无关。然而，重度产前可卡因暴露与母亲情境变量（公共援助或多胎妊娠）相互作用，与婴儿社会情感行为的改变有关，包括更高水平的行为紊乱、更多地回避照料者以及更少哭闹。
