Department of Radiology, University of Calgary, Calgary, Alberta, Canada.
Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.
Birth Defects Res. 2019 Jul 15;111(12):848-858. doi: 10.1002/bdr2.1464. Epub 2019 Jan 28.
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.
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.
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.
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.
产前和产后逆境，包括产前酒精暴露（PAE）、产前接触其他物质、毒性应激、资源不足以及产后虐待或忽视，往往同时发生。这些暴露可能会产生累积效应，或者相互作用，导致比单一暴露更糟糕的结果。然而，由于其复杂性和异质性，暴露往往难以描述。临床服务和研究经常忽略其他暴露，并将结果仅归因于一个因素。
我们提出了一种描述不良产前和产后暴露的框架，并将其应用于一个 77 名儿童的队列中。我们的方法考虑了类型、时间和频率，使用 4 点李克特量表来量化 PAE、其他产前物质暴露、产前毒性应激、产后威胁（伤害或伤害威胁）和产后剥夺（未能满足基本需求）。产后剥夺和伤害分为早期（<24 个月）和晚期（≥24 个月）两个时期，共产生七个暴露变量。通过健康记录、儿童福利记录、对亲生父母、照顾者和/或亲密的家人/朋友的访谈来确定暴露情况。
几乎所有的孩子都有同时发生的产前暴露，三分之二的孩子既有产前也有产后逆境。PAE 水平高的儿童更有可能经历晚期产后逆境，而其他产前物质暴露的儿童更有可能出现早期产后剥夺。产后逆境更有可能同时发生。
该框架提供了儿童不良暴露的全面情况，这可以为评估和干预方法以及政策提供信息，并将对未来的研究有用。
