Characterizing adverse prenatal and postnatal experiences in children
Characterizing adverse prenatal and postnatal experiences in children
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DOI：
10.1002/bdr2.1464
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发表时间：
2019-07-15
影响因子：
2.1
通讯作者：
Ben Gibbard, W.
中科院分区：
文献类型：
--
作者：
Lebel, Catherine A.;McMorris, Carly A.;Ben Gibbard, W.
产前和产后的逆境，包括产前酒精暴露（PAE），产前暴露于其他物质，有毒的压力，缺乏足够的资源，和产后虐待或忽视，往往同时发生。这些接触可能会产生累积效应，或相互作用，导致比单一接触更糟糕的结果。然而，鉴于其复杂性和异质性，暴露可能难以定性。临床服务和研究往往忽视额外的暴露，并将结果仅归因于一个因素。方法：我们提出了一个框架，表征不良的产前和产后暴露，并将其应用于一个队列的77名儿童。我们的方法考虑了类型，时间和频率，以量化PAE，其他产前物质暴露，产前毒性应激，产后威胁（伤害或伤害的威胁），和产后剥夺（未能满足基本需求）使用4点Likert型量表。产后剥夺和伤害分为早期（= 24个月）的时间段，给七个暴露变量。通过健康记录、儿童福利记录、与亲生父母、护理人员和/或亲密家人/朋友的访谈确定暴露。结果几乎所有的儿童同时发生产前暴露，和三分之二的产前和产后逆境。高PAE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有早期产后剥夺。产后逆境更有可能同时发生。结论该框架提供了一个全面的儿童的不良暴露，这可以为评估和干预方法和政策，并将是有用的，为未来的研究。
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) 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.