Developmental outcomes of 3,4-methylenedioxymethamphetamine (ecstasy)-exposed infants in the UK

This longitudinal, between-subjects cohort study (n=96) investigated whether use of recreational MDMA during pregnancy is damaging to the development of newborn children and found that prenatal MDMA exposure was related to higher ratio of male gender, lower cognitive development scores at 12 months of age, and persistently poorer motor quality and milestone achievement over the first 2 years of life. Prenatal MDMA exposure correlated with fine and gross motor delays in a dose dependent manner.

Abstract

“Objective: This paper aims to review findings from a longitudinal study of prenatal methylenedioxymethamphetamine (MDMA, “ecstasy”) on infant development.

Methods: In a prospective, longitudinal cohort design, we followed 28 MDMA-exposed and 68 non-MDMA-exposed infants from birth to 2 years of age. Women recruited voluntarily into a study of recreational drug use during pregnancy were interviewed to obtain type, frequency, and amount of recreational drug use. Their children were followed for a 2-year period after birth. A large number of drug and environmental covariates were controlled. Infants were seen at 1, 4, 12, 18, and 24 months using standardized normative tests of mental and motor development.

Results: There were no differences between MDMA-exposed and non-MDMA-exposed infants at birth except that MDMA-exposed infants were more likely to be male. Motor delays were evident in MDMA infants at each age and amount of MDMA exposure predicted motor deficits at 12 months in a dose-dependent fashion.

Conclusions: Prenatal MDMA exposure is related to fine and gross motor delays in the first 2 years of life. Follow-up studies are needed to determine long-term effects.”

Authors: Lynn T. Singer, Derek G. Moore, Meeyoung O. Min, Julia Goodwin, John J. D. Turner, Sarah Fulton & Andrew C. Parrott

Summary

Recreational use of stimulant drugs is widespread worldwide, especially among young adults aged 18 – 34years and women of child-bearing age. However, there are relatively few studies of the effects of recreational stimulant drug use on offspring who have been prenatally exposed.

3,4-Methylenedioxymethamphetamine (MDMA) is a widely used, illicit recreational drug that affects physiological and psychological functions. Pregnancy may be affected by MDMA use, including physiological overstimulation, hyperthermia, increased cortisol levels, and post-use depression, sleep impairment, and decreased appetite.

A study was conducted to investigate patterns of use of MDMA-using women during pregnancy and to assess child developmental outcomes until the age of 2years. The study found that MDMA exposed infants performed worse than nonexposed infants.

The Drugs and Infancy Study monitored self-reported recreational drug users of MDMA, tobacco, cannabis, alcohol, and cocaine during pregnancy in the UK. It focused on assessing patterns of use and developmental effects of MDMA on offspring.

Ninety-six women were recruited to participate in a study of recreational drug use during pregnancy. MDMA status was determined by maternal interview on three occasions during pregnancy or after birth, and information on frequency, amount, and duration of use before and after pregnancy was obtained for MDMA and other drugs.

Infants were evaluated at 1, 4, 12, 18, and 24 months of age with the Bayley Scales of Infant Development, the Neonatal Intensive Care Unit Network Neurobehavioral Scales, and the Preschool Language Scales. Maternal postpartum drug use and the quality of the caregiving environment were also assessed.

To assess the effects of MDMA on Bayley outcomes, two-group and three-group comparisons were evaluated at each age controlling for significant covariates. A mixed linear model approach with maximum likelihood estimation procedures was used.

Women in this sample were primarily white, married or partnered, had some university education, and were of middle socioeconomic status and average intelligence. They used tobacco, cannabis, and alcohol up to and during pregnancy, and were divided into heavier and lighter groups based on the amount of drugs taken.

3,4-Methylenedioxymethamphetamine-exposed infants were not different from non-MDMA-exposed infants on any birth parameter, except that the MDMA group was more likely to be male.

There were no significant differences in neonatal outcomes between exposed and nonexposed groups, although exposed infants were more lethargic and less hypertonic.

At 4 months, MDMA-exposed infants had slower and more delayed movements than nonexposed infants, and performed less well on the Alberta Infant Motor Scales.

At 12months, the motor deficits in the MDMA group were even more pronounced, and the amount of prenatal MDMA exposure predicted lower MDI scores, with a slight decrement in scores in the heavier group that was within average range.

MDI and PDI scores were analyzed through mixed model longitudinal analyses using measures from all time points. MDMA exposure had a significant main effect on motor outcomes.

This series of studies investigated whether recreational MDMA use during pregnancy was damaging to the children of ecstasy-using mothers. The main findings were that prenatal exposure to MDMA led to altered sex ratio, lower cognitive development scores, and poorer motor quality.

MDMA use may have persistent effects on the developing fetus via the release of stress hormones. Serotonin, the neurotransmitter primarily affected by MDMA use, is involved in the development of the fetal brain and is associated with changes in somatosensory systems and motor output.

The present study has both strengths and limitations, including a small sample size, the absence of biomarkers of substance exposure, and self-selection of a voluntary group.

There is extensive empirical evidence that recreational stimulants impair the psychobiological integrity of adolescents and adults, and that they may be particularly harmful to young female drug users who may be at risk of becoming pregnant.

In this study, children of MDMA users showed early fine and gross motor delays. Long-term follow-up is needed to assess whether deficits persist and affect school-age functioning, and pregnant women should be cautioned about potential adverse developmental effects.