Skip to main content

Advertisement

Log in

Consequences of prenatal toxin exposure for mental health in children and adolescents

A systematic review

European Child & Adolescent Psychiatry Aims and scope Submit manuscript

Abstract

Drug use during pregnancy is common and the developing foetus may be exposed to a range of environmental toxins that have long-term consequences for neurodevelopment. We conducted a systematic review of the literature to explore the results of longitudinal cohort studies that have examined this question. Out of 2,977 abstracts identified, 7 previous systematic reviews and 95 original articles met further selection criteria. These mostly addressed the neurodevelopmental effects of exposure to lead, polychlorinated biphenyls, mercury, cocaine, alcohol, marijuana, cigarettes and antidepressants. Radiation, opiates, steroids, amphetamines and caffeine have received much less attention. Findings are difficult to interpret because risk factors tend to cluster together and interact. However, some findings are consistent. Lead and PCB’s have a general effect on brain development, whilst marijuana and alcohol appear to have long-term effects specifically on attentional skills. The effects of alcohol increase with maternal age and binge drinking is more important than average intake. The effects of cocaine diminish with age and are largely mediated through psychosocial factors, whilst the relation between smoking and later delinquency is largely mediated by genetically inherited factors. Exposure to toxins during pregnancy may constitute an important but relatively unacknowledged cause of child psychiatric morbidity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Charman T (2002) The prevalence of autistic spectrum disorders—recent evidence and future challenges. Eur Child Adolesc Psychiatry 11:249–256

    Article  PubMed  Google Scholar 

  2. Fombonne E (2003) Epidemiological surveys of autism and other pervasive developmental disorders. J Autism Dev Disord 33:365–382

    Article  PubMed  Google Scholar 

  3. Rasmussen P, Gillberg C (2000) Natural outcome of ADHD with developmental co-ordination disorder at age 22 years: a controlled longitudinal community-based study. J Am Acad Child Adolesc Psychiatry 39:1424–1431

    Article  PubMed  CAS  Google Scholar 

  4. de Weerth C, Buitelaar JK, Mulder EJH (2005) Prenatal programming of behavior, physiology and cognition. Neurosci Behav Rev 29:207–208

    Google Scholar 

  5. Manning JT, Baron-Cohen S, Wheelwright S, Sanders G (2001) The 2nd to 4th digit ratio and autism. Dev Med Child Neurol 43:160–164

    Article  PubMed  CAS  Google Scholar 

  6. Owen D, Andrews MH, Matthews SG (2005) Maternal adversity, glucocorticoids and programming of neuroendocrine function and behaviour. Neurosci Behav Rev 29:209–226

    CAS  Google Scholar 

  7. Van den Bergh BRH et al (2005) Antenatal maternal anxiety and stress and the neurobehavioural development of the fetus and child: links and possible mechanisms. A review. Neurosci Behav Rev 29:237–258

    Google Scholar 

  8. Williams JHG, Greenhalgh KD, Manning JT (2003) Second to fourth finger ratio and possible precursors of developmental psychopathology in preschool children. Early Hum Dev 72:57–65

    Article  PubMed  CAS  Google Scholar 

  9. Davies S, Heyman I, Goodman R (2003) A population survey of mental health problems in children with epilepsy. Dev Med Child Neurol 45:292–295

    Article  PubMed  Google Scholar 

  10. Goodman R, Graham P (1996) Psychiatric problems in children with hemiplegia: cross sectional epidemiological survey. Br Med J 312:1065–1069

    CAS  Google Scholar 

  11. Nordin V, Gillberg C (1996) Autism spectrum disorders in children with physical or mental disability or both. 1. Clinical and epidemiological aspects. Dev Med Child Neurol 38:297–313

    Article  PubMed  CAS  Google Scholar 

  12. Steffenburg S, Gillberg C, Steffenburg U (1996) Psychiatric disorders in children and adolescents with mental retardation and active epilepsy. Arch Neurol 53:904–912

    PubMed  CAS  Google Scholar 

  13. US Dept of Health and Human Services. Substance use during pregnancy: 2002 and 2003 Update. 2-6-2005

  14. Haslam C, Lawrence W (2004) Health-related behavior and beliefs of pregnant smokers. Health Psychol 23:486–491

    Article  PubMed  Google Scholar 

  15. Jacobson SW, Jacobson JL, Sokol RJ, Chiodo LM, Corobana R (2004) Maternal age, alcohol abuse history, and quality of parenting as moderators of the effects of prenatal alcohol exposure on 7.5-year intellectual function. Alcohol Clin Exp Res 28:1732–1745

    Article  PubMed  Google Scholar 

  16. Pichini S, Puig C, Zuccaro P, Marchei E, Pellegrini M, Murillo J, Vall O, Pacifici R, Garcia-Algar O (2005) Assessment of exposure to opiates and cocaine during pregnancy in a Meditteranean city: preliminary results of the “meconium” project. Forensic Sci Int 153:59–65

    Article  PubMed  CAS  Google Scholar 

  17. Zuccato E, Chiabrando C, Castiglioni S, Calamari D, Bagnati R, Schiarea S, Fanelli R (2005) Cocaine in surface waters: a new evidence-based tool to monitor community drug abuse. Environ Health 4:14 file://H\1476-069X-4-14.pdf

    Google Scholar 

  18. World Health Organization (1992) The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. World Health Organization

  19. Eskenazi B, Castorina R (1999) Association of prenatal maternal or postnatal child environmental tobacco smoke exposure and neurodevelopmental and behavioral problems in children. Environ Health Perspect 107:991–1000

    PubMed  CAS  Google Scholar 

  20. Ribas-Fito N, Sala M, Kogevinas M, Sunyer J (2001) Polychlorinated biphenyls (PCBs) and neurological development in children: a systematic review. J Epidemiol Community Health 55:537–546

    Article  PubMed  CAS  Google Scholar 

  21. Goldstein DJ, Sundell K (1999) A review of the safety of selective serotonin reuptake inhibitors during pregnancy. Hum Psychopharmacol 14:319–324

    Article  CAS  Google Scholar 

  22. Peterson LM, Burns WJ, Widmayer SM (1995) Developmental risk for infants of maternal cocaine abusers: evaluation and critique. Clin Psychol Rev 15:739–776

    Article  Google Scholar 

  23. Frank D, Augustyn M, Knight W, Pell T, Zarin D, Frank E (2001) Growth, development and behavior in early childhood following prenatal cocaine exposure. J Am Med Assoc 285:1613–1625

    Article  CAS  Google Scholar 

  24. Wisner KL, Gelenberg AJ, Leonard H, Zarin D, Frank E (1999) Pharmacologic treatment of depression during pregnancy. J Am Med Assoc 282:1264–1269

    Article  CAS  Google Scholar 

  25. Pocock SJ, Smith M, Baghurst P (1994) Environmental lead and children’s intelligence: a systematic review of the epidemiological evidence. Br Med J 309:1189–1197

    CAS  Google Scholar 

  26. Bellinger D, Leviton A, Allred E, Rabinowitz M (1994) Pre- and postnatal lead exposure and behavior problems in school-aged children. Environmental Research 66:12–30

    Article  PubMed  CAS  Google Scholar 

  27. Dietrich KN, Ris MD, Succop PA, Berger OG, Bornschein RL (2001) Early exposure to lead and juvenile delinquency. Neurotoxicology & Teratology 23:511–518

    Article  CAS  Google Scholar 

  28. Ris MD, Dietrich KN, Succop PA, Berger OG, Bornschein RL (2004) Early exposure to lead and neuropsychological outcome in adolescence. J Int Neuropsychol Soc 10:261–270

    Article  PubMed  CAS  Google Scholar 

  29. Tong S, Baghurst P, McMichael A, Sawyer M, Mudge J (1996) Lifetime exposure to environmental lead and children’s intelligence at 11–13 years: The Port Pirie cohort study. British Medical Journal 312:1569–1575

    PubMed  CAS  Google Scholar 

  30. Wasserman GA, Graziano JH, Factor-Litvak P, Popovac D (1995) Consequences of lead exposure and iron supplementation on childhood development at age 4 years. Neurotoxicology & Teratology 16:233–240

    Article  Google Scholar 

  31. Serbin LA, Peters PL, McAffer VJ, Schwartzman AE (1991) Childhood aggression and withdrawal as predictors of adolescent pregnancy, early parenthood and environmental risk for the next generation. Can J Behav Sci 23:318–331

    Article  Google Scholar 

  32. Lai TJ, Liu X, Guo YL, Guo NW, Yu ML, Hsu CC, Rogan WJ (2002) A cohort study of behavioral problems and intelligence in children with high prenatal polychlorinated biphenyl exposure. Arch Gen Psychiatry 59:1061–1066

    Article  PubMed  Google Scholar 

  33. Jacobson JL, Jacobson SW (2003) Prenatal exposure to polychlorinated biphenyls and attention at school age. J Pediatr 143:780–788

    Article  PubMed  CAS  Google Scholar 

  34. Myers GJ, Davidson PW, Cox C, Shamlaye CF, Palumbo D, Cernichiari E, Sloane-Reeves J, Wilding GE, Kost J, Huang LS, Clarkson TW (2003) Prenatal methylmercury exposure from ocean fish consumption in the Seychelles child development study. Lancet 361:1686–1692

    Article  PubMed  CAS  Google Scholar 

  35. Grandjean P, Weihe P, White RF, Debes F, Araki S, Yokoyama K, Murata K, Sorensen N, Dahl R, Jorgensen PJ (1997) Cognitive deficit in 7-year-old children with prenatal exposure to methylmercury. Neurotoxicol Teratol 19:417–428

    Article  PubMed  CAS  Google Scholar 

  36. Davidson PW, Myers GJ, Shamlaye C, Cox C, Wilding GE (2004) Prenatal exposure to methylmercury and child development: influence of social factors. Neurotoxicol Teratol 26:553–559

    Article  PubMed  CAS  Google Scholar 

  37. Croen L, Yoshida C, Odouli R, Grether J (2005) Maternal psychiatric history, antidepressant use during pregnancy, and childhood autism. Proceedings of the International Meeting for Autism Research. S1.5. Boston, May 5th–7th

  38. Dean JCS, Hailey H, Moore SJ, Lloyd DJ, Turnpenny PD, Little J (2002) Long term health and neurodevelopment in children exposed to antiepileptic drugs before birth. J Med Genet 39:251–259

    Article  PubMed  CAS  Google Scholar 

  39. Rasalam AD, Hailey H, Williams JHG, Moore SJ, Turnpenny PD, Lloyd DJ, Dean JCS (2005) Characteristics of fetal anticonvulsant syndrome associated autistic disorder. Dev Med Child Neurol 47:551–555

    Article  PubMed  CAS  Google Scholar 

  40. French NP, Hagan R, Evans SF, Mullan A, Newnham JP (2004) Repeated antenatal corticosteroids: effects on cerebral palsy and childhood behavior. Am J Obstet Gynecol 190:588–595

    Article  PubMed  CAS  Google Scholar 

  41. Silberg JL, Parr T, Neale MC, Rutter M, Angold A, Eaves LJ (2003) Maternal smoking during pregnancy and risk to boys’ conduct disturbance: an examination of the causal hypothesis. Biol Psychiatry 53:130–135

    Article  PubMed  Google Scholar 

  42. Maughan B, Taylor A, Caspi A, Moffitt TE (2004) Prenatal smoking and early childhood conduct problems: testing genetic and environmental explanations of the association. Arch Gen Psychiatry 61:836–843

    Article  PubMed  Google Scholar 

  43. Fried PA, Watkinson B (2001) Differential effects on facets of attention in adolescents prenatally exposed to cigarettes and marihuana. Neurotoxicol Teratol 23:421–430

    Article  PubMed  CAS  Google Scholar 

  44. Wakschlag LS, Hans SL (2002) Maternal smoking during pregnancy and conduct problems in high-risk youth: a developmental framework. Dev Psychopathol 14:351–369

    Article  PubMed  Google Scholar 

  45. Batstra L, Hadders-Algra M, Neeleman J (2003) Effect of antenatal exposure to maternal smoking on behavioural problems and academic achievement in childhood: prospective evidence from a Dutch birth cohort. Early Hum Dev 75:21–33

    Article  PubMed  CAS  Google Scholar 

  46. Weissman MM, Warner V, Wickramaratne PJ, Kandel DB (1999) Maternal smoking during pregnancy and psychopathology in offspring followed to adulthood. J Am Acad Child Adolesc Psychiatry 38:892–899

    Article  PubMed  CAS  Google Scholar 

  47. Fried PA (1995) The Ottawa Prenatal Prospective Study (OPPS): methodological issues and findings: it’s easy to throw the baby out with the bath water. Life Sci 56:2159–2168

    Article  PubMed  CAS  Google Scholar 

  48. Fried PA, Watkinson B, Gray R (1998) Differential effects on cognitive functioning in 9- to 12-year olds prenatally exposed to cigarettes and marihuana. Neurotoxicol Teratol 20:293–306

    Article  PubMed  CAS  Google Scholar 

  49. Fried PA, Watkinson B, Gray R (1992) A follow-up study of attentional behavior in 6-year-old children exposed prenatally to marijuana, cigarettes, and alcohol. Neurotoxicol Teratol 14:299–311

    Article  PubMed  CAS  Google Scholar 

  50. Fried AP, Watkinson B, Siegel LS (1997) Reading and language in 9- to 12-year olds prenatally exposed to cigarettes and marijuana. Neurotoxicol Teratol 19:171–183

    Article  PubMed  CAS  Google Scholar 

  51. Caldwell B, Bradley R (1984) Home observation for measurement of the environment (HOME), Revised Edition University of Arkansas: Little Rock http://www.ualr.edu/%7ecrtldept/home4.htm

  52. Streissguth AP, Barr HM, Sampson PD, Bookstein FL (1994) Prenatal alcohol and offspring development: the first 14 years. Drug Alcohol Depend 36:89–99

    Article  PubMed  CAS  Google Scholar 

  53. Goldschmidt L, Richardson GA, Stoffer DS, Geva D, Day NL (1996) Prenatal alcohol exposure and academic achievement at age six: a nonlinear fit. Alcohol Clin Exp Res 20:763–770

    Article  PubMed  CAS  Google Scholar 

  54. Bailey BN, Delaney-Black V, Covington CY, Ager J, Janisse J, Hannigan JH, Sokol RJ (2004) Prenatal exposure to binge drinking and cognitive and behavioral outcomes at age 7 years. Am J Obstet Gynecol 191:1037–1043

    Article  PubMed  Google Scholar 

  55. Guerri C, Riley E, Strömland K (1999) Commentary on the recommendations of the Royal College of Obstetricians and Gynaecologists concerning alcohol consumption in pregnancy. Alcohol Alcohol 34(4):497–501

    PubMed  CAS  Google Scholar 

  56. Goldschmidt L, Day NL, Richardson GA (2000) Effects of prenatal marijuana exposure on child behavior problems at age 10. Neurotoxicol Teratol 22:325–336

    Article  PubMed  CAS  Google Scholar 

  57. Singer LT, Arendt R, Minnes S, Salvator A, Siegel AC, Lewis BA (2001) Developing language skills of cocaine-exposed infants. Pediatrics 107:1057–1064

    Article  PubMed  CAS  Google Scholar 

  58. Singer LT, Arendt R, Minnes S, Farkas K, Salvator A, Kirchner HL, Kliegman R (2002) Cognitive and motor outcomes of cocaine-exposed infants. J Am Med Assoc 287: 1952–1960

    Article  CAS  Google Scholar 

  59. Singer LT, Minnes S, Short E, Arendt R, Farkas K, Lewis B, Klein N, Russ S, Min MO, Kirchner HL (2004) Cognitive outcomes of preschool children with prenatal cocaine exposure. J Am Med Assoc 291:2448–2456

    Article  CAS  Google Scholar 

  60. Singer L, Arendt R, Farkas K, Minnes S, Huang J, Yamashita T (1997) Relationship of prenatal cocaine exposure and maternal postpartum psychological distress to child developmental outcome. Dev Psychopathol 9:473–489

    Article  PubMed  CAS  Google Scholar 

  61. Messinger DS, Bauer CR, Das A, Seifer R, Lester BM, Lagasse LL, Wright LL, Shankaran S, Bada HS, Smeriglio VL, Langer JC, Beeghly M, Poole WK (2004) The maternal lifestyle study: cognitive, motor, and behavioral outcomes of cocaine-exposed and opiate-exposed infants through 3 years of age. Pediatrics 113:1677–1685

    Article  PubMed  Google Scholar 

  62. Wesseling J, Van Driel D, Heymans HS, Rosendaal FR, Geven-Boere LM, Smrkovsky M, Touwen BC, Sauer PJ, Van der Veer E (2001) Coumarins during pregnancy: long-term effects on growth and development of school-age children. Thromb Haemost 85:609–613

    PubMed  CAS  Google Scholar 

  63. Nyagu AI, Loganovsky KN, Loganovskaja TK (1998) Psychophysiologic aftereffects of prenatal irradiation. Int J Psychophysiol 30:303–311

    Article  PubMed  CAS  Google Scholar 

  64. Viggedal G, Hagberg BS, Laegreid L, Aronsson M (1993) Mental development in late infancy after prenatal exposure to benzodiazepines: a prospective study. J Child Psychol Psychiatry 34:295–305

    Article  PubMed  CAS  Google Scholar 

  65. Eriksson M, Jonsson B, Steneroth G, Zetterstrom R (2000) Amphetamine abuse during pregnancy: environmental factors and outcome after 14–15 years. Scand J Public Health 28:154–157

    Article  PubMed  CAS  Google Scholar 

  66. Barr HM, Streissguth AP (1991) Caffeine use during pregnancy and child outcome: a 7-year prospective study. Neurotoxicol Teratol 13:441–448

    Article  PubMed  CAS  Google Scholar 

  67. Moe V (2002) Foster-placed and adopted children exposed in utero to opiates and other substances: prediction and outcome at four and a half years. J Dev Behav Pediatr 23:330–339

    PubMed  Google Scholar 

  68. Slinning K (2004) Foster placed children prenatally exposed to poly-substances—attention-related problems at ages 2 and 4 1/2. Eur Child Adolesc Psychiatry 13:19–27

    Article  PubMed  CAS  Google Scholar 

  69. van Baar AL, Soepatmi S, Gunning WB, Akkerhuis GW (1994) Development after prenatal exposure to cocaine, heroin and methadone. Acta Paediatr Suppl 404:40–46

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We are grateful to Christopher Gillberg, the Scottish ABCD study group and Amudha Poobalan for helpful comments during the design of the search strategy.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Justin H. G. Williams.

Electronic Supplementary Material

Rights and permissions

Reprints and permissions

About this article

Cite this article

Williams, J.H.G., Ross, L. Consequences of prenatal toxin exposure for mental health in children and adolescents. Eur Child Adolesc Psychiatry 16, 243–253 (2007). https://doi.org/10.1007/s00787-006-0596-6

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00787-006-0596-6

Keywords

Navigation