OBJECTIVE: Most drug use screening measures rely on and are validated against self-report. Fear of negative consequences often promotes denial of drug use. For pregnant women, social stigma and fear of legal consequences make underreporting of drug use even more likely. An indirect screener that could effectively identify pregnant women at risk for illicit drug use without reliance on disclosure would be clinically significant. The purpose of the current study was to develop and validate an indirect measure of prenatal drug use by comparing correlates of prenatal drug use to urinalysis results. METHOD: Pregnant women attending an OB appointment at the VCUHS Women’s Health Clinic were recruited and consented to participate in an anonymous, two-phase study. In Phase 1, women completed a 20-minute computerized assessment which included a true/false index of items known to tap behavioral, medical, psychological, experiential and demographic correlates of drug abuse and dependence. In Phase 2, participants were asked to provide a urine sample for drug testing. Women received a $20 gift card after they participated in each phase. RESULTS: Two hundred and thirty-one women completed both Phase 1 and 2 (94% completion rate). Participants were primarily African-American (66%), single (75%) and receiving public assistance (70%). Urinalysis revealed that 16% of the sample tested positive for recent drug use, while only 5% of women self-reported past month drug use. After examining the univariate and multivariate relationships between each indirect item and drug status (i.e., positive or negative urinalysis), six indirect items were chosen to comprise the Wayne Indirect Drug Use Screener-Pregnancy (WIDUS-P). Cross-validation analyses resulted in a sensitivity of .90, specificity of .75, and AUC of .85. In comparison to direct screening approaches, the WIDUS-P was superior in identifying pregnant women who had used drugs recently. CONCLUSIONS: Findings support the use of an indirect screening tool to identify prenatal drug use, especially over currently-used direct methods. Such a measure could easily be implemented into regular clinic practice and result in more cost-effective and better identification of prenatal drug use.

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With the incidence of prenatal drug exposure increasing, it is important that preschool teachers are prepared and confident in serving the needs of children affected by this exposure. Teachers need more training and education to prepare them for working with children with prenatal drug exposure. The purpose of this sequential mixed-methods study was to explore the perceptions, training, and shared experiences of preschool teachers when working with 4- and 5-year-old preschool children who have experienced prenatal drug exposure. The researcher invited 77 preschool teachers in northeast Tennessee working in either Head Start or Tennessee Voluntary Pre-K Initiative programs to complete an initial quantitative survey – of which 53 participated. Of the survey participants, 34 reported they might have worked with a child with prenatal drug exposure. Six of those teachers who said they had experience with children with prenatal drug exposure participated in a follow up semi-structured interview with the researcher. The findings revealed that preschool teachers were favorable toward children with prenatal drug exposure regarding the children’s ability to learn. Preschool teachers were already using many effective interventions (e.g., working one-on-one with the child, offering flexible seating options, repetition of information) that they may have used with other children with special needs, but they were eager for more information about the best way to work with these children. School leaders and those in teacher preparation programs would be excellent advocates in spreading knowledge and translating medical knowledge into resources more applicable to the teaching and childcare profession. It is important that the information become more accessible to all teachers and stakeholders in education.

[pt] O consumo de álcool durante gravidez pode alterar o desenvolvimento neural do feto, causando defeitos ao longo da vida. As consequências são diversas e compõe o termo coletivo: Transtorno do Espectro Alcoólico Fetal (TEAF). Esse transtorno é considerado a causa mais comum de deficiência cognitiva evitável no mundo. Estimativas apontam que no Brasil entre 1 e 1,5% das crianças nascem com alterações no sistema nervoso devido à exposição ao álcool in útero. O consumo do álcool é frequente entre mulheres grávidas muitas vezes por desconhecimento dos seus efeitos adversos no desenvolvimento do feto. Outra droga comumente utilizada por mulheres grávidas é a maconha com intuito de amenizar o enjoo durante a gestação. A presente dissertação explora os efeitos da exposição pré-natal ao álcool no feto (em conjunto ou não do uso da maconha) em estudos pré-clínicos e clínicos. Dois artigos foram gerados para a realização deste trabalho. O primeiro artigo relata os mecanismos e as consequências do consumo simultâneo de álcool e maconha durante gravidez, cujo efeito é ainda mais nocivo ao desenvolvimento do feto do que apenas a exposição ao álcool. Dados recentes demonstram a interação do etanol e da maconha com o sistema Endocanabinoide, que tem um papel importante no neurodesenvolvimento. Depois do fechamento do tubo neural, que acontece durante a terceira semana da gestação humana, os olhos e o cérebro se desenvolvem do neuroepitélio. Ambos, o álcool e maconha interferem sinergicamente nesse processo via receptores canabinóides, alterando assim a sinalização “sonichedgehog”, que por sua vez, resulta em alterações morfológicas e comportamentais em modelos animais. Além disso, o artigo relata os mais recentes achados de estudos clínicos sobre a combinação da dose e tipo de constituintes químicos da machonha, bem como os desfechos morfológicos e neurocomportamentais da exposição conjunta do álcool e da maconha. O segundo artigo é uma revisão sistemática que investiga as pesquisas realizadas no Brasil sobre o TEAF, com ênfase nos instrumentos usados para a avaliação neuropsicológica de indivíduos com TEAF. Enquanto países desenvolvidos têm décadas de pesquisa sobre o TEAF, no Brasil, inúmeros fatores comprometem o progresso nesta e outras áreas de pesquisa. Entre esses fatores podemos citar, divergências socioeconômicas, culturais e geopolíticas, que dificultam o desenvolvimento, adaptação e validação de instrumentos utilizados no diagnóstico e na avaliação neuropsicológica do TEAF. Além disso, vale ressaltar que a vulnerabilidade socioeconômica da população brasileira é um fator importante no aumento da ocorrência de formas mais graves de TEAF. A revisão sistemática aponta para a necessidade da validação das ferramentas neuropsicológicas de diagnóstico e avaliação cognitiva de pessoas com TEAF e da participação de uma equipe multidisciplinar no diagnóstico do TEAF. / [en] Alcohol consumption during pregnancy may damage the development of the fetus, resulting in the most common preventable cause of neurodevelopmental disability in the world: Fetal Alcohol Spectrum Disorders (FASD). The present dissertation aims to discuss the effects of alcohol on the developing CNS through two articles. The first article elucidates the mechanisms and outcomes of the combined alcohol and cannabis exposure in the offspring through preclinical studies. Alcohol teratogenesis is more potent when administered with cannabis and has more negative effects on the fetus than alcohol alone. Recent data demonstrate the interaction of ethanol and cannabis with the Endocannabinoid system, which plays an important role in neurodevelopment and explains the morphological and behavioral changes seen in preclinical studies. The second article is a systematic review that investigates Brazilian research on FASD, focusing on the instruments used for the neuropsychological assessment of individuals with FASD. While developed countries have decades of research on FASD, in Brazil numerous factors slow down the progress of in this and other areas of research. Socioeconomic status, cultural, and geopolitical divergences are some of these factors, which hinder the development, adaptation, and validation of instruments used in the diagnosis and neuropsychological assessment of FASD. In addition, it is worth noting that the socioeconomic vulnerability of the Brazilian population is an important factor in the increase in the occurrence of more severe forms of FASD. The systematic review points to the need to validate neuropsychological tools for the diagnosis and cognitive assessment of individuals with FASD in Brazil, and the participation of a multidisciplinary team in the diagnosis of FASD.