Secondary Disabilities in Finnish Youth with Prenatal Substance Exposure: A longitudinal register-based cohort study on secondary education, financial difficulties and mood and neurotic disorders in youth with prenatal substance exposure

Niina-Maria Nissinen

Research output: Book/ReportDoctoral thesisCollection of Articles

Abstract

Exposure to substances (i.e.alcohol and/or illicit drugs) during pregnancy imposes a significant risk for fetal development, especially for the central nervous system (CNS) and brain development. Impairments in the CNS can manifest as various deficits in cognitive and behavioural functioning, commonly referred to as primary disabilities in the context of prenatal substance exposure. The primary disabilities can predispose an individual with prenatal substance exposure to other challenges in various areas of life, including mental health, education, employment and financial self-supporting. These disabilities prenatally substance exposed individuals may encounter are commonly termed secondary disabilities. In addition to risk factors occurring during the prenatal period, psychosocial factors of the caregiving environment can also influence one’s developmental trajectories. The postnatal caregiving environment of children with prenatal substance exposure is often characterised by adversities, and a high proportion of these children are placed in out-of-home care (OHC) in early childhood. Thus, secondary disabilities in youth with prenatal substance exposure may result from this double jeopardy. However, we know relatively little about the secondary disabilities in youth with prenatal substance exposure and the influence of other risk factors (especially adversities and caregiving instability in the postnatal caregiving environment) on these secondary disabilities.

The overall aim of this dissertation was to study secondary disabilities in Finnish youth aged 15 to 24 years old with prenatal substance exposure. More specifically, the aim was to investigate: (1) completed secondary education (Study I), (2) financial difficulties measured as the recipiency of long-term financial social assistance (FSA), and (3) mood and neurotic disorders measured as specialised healthcare episodes (i.e. inpatient or outpatient hospital care) for mood and neurotic disorders -related diagnosis (Study III) among youth with prenatal substance exposure. In all the sub-studies, the aim was also to study associations between prenatal substance exposure, youth characteristics, and adverse maternal characteristics and OHC, and the studied secondary disabilities.

This dissertation was based on the ADEF Helsinki (Alcohol and/or Drug Exposure During Fetal Life) study, which is a longitudinal register-based cohort study. The overall study population consisted of 615 youth with prenatal exposure to substances (i.e. the exposed cohort) and 1787 matched unexposed youth (i.e. the unexposed cohort). The youth in the exposed cohort were born in 1992–2001 to mothers whose pregnancies were followed up at the special antenatal clinics (i.e. HAL clinics) in the Helsinki metropolitan area due to identified substance abuse during pregnancy. Youth in the unexposed cohort were born in 1992–2001 to mothers with no registered evidence of substance use one year before the birth of the offspring or at the time of birth in the national health and social care registers. The cohorts were matched for five maternal characteristics including maternal age at the time of offspring’s birth, parity, number of fetuses, month of birth, and delivery hospital of the index child. Register data were collected identically for the exposed and unexposed mother-child dyads from birth until the end of follow-up in 2016.

Multivariable logistic regression analysis was applied in Study I to investigate completed secondary education, whereas financial difficulties in Study II were studied using generalised linear models and mediation analysis. Mood and neurotic disorders in Study III were studied using multivariable Cox’s proportional hazard regression analysis and mediation analyses.

Overall, the results of this dissertation showed that youth with prenatal substance exposure had an increased likelihood of experiencing secondary disabilities compared with unexposed youth. More specifically, the results of the descriptive and unadjusted analyses showed that compared to unexposed youth, youth with prenatal substance exposure had: (1) delayed completion of secondary education and an overall lower secondary education completion rate (Study I), (2) higher likelihood of financial difficulties (Study II) and (3) a two-fold higher likelihood of being in specialised healthcare for mood and neurotic disorders (Study III).

Furthermore, the results of this dissertation showed: (4) maternal prenatal substance abuse was interlinked with an accumulation of adversities in the postnatal caregiving environment, and a high proportion of prenatally substance-exposed youth had been placed in OHC in early childhood. These factors had a strong influence on secondary disabilities apart from on secondary education completion. The results of the adjusted analyses showed: (5) prenatal substance exposure was not independently associated with a lack of secondary education, and different forms of youth mental/behavioural disorders independently reduced the likelihood of completed secondary education. (6) Prenatal substance exposure was not independently associated with youth’s financial difficulties, and these difficulties were influenced by youth’s mental/behavioural disorders and lack of secondary education in addition to maternal financial difficulties and OHC. Maternal financial difficulties and OHC also mediated a large proportion of the association between prenatal substance exposure and youth’s financial difficulties. (7) The association between prenatal substance exposure and mood and neurotic disorders was attenuated to a non-significant level when the influence of other predictors was controlled for. Accumulation of adverse maternal characteristics and OHC in addition to female sex were associated with an increased likelihood of mood and neurotic disorders. OHC also mediated a large proportion of the association between prenatal substance exposure and youth’s mood and neurotic disorders.

In light of the research findings, youth with prenatal substance exposure seem to be a group vulnerable to various avoidable secondary disabilities in the youth period, especially when considering the accumulation of postnatal risk factors in these populations and their associations with secondary disabilities.

The dissertation sheds light on areas where further research is needed, including studies on secondary disabilities incorporating information on primary disabilities in prenatally substance-exposed youth. This information could provide a better understanding of risk factors that increase susceptibility to secondary disabilities, and providing directions for the prevention of secondary disabilities in these youth. The study also highlights the need for studies including more detailed information on the characteristics of the postnatal caregiving environment and their associations with secondary disabilities in youth with prenatal substance exposure. The results also indicated implications for public health and prevention and the need for multiprofessional preventative measures at different levels: from the prevention of substance use during pregnancy to the early and long-term individualised support for the affected individual and their family. This also calls for more comprehensive knowledge and adequate training of professionals. The results also highlight the need for preventative measures to secure a safe and stable postnatal caregiving environment, especially among children and youth in OHC.
Original languageEnglish
Place of PublicationTampere
ISBN (Electronic)978-952-03-3068-2
Publication statusPublished - 2023
Publication typeG5 Doctoral dissertation (articles)

Publication series

NameTampere University Dissertations - Tampereen yliopiston väitöskirjat
Volume867
ISSN (Print)2489-9860
ISSN (Electronic)2490-0028

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