reports characteristics of women who used MDMA versus women who did not use MDMA while pregnant. The maternal sample at enrollment was primarily white, married or with a partner, with some university education, middle socioeconomic status, and in the average range of intellectual ability. MDMA-using women differed from nonusing women only in having fewer children. Overall prenatal drug use and the negative sequelae of drug use differed between groups ( and ). Women who used MDMA during pregnancy had higher Drug Abuse Screening Test scores, indicating greater severity of sequelae from drug use, although both groups scored very low.
Maternal and Child Characteristics
Sample Characteristics at 1-Year Follow-up by Heavier, Lighter, and Non-MDMA Exposure (n = 79)
All births were singleton and birth parameter outcomes did not differ by group except that MDMA-exposed infants were more likely to be male. One child in the MDMA group was diagnosed with Townes-Brocks Syndrome, a rare genetic autosomal dominant multiple malformation of the gene SALL1.26
All outcomes with significant findings were rerun excluding this child and results did not differ. Thus, the presented findings include all in the MDMA-exposed group.
Compared with mothers who came to the 12-month assessment, mothers who did not come were younger, less educated, had a lower score on the Wechsler Abbreviated Scale of Intelligence Similarities subtest, and used more cigarettes during pregnancy. No other difference was found. describes the characteristics of mothers and infants seen at 12 months compared by heavier, lighter, and nonexposed status, indicating similar differences as seen in the dichotomous comparisons.
describes the average and median drug use for heavier, lighter, and no-use groups across all substances reported. MDMA users used more tobacco, marijuana, cocaine, amphetamines, LSD, and mushrooms than nonusers. Non-MDMA users were more likely to decrease their use of other drugs during pregnancy than MDMA users (see Moore et al15
and Singer et al14
for details). Over the pregnancy, most MDMA users discontinued use, with only 1 woman reporting use in the third trimester.
Average Maternal Drug Use During Pregnancy by Heavier, Lighter, and Non-MDMA Exposure
Before pregnancy, the mean number of tablets ingested per week was 3.2 (SD = 5.2, Range = 0.1–26.3) for those who used MDMA during pregnancy. The mean total amount of MDMA used during pregnancy and the month previous was 25 tablets (SD = 43.7, Range = 0.45–180). Heavier users averaged 3.3 (±4) tablets in the month before pregnancy compared with 0.12 ± 0.2 tablets for lighter users (Wilcoxon test P < .007); 1.6 ± 2 vs 0.12 ± 1 tablets in the first trimester (P < .12), and 0.15 ± 0.6 vs 0.02 ± 0.1 in the second trimester (P > .20).
Child Outcomes at 12 Months
Higher amounts of MDMA exposure predicted poorer mental and motor outcomes and assessor ratings of poorer motor quality at 12 months, controlling for covariates (see , , , and ). Group outcomes based on heavier, lighter, and no exposure indicated that infants with heavier exposure had a 5-point deficit in MDI, compared with lighter and nonexposed MDI children. Two children in the more heavily exposed group were in the at-risk range (<85), compared with no children in the other groups. Greater deficits related to heavier MDMA exposure were found in motor outcomes, with most of the more heavily exposed children classified as at-risk (PDI < 85), and one-third demonstrating significant developmental delay (PDI < 70), compared with less than a third at-risk and <10% in the delayed range in the lighter and nonexposed groups. There was also a nonsignificant trend for MDMA exposure to predict less orientation and engagement (β = –1.9, t = –1.7, P < .09).
Effects of Amount of MDMA Exposure Over Pregnancy and Month Previous on Bayley Mental Development Index at 12 Months
Effects of Amount of MDMA Exposure Over Pregnancy and Month Previous on Bayley Psychomotor Development Index at 12 Months
Effects of MDMA Exposure Over Pregnancy and Month Previous on Bayley Behavioral Rating Scale Motor Quality at 12 Months
Twelve-Month (Adjusted) Outcomes by Heavier Versus Lighter and Nonexposed MDMA Status, Mean (SD)
MDMA exposure was unrelated to language or emotional regulation outcomes. Lighter MDMA-exposed infants were equivalent to nonexposed infants on all outcomes. There were no differences in maternal report of parenting stress related to child characteristics.
Several family characteristics and drug exposures had effects on outcomes in addition to MDMA. The Home Observation of the Environment was related to higher MDI (β = 0.65, t = 2.4, P < .02), and better emotional regulation (β = 3.01, t = 3.01, P < .004), orientation (β = 0.24, t = 2.2, P < .03), and language scores (all with P < .05). Higher maternal General Severity Index predicted greater child domain stress (β = 0.60, t = 1.9, P < .057). Boys had lower MDI (β = –4.0, t = 2.0, P < .05), and lower emotional regulation scores (β = –15.3, t = –2.1, P < .036). Higher alcohol exposure predicted better orientation (β = 6.8 ± 3.0, t = 2.5, P < .02) and expressive language (β = 2.9 ± 1.0, t = 3.1, P < .003), whereas higher crack-cocaine exposure predicted lower expressive language scores (β = –5.3 ± –2.5, t = –2.1, P < .04).