Externalizing Behavioral Problems, Stress Reactivity And Obesity Adolescents Within Utero Cocaine Exposure

Prenatal cocaine exposure (PCE) has been implicated as a risk factor for pediatric obesity (OBE) by neurochemically impacting dopaminergic pathways that lead to compulsive/impulsive behavior (externalizing disorders) and functioning as an intrauterine stressor altering neuroendocrine systems (cortisol reactivity) related to metabolism and behavioral dysregulation. Higher symptoms of externalizing disorders (e.g., ADHD and ODD) have been associated with PCE and OBE. Cortisol reactivity has also been associated with PCE and OBE. We know of no research examining the association between PCE, externalizing disorders/cortisol reactivity and OBE. Objective. To determine relevant pathways between PCE and OBE (BMI for age ≥ sex-specific 95 th percentile) and overweight (OW, BMI for age ≥ sex-specific 85 th and th percentile). Methods. We examined adolescents (N=1388; n=658 PCE; n=730 matched comparisons) with height and weight data at 12 years of age from the Maternal Lifestyle Study (52% boys, 77% Black). Planned comparisons tested the association between PCE and OBE/OW on teacher reported symptoms of externalizing disorders at 7 years (ADHD-inattentive, hyperactive/impulsive and combined types, oppositional defiance disorder [ODD]) and on cortisol reactivity at 11 years of age. Results. The sample was 26% OBE and 17% OW. More symptoms of ADHD (all types) and ODD were reported in OBE PCE adolescents vs. OBE non PCE, PCE normal weight, and non PCE normal weight adolescents (all p ’s p Conclusions. We found the highest symptoms of ADHD and ODD among PCE OBE and increased cortisol reactivity among PCE OW adolescents. Findings suggest externalizing disorders may mediate the pathway between PCE and OBE. The differential effects of externalizing disorders on OBE and stress reactivity on OW highlight the possibility of two pathways for PCE and OBE.