Context Despite recent studies that failed to show catastrophic effects of prenatal
cocaine exposure, popular attitudes and public policies still reflect the
belief that cocaine is a uniquely dangerous teratogen.
Objective To critically review outcomes in early childhood after prenatal cocaine
exposure in 5 domains: physical growth; cognition; language skills; motor
skills; and behavior, attention, affect, and neurophysiology.
Data Sources Search of MEDLINE and Psychological Abstracts
from 1984 to October 2000.
Study Selection Studies selected for detailed review (1) were published in a peer-reviewed
English-language journal; (2) included a comparison group; (3) recruited samples
prospectively in the perinatal period; (4) used masked assessment; and (5)
did not include a substantial proportion of subjects exposed in utero to opiates,
amphetamines, phencyclidine, or maternal human immunodeficiency virus infection.
Data Extraction Thirty-six of 74 articles met criteria and were reviewed by 3 authors.
Disagreements were resolved by consensus.
Data Synthesis After controlling for confounders, there was no consistent negative
association between prenatal cocaine exposure and physical growth, developmental
test scores, or receptive or expressive language. Less optimal motor scores
have been found up to age 7 months but not thereafter, and may reflect heavy
tobacco exposure. No independent cocaine effects have been shown on standardized
parent and teacher reports of child behavior scored by accepted criteria.
Experimental paradigms and novel statistical manipulations of standard instruments
suggest an association between prenatal cocaine exposure and decreased attentiveness
and emotional expressivity, as well as differences on neurophysiologic and
attentional/affective findings.
Conclusions Among children aged 6 years or younger, there is no convincing evidence
that prenatal cocaine exposure is associated with developmental toxic effects
that are different in severity, scope, or kind from the sequelae of multiple
other risk factors. Many findings once thought to be specific effects of in
utero cocaine exposure are correlated with other factors, including prenatal
exposure to tobacco, marijuana, or alcohol, and the quality of the child's
environment. Further replication is required of preliminary neurologic findings.