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September 1, 2004

Lead Exposure and Cognitive Outcomes of Children With Prenatal Cocaine Exposure

JAMA. 2004;292(9):1021. doi:10.1001/jama.292.9.1021-a

To the Editor: We read with interest the article by Dr Singer et al1 concerning the cognitive outcomes of preschool children with prenatal exposure to cocaine. The authors make a concerted effort to control for multiple confounding variables, including sex, intelligence of caregivers, and degree of cocaine exposure. They also stress the importance of the environment in which the children are placed as a determinant of their cognitive outcome. However, they do not address lead levels, an important environmental variable known to be strongly associated with both socioeconomic status and development of cognitive ability.2-5 We believe that the absence of this information may weaken their conclusions.

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