Acute Neonatal Effects of Cocaine Exposure During Pregnancy | Infectious Diseases | JAMA Pediatrics | JAMA Network
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September 2005

Acute Neonatal Effects of Cocaine Exposure During Pregnancy

Author Affiliations

Author Affiliations: Department of Pediatrics, University of Miami School of Medicine, Miami, Fla (Dr Bauer); Research Triangle Institute, Research Triangle Park, NC (Mr Langer); Department of Pediatrics, Wayne State University School of Medicine, Detroit, Mich (Dr Shankaran); Department of Pediatrics, University of Tennessee, Memphis, College of Medicine (Dr Bada); Department of Pediatrics, Brown Medical School, Women’s and Infants’ Hospital, Providence, RI (Dr Lester); National Institute of Child Health and Human Development, Bethesda, Md (Dr Wright); The George Washington University Biostatistics Center, Washington, DC (Ms Krause-Steinrauf and Dr Verter); National Institute on Drug Abuse, Bethesda (Dr Smeriglio); Center for Substance Abuse Treatment, Washington (Dr Finnegan); and Administration on Children, Youth, and Families, Washington (Dr Maza). Dr Bada is now at the University of Kentucky, Lexington. Dr Finnegan is now at the Office of Research on Women’s Health, National Institutes of Health, Bethesda.

Arch Pediatr Adolesc Med. 2005;159(9):824-834. doi:10.1001/archpedi.159.9.824

Objective  To identify associations between cocaine exposure during pregnancy and medical conditions in newborn infants from birth through hospital discharge.

Design  Multisite, prospective, randomized study.

Setting  Brown University, University of Miami, University of Tennessee (Memphis), and Wayne State University.

Subjects  A total of 717 cocaine-exposed infants and 7442 nonexposed infants.

Main Outcome Measures  Results of physical examination and conditions observed during hospitalization.

Results  Cocaine-exposed infants were about 1.2 weeks younger, weighed 536 g less, measured 2.6 cm shorter, and had head circumference 1.5 cm smaller than nonexposed infants (all P<.001). Results did not confirm previously reported abnormalities. Central and autonomic nervous system symptoms were more frequent in the exposed group: jittery/tremors (adjusted odds ratio, 2.17; 99% confidence interval, 1.44-3.29), high-pitched cry (2.44; 1.06-5.66), irritability (1.81; 1.18-2.80), excessive suck (3.58; 1.63-7.88), hyperalertness (7.78; 1.72-35.06), and autonomic instability (2.64; 1.17-5.95). No differences were detected in organ systems by ultrasound examination. Exposed infants had more infections (3.09; 1.76-5.45), including hepatitis (13.46; 7.46-24.29), syphilis (8.84; 3.74-20.88), and human immunodeficiency virus exposure (12.37; 2.20-69.51); were less often breastfed (0.26; 0.15-0.44); had more child protective services referrals (48.92; 28.77-83.20); and were more often not living with their biological mother (18.70; 10.53-33.20).

Conclusions  Central and autonomic nervous system symptoms were more frequent in the exposed cohort and persisted in an adjusted analysis. They were usually transient and may be a true cocaine effect. Abnormal anatomic outcomes previously reported were not confirmed. Increased infections, particularly sexually transmitted diseases, pose a serious public health challenge. Exposure increased involvement of child protective services and out-of-home placement.