NEURODEVELOPMENT OF ADOPTED-CHILDREN EXPOSED IN-UTERO TO COCAINE

Objective: To assess the neurodevelopment of adopted children who had been exposed in utero to cocaine. Design: A case-control observational study. Participants: Twenty-three children aged 14 months to 6.5 year s exposed in utero to cocaine and their adoptive mothers, and 23 age-m atched control children not exposed to cocaine and their mothers, matc hed with the adoptive mothers for IQ and socioeconomic status. Setting : The Motherisk programme at The Hospital for Sick Children, Toronto, a consultation service for chemical exposure during pregnancy. Main ou tcome measures: Height, weight and head circumference at birth and at follow-up, and achievement on standard tests of cognitive and language development. Results: Compared with the control group, children expos ed in utero to cocaine had an 8 fold increased risk for microcephaly ( 95% confidence interval 1.5 to 42.3); they also had a lower mean birth weight (p = 0.005) and a lower gestational age (p = 0.002). In follow -up the cocaine-exposed children caught up with the control subjects i n weight and stature but not in head circumference (mean 31st percenti le v. 63rd percentile) (p = 0.001). Although there were no significant differences between the two groups in global IQ, the cocaine-exposed children had significantly lower scores than the control subjects on t he Reynell language test for both verbal comprehension (p = 0.003) and expressive language (p = 0.001). Conclusions: This is the first study to document that intrauterine exposure to cocaine is associated with measurable and clinically significant toxic neurologic effects, indepe ndent of postnatal home and environmental confounders. Because women w ho use cocaine during pregnancy almost invariably smoke cigarettes and often use alcohol, it is impossible to attribute the measured toxic e ffects to cocaine alone.