Growth of infants prenatally exposed to cocaine/crack: Comparison of a prenatal care and a no prenatal care sample

Objective. It has not been possible to draw firm conclusions about the effe cts of prenatal cocaine exposure because of methodologic problems involved in the conduct of this research. This study, designed to overcome some of t hese methodologic problems, is a prospective, longitudinal investigation of the effects of prenatal cocaine/crack exposure on neonatal growth in two s amples, one with and one without prenatal care (PC). Methods. Women in the PC sample (n = 295) were interviewed at the end of ea ch trimester about their use of cocaine, crack, alcohol, tobacco, marijuana , and other drugs. Women in the no prenatal care (NPC) sample (n = 98) were interviewed at delivery about their drug use during each trimester of preg nancy. In both samples, information was also obtained about sociodemographi c, lifestyle, psychologic, and social support characteristics. Both samples consisted of women who were predominantly low income, single, and high sch ool educated. Of the women, 48% in the PC sample were black; 81% in the NPC sample were black. Infants were examined during the postpartum hospital st ay by project nurses who were blind to maternal substance use status. Results. Women in both samples who used cocaine/crack during pregnancy were older, had lower family incomes, and used more alcohol than did women who did not use cocaine/crack during pregnancy. In addition, women in the NPC s ample were more likely to be black, less educated, gained less weight durin g pregnancy, and used more alcohol than did women in the PC sample, regardl ess of cocaine use. In both samples, cocaine/crack use during early pregnan cy predicted reduced gestational age, birth weight, length, and head circum ference, after controlling for the significant covariates of cocaine use. I n a comparison of the samples, the offspring of the NPC/cocaine group were significantly smaller than were the offspring of the PC/no cocaine group, w hereas the offspring of the PC/cocaine and NPC/cocaine groups did not diffe r. Conclusions. These results indicate that exposure to cocaine/crack during e arly pregnancy decreases the intrauterine growth of exposed offspring in wo men with and without PC. Each of the growth parameters was affected indicat ing symmetric growth retardation. The adequacy of PC was not a significant factor in determining the difference between cocaine-exposed and nonexposed infants. These samples are being followed throughout childhood to determin e whether there are long-term effects of prenatal cocaine/crack exposure on growth.