Growth, development, and behavior in early childhood following prenatal cocaine exposure - A systematic review

Context Despite recent studies that failed to show catastrophic effects of prenatal cocaine exposure, popular attitudes and public policies still refl ect the belief that cocaine is a uniquely dangerous teratogen. Objective To critically review outcomes in early childhood after prenatal c ocaine 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 Oct ober 2000. Study Selection Studies selected for detailed review (1) were published in a peer-reviewed English-language journal; (2) included a corn parison group ; (3) recruited samples prospectively in the perinatal period; (4) used mas ked assessment; and (5) did not include a substantial proportion of subject s exposed in utero to opiates, amphetamines, phencyclidine, or maternal hum an 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 n egative association between prenatal cocaine exposure and physical growth, developmental test scores, or receptive or expressive language. Less optima l motor scores have been found up to age 7 months but not thereafter, and m ay 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 manipula tions of standard instruments suggest an association between prenatal cocai ne exposure and decreased attentiveness and emotional expressivity, as well as differences on neurophysiologic and attentional/affecive findings. Conclusions Among children aged 6 years or younger, there is no convincing evidence that prenatal cocaine exposure is associated with developmental to xic effects that are different in severity, scope, or kind from the sequela e of multiple other risk factors. Many findings once thought to be specific effects of in utero cocaine exposure are correlated with other factors, in cluding prenatal exposure to tobacco, marijuana, or alcohol, and the qualit y of the child's environment. Further replication is required of preliminar y neurologic findings.