Journal Issue: Health Care Reform Volume 3 Number 2 Summer/Fall 1993
Medical and Developmental Impact of Prenatal Drug Exposure
Dr. Barry Zuckerman, chief of the Division of Developmental and Behavioral Pediatrics at Boston City Hospital, provides the following update:
By spring 1991, preliminary studies had raised significant concerns about prenatal cocaine exposure because of findings of adverse effects on newborns, including smaller growth and head circumference, an excessively high rate of sudden infant death syndrome (SIDS), increased birth defects, and increased neurobehavioral dysfunction compared with non-cocaine-exposed infants.8 Subsequent studies with improved scientific rigor have confirmed findings for smaller growth and head circumference, but not the other findings.9 Smaller head circumference reflects poorer brain growth. Some children born with smaller head circumference grow to have normal size heads and others do not.10
The findings for neurobehavioral dysfunction (e.g., irritability in newborns) are inconsistent, but if there is such impact, the current state of knowledge suggests it is small. The first, and at this time only, study to follow up cocaine and not opiate-exposed infants shows no mean differences on scores of the child's development at two years of age when cocaine-exposed children were compared with social-class-matched controls.10 This finding is consistent with previous studies of opiate-exposed infants conducted before cocaine became a problem.11
The best summary of the present state of information is that children exposed to cocaine prenatally are at risk but not doomed. However, there are still many questions to answer. Cocaine is a powerful drug that theoretically may influence the child's capacity to pay attention and regulate his or her emotions. Because these functions cannot be evaluated accurately in infants and young children, definitive conclusions regarding possible neurobehavioral effects of prenatal cocaine exposure, if any, will not be known until rigorous scientific studies are conducted on school-aged children. Other questions that need to be answered include the impact on newborns of heavy cocaine use by their mothers during pregnancy and of the interaction of cocaine and other legal and illegal drugs. The extent of the role of the child's environment, including nutrition and caretaking, and the impact of the child's exposure to violence in his home and community still need to be addressed. Whatever the ultimate results of long-term studies, clinical experience suggests that there is a great variability of function among children with histories of prenatal cocaine exposure.
Reports in the lay press based primarily on anecdotes and preliminary clinical observations resulted in a rush to judgment on the impact of cocaine.12 Cocaine-exposed infants and young children, or as they were referred to in the press, "crack babies," were described as being unable to control their impulses and unable to learn. These descriptions were not based on scientific data. By contrast, the limited data available at this time indicate that a supportive caretaking environment may do much to compensate for the child's early drug exposure.