Prenatal cocaine exposure

Richardson GA. (1998). Prenatal cocaine exposure. A longitudinal study of development. Ann N Y Acad Sci. 846 144-52. 

Ridener Gottwald, S. and Thurman, S.K. (1994) The effects of prenatal cocaine exposure on mother-infant interaction and arousal in the newborn period. Topics in Early Childhood Special... 

Keller, R.W. and Snyder-Keller, A. (2000) Prenatal cocaine exposure. Ann NY Acad Sci 909 217-232. 

In a third study the Robert Wood Johnson database of published literature on prenatal cocaine exposure and child outcome was examined (274). Only 8 of 101 studies focused on school-age children. Intelligence quotient (IQ), receptive language, and expressive language were measured. This meta-analysis showed an average difference of 3.12 IQ points between cocaine-exposed and control groups. When the IQ distribution is shifted downwards by this amount, there is a 1.6-fold increase in the number of children with IQs under 70. The authors noted that the calculated decrement in IQ in exposed children is subtle and does not include the possible effect of the drug on domains of function such as language abilities. 

The effects of prenatal cocaine exposure on information processing and developmental assessment have been studied in 108 infants aged 3 months, 61 of whom had been exposed to cocaine, and 47 controls using an infant-control habituation and novelty responsiveness procedure in a developmental assessment using the Bayley Scales of Infant Development (276). Infants exposed to cocaine prenatally were significantly more likely than controls to... 

The behavioral effects of prenatal cocaine exposure at age 5 years have been studied in 140 children exposed to cocaine, 61 exposed to alcohol, tobacco, and/or marijuana, and 120 not exposed to any drugs (290). They were evaluated with the Achenbach Child Behavior Checklist. There was no association between behavior and intrauterine cocaine exposure. However, the current behavioral health of the mother, including recent drug use and psychological functioning, did affect the child s internalizing and externalizing behavior. 

However, in a prospective, large-scale, longitudinal study there was no association between prenatal cocaine exposure and congenital anomalies in 272 offspring of 154 cocaine-using mothers and 154 non-using matched... 

This review generated responses from other authorities in the field. Some commented that the conclusions may be premature, given the age of the subjects, and drew attention to several studies that have shown subtle but consistent deficits in cognitive and attentional processes in 6-and 7-year-old children (302). These effects may become more prominent as development continues and may persist into adulthood. Others criticized the attempt to isolate cocaine exposure from all other associated risk factors from a public health perspective, prenatal cocaine exposure clusters with other risk factors, such as poor caregiving, child maltreatment, domestic violence, and prenatal exposure to other substances (303). Furthermore, the selection criteria narrowed the total articles reviewed to under half of the 74 articles found. Others suggested that the study had been misinterpreted (304). 

In a retrospective review of all dysrhythmias in children with prenatal cocaine exposure, 18 cases were detected in 554 infants who had positive urine screens for cocaine (318). In 13 neonates the dysrhythmia occurred beyond the period of direct cocaine exposure and six of the children had dysrhythmias after the neonatal period. Most of the dysrhythmias were supraventricular extra beats. Overall, the rate of consultations for dysrhythmias was higher among cocaine-exposed neonates than expected. Some cocaine-exposed children had symptomatic dysrhythmias that were persistent or recurrent and required treatment to maintain cardiac output and restore normal cardiac rhythm. Children who were exposed prenatally to cocaine appeared to be at increased risk of abnormal responses to stress, manifested by symptomatic dysrhythmias beyond the period of cocaine exposure. 

Prenatal cocaine exposure has been associated with subependymal hemorrhage and subependymal cyst formation in term neonates and more recently in preterm neonates (<36 weeks of gestation) (325). Medical records and cranial sonograms obtained during 1 year on 122 premature infants showed an increased incidence of subependymal cysts in preterm cocaine-exposed infants (8 of 18) compared with non-exposed infants (8 of 99). There was no increase in the incidence of major structural abnormalities. All subependymal cysts resolved by 4 months of age. The authors noted that the neurodevelop-mental implications of such cyst formation are unknown. 

A second report from the Maternal Lifestyle Study focused on motor development in 392 children prenatally exposed to cocaine and 776 non-exposed control infants who were identified by meconium assay and mothers self-reporting (327). Motor skills were assessed at 1 month with the NICU Network Neurobehavioral Scale (NNNS), at 4 months with the posture and fine motor assessment of infants (PFMAI), at 12 months with the Bayley Scales of Infant Development-2nd edition (BSID-II), and at 18 months with the Peabody Developmental Motor Scales (PDMS). The infants with prenatal cocaine exposure had motor skill deficits at 1 month, but normal function at 18 months. Heavy cocaine use was associated with poorer motor performance. Both lower and higher nicotine exposures related to poorer motor performance. 

The long-term consequences of prenatal cocaine exposure in school-age children on intelligence, visuomotor skills, and motor abilities have been studied by comparing 101 children exposed perinatally to cocaine with 130 unexposed children at age 7 years (332). The children who were exposed prenatally to cocaine continued to... 

It has been argued that cocaine exposure effects will be most evident in the domains of attention and affective regulation (Frank 1613,350). It is therefore plausible that the effects of prenatal cocaine exposure may nevertheless become more evident during the development of more advanced motor (351), cognitive (352), language (353), and behavioral skills (354). 

It has been argued that a failure to find enduring behavioral effects of prenatal cocaine exposure in some studies may have been related to the use of broad, relatively insensitive measures (357,358). Furthermore, to judge the effect of prenatal cocaine exposure based on a dichotomous variable (yes/no) may not be an appropriate study design (359,360). 

In the second study the same group evaluated the effects of prenatal cocaine exposure on child behavior in 506 African-American mother-child pairs (363). The mothers were identified as cocaine users and non-users during the initial prenatal visits with urine screen confirmation. Offspring behavior was assessed 6-7 years later using caregiver reports with the Achenbach Child Behavior Checklist (CBCL). Analyses stratified by sex and prenatal alcohol exposure showed that behaviors in girls without prenatal alcohol exposure but with prenatal cocaine exposure were adverse 6.5% of the unique variance in behavior was related to prenatal cocaine... 

Although data from animal research has also confirmed a sex-specific effect of prenatal cocaine exposure (364), studies in humans have not consistently supported this (365). Nevertheless, there is other evidence that prenatal cocaine exposure has a sex-related effect on cognition at 4 years of age (366). 

The Miami Prenatal Cocaine Study is a prospective study starting at birth. The effect of prenatal cocaine exposure on language functioning in 476 full-term African-American infants has been evaluated longitudinally at six times, from 4 months to 3 years of age (369). The children were categorized as cocaine-exposed (n = 253) or non-cocaine exposed (n = 223) by maternal self report and bioassays using maternal/infant urine and meconium. The Bay ley Scale of Infant... 

Jones KL. Developmental pathogenesis of defects associated with prenatal cocaine exposure fetal vascular disruption. Clin Perinatol 1991 18(l) 139-46. 

Wasserman GA, Kline JK, Bateman DA, Chiriboga C, Lumey LH, Friedlander H, Melton L, Heagarty MC. Prenatal cocaine exposure and school-age intelligence. Drug Alcohol Depend 1998 50(3) 203-10. 

Delaney-Black V, Covington C, Templin T, Ager J, Martier S, Sokol R. Prenatal cocaine exposure and child behavior. Pediatrics 1998 102(4 Pt l) 945-50. 

Tronick EZ, Frank DA, Cabral H, Mirochnick M, Zuckerman B. Late dose-response effects of prenatal cocaine exposure on newborn neurobehavioral performance. Pediatrics 1996 98(l) 76-83. 

Held JR, Riggs ML, Dorman C. The effect of prenatal cocaine exposure on neurobehavioral outcome a metaanalysis. Neurotoxicol Teratol 1999 21(6) 619-25. 

Frank DA, Jacobs RR, Beeghly M, Augustyn M, Bellinger D, Cabral H, Heeren T. Level of prenatal cocaine exposure and scores on the Bayley Scales of Infant Development modifying effects of caregiver, early intervention, and birth weight. Pediatrics 2002 110(6) 1143-52. 

Maries SL, Reed M, Evans JA. Humeroradial synostosis, ulnar aplasia and oligodactyly, with contralateral amelia, in a child with prenatal cocaine exposure. Am J Med Genet 2003 116A 85-9. 

Church MW, Holmes PA, Tilak JP, Hotra JW. Prenatal cocaine exposure influences the growth and life span of laboratory rats. Neurotoxicol Teratol 2004 26 429 11. 

Bandstra ES, Morrow CE, Anthony JC, Churchill SS, Chitwood DC, Steele BW, Ofir AY, Xue L. Intrauterine growth of full-term infants impact of prenatal cocaine exposure. Pediatrics 2001 108(6) 1309-19. 

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