This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (148)  • Contact me when this article is cited  Related Content  • Related letter  • Related articles  • Similar articles in JAMA  Topic Collections  • Pediatrics  • Child Development  • Substance Abuse/ Alcoholism  • Review  • Alert me on articles by topic  Social Bookmarking   What's this?

A Systematic Review

Deborah A. Frank, MD; Marilyn Augustyn, MD; Wanda Grant Knight, PhD; Tripler Pell, MSc; Barry Zuckerman, MD

JAMA. 2001;285:1613-1625.

Context  Despite recent studies that failed to show catastrophic effects of prenatal cocaine exposure, popular attitudes and public policies still reflect the belief that cocaine is a uniquely dangerous teratogen.

Objective  To critically review outcomes in early childhood after prenatal cocaine 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 October 2000.

Study Selection  Studies selected for detailed review (1) were published in a peer-reviewed English-language journal; (2) included a comparison group; (3) recruited samples prospectively in the perinatal period; (4) used masked assessment; and (5) did not include a substantial proportion of subjects exposed in utero to opiates, amphetamines, phencyclidine, or maternal human 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 negative association between prenatal cocaine exposure and physical growth, developmental test scores, or receptive or expressive language. Less optimal motor scores have been found up to age 7 months but not thereafter, and may 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 manipulations of standard instruments suggest an association between prenatal cocaine exposure and decreased attentiveness and emotional expressivity, as well as differences on neurophysiologic and attentional/affective findings.

Conclusions  Among children aged 6 years or younger, there is no convincing evidence that prenatal cocaine exposure is associated with developmental toxic effects that are different in severity, scope, or kind from the sequelae of multiple other risk factors. Many findings once thought to be specific effects of in utero cocaine exposure are correlated with other factors, including prenatal exposure to tobacco, marijuana, or alcohol, and the quality of the child's environment. Further replication is required of preliminary neurologic findings.

Author Affiliations: Boston University School of Medicine (Drs Frank, Augustyn, Grant Knight, and Zuckerman and Ms Pell) and Boston University School of Public Health (Drs Frank and Zuckerman), Boston, Mass.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED LETTER

Prenatal Cocaine Exposure as a Risk Factor for Later Developmental Outcomes
Gregg D. Stanwood, Pat Levitt, Lynn T. Singer, Robert E. Arendt, Virginia Delaney-Black, Chandice Y. Covington, Beth Nordstrom-Klee, Robert J. Sokol, Deborah A. Frank, Marilyn Augustyn, Wanda Grant Knight, Tripler Pell, and Barry Zuckerman
JAMA. 2001;286(1):45-47.
EXTRACT | FULL TEXT  

RELATED ARTICLES

Cocaine and Pregnancy—Time to Look at the Evidence
Wendy Chavkin
JAMA. 2001;285(12):1626-1628.
EXTRACT | FULL TEXT  

March 28, 2001
JAMA. 2001;285(12):1649-1650.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Family relationships in childhood and common psychiatric disorders in later life: systematic review of prospective studies
Weich et al.
Br. J. Psychiatry 2009;194:392-398.
ABSTRACT | FULL TEXT  

Biobehavioral Outcomes in Adolescents and Young Adults Prenatally Exposed to Cocaine: Evidence From Animal Models
Chae and Covington
Biol Res Nurs 2009;10:318-330.
ABSTRACT  

Short- and long-term adverse effects of cocaine abuse during pregnancy on the heart development
Meyer and Zhang
Ther Adv Cardiovasc Dis 2009;3:7-16.
ABSTRACT  

Effects of Prenatal Cocaine Exposure on Special Education in School-Aged Children
Levine et al.
Pediatrics 2008;122:e83-e91.
ABSTRACT | FULL TEXT  

Volumetric MRI Study of Brain in Children With Intrauterine Exposure to Cocaine, Alcohol, Tobacco, and Marijuana
Rivkin et al.
Pediatrics 2008;121:741-750.
ABSTRACT | FULL TEXT  

Altered Resting Cerebral Blood Flow in Adolescents With in Utero Cocaine Exposure Revealed by Perfusion Functional MRI
Rao et al.
Pediatrics 2007;120:e1245-e1254.
ABSTRACT | FULL TEXT  

Drug misuse during pregnancy and fetal toxicity
Anderson and Choonara
Arch. Dis. Child. Fetal Neonatal Ed. 2007;92:F332-F333.
FULL TEXT  

Impact of Prenatal Cocaine Exposure on Child Behavior Problems Through School Age
Bada et al.
Pediatrics 2007;119:e348-e359.
ABSTRACT | FULL TEXT  

Diffusion Tensor Imaging of Frontal White Matter and Executive Functioning in Cocaine-Exposed Children
Warner et al.
Pediatrics 2006;118:2014-2024.
ABSTRACT | FULL TEXT  

Proximal Variables in Families of Children Prenatally Exposed to Cocaine and Enrolled in a Center- or Home-Based Intervention
Bolzani Dinehart et al.
Journal of Early Intervention 2006;29:32-47.
ABSTRACT  

A Prospective Controlled Study of Neurodevelopment in HIV-Uninfected Children Exposed to Combination Antiretroviral Drugs in Pregnancy
Alimenti et al.
Pediatrics 2006;118:e1139-e1145.
ABSTRACT | FULL TEXT  

Introduction to the Special Issue: Impact of Prenatal Substance Exposure on Children's Health, Development, School Performance, and Risk Behavior
Coles and Black
J Pediatr Psychol 2006;31:1-4.
FULL TEXT  

Prenatal Cocaine Exposure and Children's Language Functioning at 6 and 9.5 Years: Moderating Effects of Child Age, Birthweight, and Gender
Beeghly et al.
J Pediatr Psychol 2006;31:98-115.
ABSTRACT | FULL TEXT  

Outcome from a Prospective, Longitudinal Study of Prenatal Cocaine Use: Preschool Development at 3 Years of Age
Behnke et al.
J Pediatr Psychol 2006;31:41-49.
ABSTRACT | FULL TEXT  

Acute Neonatal Effects of Cocaine Exposure During Pregnancy
Bauer et al.
Arch Pediatr Adolesc Med 2005;159:824-834.
ABSTRACT | FULL TEXT  

Association Between Patterns of Maternal Substance Use and Infant Birth Weight, Length, and Head Circumference
Shankaran et al.
Pediatrics 2004;114:e226-e234.
ABSTRACT | FULL TEXT  

The Maternal Lifestyle Study: Cognitive, Motor, and Behavioral Outcomes of Cocaine-Exposed and Opiate-Exposed Infants Through Three Years of Age
Messinger et al.
Pediatrics 2004;113:1677-1685.
ABSTRACT | FULL TEXT  

Critical Social and Medical Constructions of Perinatal Substance Misuse: Truth in the Making
Marcellus
Journal of Family Nursing 2003;9:438-452.
ABSTRACT  

Comparison of Intelligence, School Readiness Skills, and Attention in In-Utero Drug-Exposed and Nonexposed Preschool Children
Butz et al.
CLIN PEDIATR 2003;42:727-739.
ABSTRACT  

Providing Subsidies and Incentives for Norplant, Sterilization and Other Contraception: Allowing Economic Theory to Inform Ethical Analysis
Mauldon
J Law Med Ethics 2003;31:351-364.
 

Maternal Lifestyle Factors in Pregnancy Risk of Attention Deficit Hyperactivity Disorder and Associated Behaviors: Review of the Current Evidence
Linnet et al.
Am. J. Psychiatry 2003;160:1028-1040.
ABSTRACT | FULL TEXT  

The Status of Pregnant Women and Fetuses in US Criminal Law
Harris and Paltrow
JAMA 2003;289:1697-1699.
FULL TEXT  

Comparison of meconium and neonatal hair analysis for detection of gestational exposure to drugs of abuse
Bar-Oz et al.
Arch. Dis. Child. Fetal Neonatal Ed. 2003;88:F98-F100.
ABSTRACT | FULL TEXT  

Drug-Exposed Infants and Developmental Outcome: Effects of a Home Intervention and Ongoing Maternal Drug Use
Schuler et al.
Arch Pediatr Adolesc Med 2003;157:133-138.
ABSTRACT | FULL TEXT  

The Maternal Lifestyle Study: Effects of Substance Exposure During Pregnancy on Neurodevelopmental Outcome in 1-Month-Old Infants
Lester et al.
Pediatrics 2002;110:1182-1192.
ABSTRACT | FULL TEXT  

Maternal Smoking During Pregnancy and Severe Antisocial Behavior in Offspring: A Review
Wakschlag et al.
AJPH 2002;92:966-974.
ABSTRACT | FULL TEXT  

Cognitive and Motor Outcomes of Cocaine-Exposed Infants
Singer et al.
JAMA 2002;287:1952-1960.
ABSTRACT | FULL TEXT  

Cocaine-Exposed Infants and Developmental Outcomes: "Crack Kids" Revisited
Zuckerman et al.
JAMA 2002;287:1990-1991.
FULL TEXT  

Parental Behavior And Child Health
Case and Paxson
Health Aff (Millwood) 2002;21:164-178.
ABSTRACT | FULL TEXT  

A 28-Year-Old Man Addicted to Cocaine
Hyman
JAMA 2001;286:2586-2594.
FULL TEXT  

Review: prenatal exposure to cocaine does not independently affect physical growth, cognition, or language skills
Myles
Evid. Based Ment. Health 2001;4:121-121.
FULL TEXT  

Head growth and neurodevelopment of infants born to HIV-1-infected drug-using women
Macmillan et al.
Neurology 2001;57:1402-1411.
ABSTRACT | FULL TEXT  

Other Articles Noted
Evid. Based Nurs. 2001;4:E1-11.
FULL TEXT  

Effectiveness of a Home Intervention for Perceived Child Behavioral Problems and Parenting Stress in Children With In Utero Drug Exposure
Butz et al.
Arch Pediatr Adolesc Med 2001;155:1029-1037.
ABSTRACT | FULL TEXT  

Prenatal Cocaine Exposure as a Risk Factor for Later Developmental Outcomes
Stanwood et al.
JAMA 2001;286:45-47.
FULL TEXT  

Testing Poor Pregnant Women for Cocaine -- Physicians as Police Investigators
Annas
NEJM 2001;344:1729-1732.
FULL TEXT  

Cocaine and Pregnancy--Time to Look at the Evidence
Chavkin
JAMA 2001;285:1626-1628.
FULL TEXT