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To the Editor: The meta-analysis by Dr Frank and colleagues¹ concluded that cocaine exposure in utero does not affect physical or behavioral development in offspring. As pointed out by the authors, many inconsistent observations have been reported in the clinical literature, and confounding factors, such as polydrug use, further complicate the interpretation of these studies.

It was disappointing, however, that the authors did not highlight the results of recent studies in which children have been prospectively followed up. These studies have shown subtle but consistent deficits in cognitive and attentional processes in 6- and 7-year old children,^2-4 effects that may become more prominent as their cognitive and social development continues. Cocaine has potent effects on neurotransmitters with known effects on the development of limbic cortical circuitry.⁵ Thus, it is not surprising that in utero exposure to cocaine might lead to cognitive and emotional difficulties in older children and even into . . . [Full Text of this Article]

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Growth, Development, and Behavior in Early Childhood Following Prenatal Cocaine Exposure: A Systematic Review
Deborah A. Frank, Marilyn Augustyn, Wanda Grant Knight, Tripler Pell, and Barry Zuckerman
JAMA. 2001;285(12):1613-1625.
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