Pubdate: TUe, 27 Mar 2001
Source: Los Angeles Times (CA)
Copyright: 2001 Los Angeles Times
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Author: Lindsey Tanner, AP Medical Writer
Bookmark: http://www.mapinc.org/coke.htm (Cocaine)

STUDY FIGHTS 'CRACK BABY' SYNDROME

CHICAGO--The "crack baby" phenomenon is overblown, according to a study 
that suggests poverty and the use of cigarettes, alcohol and other drugs 
while pregnant are just as likely as cocaine to cause developmental 
problems in children.

Blaming such problems on prenatal cocaine use alone has unfairly 
stigmatized children, creating an unfounded fear in teachers that "crack 
kids" will be backward and disruptive, according to the study, an analysis 
of 36 previous studies.

"I'm not trying to be Pollyanna-ish and say there are not problems" with 
cocaine use by pregnant women, said Dr. Deborah A. Frank, an associate 
professor of pediatrics at Boston University who led the analysis. "I'm 
saying there are many more serious risks to children's development."

The analysis appears in Wednesday's Journal of the American Medical 
Association.

The perception that crack babies are a unique phenomenon stems from an 
overreaction to research that did not adequately take into account such 
factors as family environment and cocaine mothers' use of other substances 
while pregnant, the researchers said.

Women who use cocaine while pregnant often smoke, drink, take other illegal 
drugs and live in poverty or otherwise unhealthy environments.

These factors can explain all or some of the problems once solely blamed on 
cocaine's presumed effects on the developing fetus, such as low birth 
weight, small head size, low scores on mental-development tests and 
behavioral problems such as attention deficits, the researchers said.

Alan Leshner, director of the National Institute on Drug Abuse, said that 
while researchers believe the effects of prenatal cocaine exposure "are not 
nearly as dramatic as people initially thought," the study should not be 
misinterpreted to suggest that cocaine during pregnancy isn't harmful.

"Most of the effects are thought to be on behavioral characteristics, most 
of which won't be apparent until kids are getting older," Leshner said.

Whether prenatal cocaine use can cause developmental problems that do not 
appear until after age 6 or at puberty is being studied.

In an accompanying editorial, Dr. Wendy Chavkin of Columbia University said 
the crack baby "has become a convenient symbol for an aggressive war on 
drug users because of the implication that anyone who is selfish enough to 
irreparably damage a child for the sake of a quick high deserves retribution."

"This image, promoted by the mass media, makes it easier to advocate a 
simplistic, punitive response than to address the complex causes of drug 
use," she said.

The JAMA study follows last week's Supreme Court ruling barring public 
hospitals from testing pregnant women for drugs and giving the results to 
police without consent. That case involved a South Carolina hospital's 
now-abandoned drug-testing policy, designed to stop pregnant women from 
harming fetuses by using crack. It resulted in 30 arrests.

Frank was among doctors and medical groups, including the American Medical 
Association, who filed briefs opposing the drug-testing policy.

Pharmacologist John A. Harvey, co-editor of a 1997 New York Academy of 
Sciences report that linked prenatal cocaine exposure with subtle 
neurological damage, said Frank's review muddles science with politics.

"They play up the problems of tobacco and alcohol very appropriately ... 
and then they say, 'Well, cocaine is no worse,"' said Harvey, of MCP 
Hahnemann University in Philadelphia. "Well, that makes it pretty bad."

Smoking and drinking during pregnancy have been linked to developmental and 
behavioral problems in children.

Animal studies suggest cocaine use alone in pregnancy hampers nerve cell 
development in the fetal brain, resulting in behavioral problems that get 
worse with age, Harvey said. 
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