Pubdate: Tue, 03 Dec 2002
Source: Reuters (Wire)
Copyright: 2002 Reuters Limited
Author: Charnicia E. Huggins

FETAL COCAINE EXPOSURE MAY NOT STUNT DEVELOPMENT

NEW YORK - Contrary to many experts' predictions, infants born to mothers 
who used cocaine heavily during pregnancy do not seem to have developmental 
delays in early life, new study findings show.

During the cocaine epidemic in the US, in the late 1980s and early 1990s, 
many expected that children exposed in the womb to their mother's cocaine 
use, or "crack babies," would suffer lasting developmental impairment.

However, the idea that these children are "doomed at birth" is not 
consistent with the present study findings, which looked at children up to 
the age of 2 years, or with previous research, lead study author Dr. 
Deborah A. Frank of Boston University's School of Medicine in 
Massachusetts, told Reuters Health.

"This stereotype does as much harm, if not more, to children as the actual 
physiological impact of prenatal exposure," Frank added. "The negative 
expectations of these children are in itself very harmful."

Frank and her colleagues studied 203 mother-infant pairs, including mothers 
who were heavy cocaine users, meaning they had used cocaine on more than 62 
days during their pregnancy; light users; non-users and their full-term 
infants. The infants' psychomotor and mental development was tested at 6, 
12 and 24 months of age. Psychomotor function involves physical activity 
that is linked to mental processes, for example learning to grasp an object 
or to crawl or walk.

Overall, infants who were exposed to high levels of cocaine did not have a 
higher risk of mental or psychomotor developmental problems, the 
investigators report in the December issue of Pediatrics. But they did have 
slightly lower scores if they were also lower birth weight infants, the 
report indicates.

In general, lower birth weight infants--regardless of their cocaine 
exposure--did not perform as well on tests of their mental abilities as 
their normal-weight peers, but those who were also exposed to high levels 
of cocaine scored lower on mental and psychomotor tests.

The reason for this may be due to social factors, including the infants' 
home environment, study findings suggest.

Infants who were heavily exposed to cocaine were more likely to have been 
taken out of their mother's custody and placed with unrelated foster 
parents, the authors note. Those who were cared for by another family 
member, however, had more developmental problems at later ages than did 
infants who were left in the care of their biological mother.

Related caregivers are not always properly evaluated and monitored--as are 
foster parents and biological mothers with a history of drug use--and may 
not have the necessary support and resources necessary to provide the best 
care for the infant, Frank explained.

In other findings, all of the infants scored lower on their developmental 
tests as they got older. "That's the sad news," Frank said. "Poverty 
corrodes child development.

"But for everybody, early intervention helped to decrease the magnitude of 
that decline," she added.

Early speech, physical therapy and other intervention services seemed to 
protect heavily cocaine-exposed infants against problems in their mental 
and psychomotor development, study findings indicate.

In fact, the heavily exposed infants who received early intervention 
performed better in tests of their mental development than less-exposed or 
non-exposed infants. This may be because infants exposed to high levels of 
cocaine were more likely to get such help earlier--before their first 
birthday--than their peers, the researchers speculate.

In general, the development of cocaine-exposed infants "very much depends 
on what happens to them after they are born," Frank said, citing the 
importance of appropriate caregivers and intervention.

Further, cocaine-exposed infants can benefit from the same types of 
intervention programs that every impoverished child at risk for 
developmental problems needs, Frank said. "People need not be scared to 
enroll these children in the same programs." The cocaine-exposed children 
"didn't need anything extraordinary," she added.

Finally, to ensure that cocaine-exposed infants placed in the care of a 
relative receive the same quality of care as their peers, pediatricians 
should "advocate for measures to decrease caregiver burden, increase 
resources, and enhance supervision for caregivers providing kinship care to 
the level of that provided for unrelated foster parents," the researchers 
write.

"You have to support the children, and you have to support the caregiver, 
whoever it is," Frank said.

Grants from the National Institute of Drug Abuse and the National Center 
for Research Resources funded the study.

SOURCE: Pediatrics 2002;110:1143-1152.
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