Birth Outcome From a Prospective, Matched Study of Prenatal Crack/Cocaine Use: I. Interactive and Dose Effects on Health and Growth

Eyler, Fonda Davis; Behnke, Marylou; Conlon, Michael; Woods, Nanci Stewart; Wobie, Kathleen

doi:10.1542/peds.101.2.229

Cited by 114 publications

(71 citation statements)

References 64 publications

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“…Research on prenatal malnutrition indicates that growth of brain structures, and therefore head size, recover after nutritional rehabilitation [23], providing an explanation for why head circumference in this cohort may have been affected by cocaine at birth but not at 6 years. While lower growth parameters have been found consistently for prenatally cocaine-exposed children when evaluating outcomes at birth [4,5,9,12,31,36], findings for long-term growth outcomes to age 7 are inconclusive [11,30].…”

Section: Discussionmentioning

confidence: 99%

“…Related to fetal growth however, there are consistent findings indicating that after consideration of a large number of covariates, prenatal cocaine exposure has specific effects on infant birth parameters including head circumference, weight and length [4,5,9,11,12,31,37,41]. Growth deficits are believed to result from poor maternal nutrition, restricted placental blood flow or some other unknown mechanism.…”

Section: Introductionmentioning

confidence: 99%

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Dysmorphic and anthropometric outcomes in 6-year-old prenatally cocaine-exposed children

Minnes

Robin

Alt

et al. 2006

Neurotoxicology and Teratology

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Dysmorphologic and anthropometric assessments were performed on 154 6-year-old children prenatally exposed to cocaine (PCE) and 131 high-risk controls (NCE) of similar race and social class. Adjusted mean height z scores demonstrated a dose-response with metahydroxybenzoylecgonine above a threshold of 100 ng/g of meconium and greater cocaine exposure predicted lower weight for height z score. Higher average alcohol exposure throughout pregnancy and 3rd trimester predicted lower head circumference and weight z scores, respectively. Severity of marijuana use also predicted lower height for age but greater weight for height. There was not an increased rate of minor anomalies among the PCE cohort, nor was a consistent phenotype identified. After controlling for covariates, higher average prenatal cigarette exposure predicted higher incidence of cranial facial abnormalities. First trimester alcohol exposure predicted greater rates of ear abnormalities and third trimester marijuana exposure predicted greater rates of chest and head shape abnormalities. These finding indicate that prenatal cocaine exposure has a negative effect on specific growth outcomes including standardized height and weight for height, but not a systematic pattern of structural abnormalities.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Dysmorphic and anthropometric outcomes in 6-year-old prenatally cocaine-exposed children

Minnes

Robin

Alt

et al. 2006

Neurotoxicology and Teratology

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“…17 Briefly, more than 2,500 potential participants were approached when they first entered the prenatal care system or, in the case of no prenatal care, when they presented to deliver. Experienced research staff carefully obtained informed consent from 85% of the mothers, who were then interviewed in depth.…”

Section: Participantsmentioning

confidence: 99%

“…All of these groups differences parallel those found in the original cohort. 17 Table 1 also illustrates that the children with PCE were much more likely to have changed caregivers at least once since birth compared to the children with no PCE. Only 52% of the children with PCE, compared to 95% of the non-cocaine exposed children, were living with their biological mothers at the time of the 3-year assessment.…”

Section: Participantsmentioning

confidence: 99%

Predicting Caregiver-Reported Behavior Problems in Cocaine-Exposed Children at 3 Years

Warner

Behnke

Hou

et al. 2006

Journal of Developmental & Behavioral Pediatrics

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Predictors of caregiver-reported behavior problems for 3-year-olds with prenatal cocaine exposure (PCE) and matched controls were examined using structural equation modeling. We tested whether PCE had a direct effect on child behavior problems in a model that included other prenatal drug exposure, child sex, caregiver depression, and the quality of the child's home environment. The sample (N = 256) was drawn from a longitudinal, prospective study of children of (predominantly crack) cocaine-using women and controls matched on race, socioeconomic status, parity, and pregnancy risk. Child Behavior Problems was modeled as a latent variable composed of the 48-item Conners' Parent Report Scale Conduct Problem and ImpulsiveHyperactive scales and the Eyberg Child Behavior Inventory Intensity scale. Caregiver depression was the only significant predictor of Child Behavior Problems. Mean levels of caregiver selfreported depression and reported child behavior problems did not differ between groups. Mean depression scores were well above the recommended clinical cutoff while mean child behavior problems scores were within normal limits. The model explained 21% of the variance in caregiver-reported child behavior problems in our sample of rural African American, low SES youngsters. Non-maternal caregivers of cocaine-exposed children had significantly lower mean depression scores and mean child behavior problems ratings for 2 of 3 scales used in the study compared to biological mothers of children with PCE and controls. For all groups, much larger proportions of children were rated as having clinically significant behavior problems than would be expected based on the prevalence of behavior problems in the general population.Since the coining of the term "crack baby" in the 1980s, dire predictions have been made about the developmental outcomes of children with prenatal cocaine exposure (PCE). These premature forecasts were based, in part, on research conducted using animal models in which considerable deleterious effects of PCE on offspring were found as well as in case reports and clinical studies of polydrug users. Early controlled studies of neonates and young infants with PCE did indicate difficulties with state and behavioral regulation including problems with alertness, orientation, irritability, and arousal-modulated attention which raised the concern that these children could be at risk for externalizing behavior problems in the future. 1 While well-designed prospective studies in humans during the past decade have yielded more equivocal results, most studies have been consistent with the conclusion that PCE exerts clinically subtle but statistically significant effects that could result in considerable costs to society. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptThe literature on child behavior problems in children with PCE, as with other developmental outcomes, is plagued by conflicting findings. Not one of seven published studies using parent-report measures of behavior probl...

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“…M aternal cocaine use during pregnancy has been associated with decreased growth parameters at birth for infants. [1][2][3][4][5] Women who use cocaine during pregnancy are often exposed to many drugs, including alcohol and tobacco, 1-6 both of which have been shown to have effects on birth weight in studies evaluating the use of these substances alone or in combination. [7][8][9][10][11][12][13] The timing and amount of fetal exposure to cocaine, tobacco, and alcohol during pregnancy also have been noted to influence birth weight.…”

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confidence: 99%

Association Between Patterns of Maternal Substance Use and Infant Birth Weight, Length, and Head Circumference

et al. 2004

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ABSTRACT. Objective. To determine the effects of patterns of drug use during term pregnancy on infant growth parameters at birth.Methods. Histories of cocaine, opiate, alcohol, tobacco, and marijuana use during the 3-month period before pregnancy and the 3 trimesters of pregnancy were recorded at the infants' 1-month visit. Patterns of use were categorized as consistently high, moderate, or low/ none or increasing/decreasing, and effects on growth parameters were analyzed in multivariate linear regression analyses, with adjustment for clinical site, maternal age, prepregnancy weight, multidrug use, and socioeconomic status.Results. A total of 241 cocaine-exposed women and 410 non-cocaine-exposed women participated in the study. In the cocaine-exposed group, 75% used alcohol, 90% used tobacco, and 53% used marijuana; in the noncocaine-exposed group, 57% used alcohol, 34% used tobacco, and 19% used marijuana. Birth weight, birth length, and head circumference were significantly greater among infants born to women who used no drugs, compared with women with any cocaine, opiate, alcohol, tobacco, or marijuana use, and were greater among infants born to cocaine nonusers, compared with cocaine users. With adjustment for confounders, birth weight was significantly affected by cocaine (deficit of 250 g with consistently low pattern) and tobacco (deficits of 232 g with consistently high pattern, 173 g with consistently moderate pattern, 153 g with decreasing pattern, and 103 g with consistently low pattern). Head size was affected by cocaine (deficit of 0.98 cm with consistently moderate pattern) and tobacco (deficits of 0.72 cm with consistently high pattern and 0.89 cm with consistently moderate pattern). Birth length was affected by tobacco use only (deficits of 0.82 cm with consistently high pattern and 0.98 cm with decreasing use).Conclusion. Patterns of tobacco use during pregnancy affect birth weight, length, and head circumference, whereas cocaine affects birth weight and head size, when adjustments are made for confounders, including multidrug use. Pediatrics 2004;114:e226 -e234. URL: http: //www.pediatrics.org/cgi/content/full/114/2/e226; prenatal, cocaine, alcohol, tobacco, marijuana, infant birth weight, length, head circumference.ABBREVIATIONS. MISU, Maternal Inventory of Substance Use. M aternal cocaine use during pregnancy has been associated with decreased growth parameters at birth for infants. [1][2][3][4][5] Women who use cocaine during pregnancy are often exposed to many drugs, including alcohol and tobacco, 1-6 both of which have been shown to have effects on birth weight in studies evaluating the use of these substances alone or in combination. [7][8][9][10][11][12][13] The timing and amount of fetal exposure to cocaine, tobacco, and alcohol during pregnancy also have been noted to influence birth weight. 2,10,11,14 Infants born to women who stopped smoking had higher birth weights than did those born to women who reduced smoking or who did not change behavior. 10,11 Infants born to women who drank ...

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Birth Outcome From a Prospective, Matched Study of Prenatal Crack/Cocaine Use: I. Interactive and Dose Effects on Health and Growth

Cited by 114 publications

References 64 publications

Dysmorphic and anthropometric outcomes in 6-year-old prenatally cocaine-exposed children

Dysmorphic and anthropometric outcomes in 6-year-old prenatally cocaine-exposed children

Predicting Caregiver-Reported Behavior Problems in Cocaine-Exposed Children at 3 Years

Association Between Patterns of Maternal Substance Use and Infant Birth Weight, Length, and Head Circumference

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