Neurodevelopmental Effects of Cocaine

Abstract

How and to what extent fetal cocaine exposure produces specific, negative, long-term effects on infant neurodevelopmental competence has not yet been determined. We have argued previously that results from animal studies, the findings of intrauterine growth retardation in human studies, and the markedly higher incidence of numerous associated risk factors in cocaine-exposed cohorts herald significant clinical risk to the developing infant. Recognition of infant risk status should not imply condemnation of a group of children but, as with preterm infants, lead to aggressive, national, social, and scientific efforts to delineate and intervene with potential sequelae of drug exposure.

Psychosocial and behavioral factors related to the post-partum placements of infants born to cocaine-using women

“…The use of cocaine and other substances of abuse during pregnancy is considered a substantial postnatal risk factor for infant neglect and abuse (Hans, 2002;Mayes, 1995;Singer, Arendt, & Minnes, 1993). Evidence of maternal substance use, especially of illegal drugs such as heroin and cocaine, often results in the removal of the infant from maternal custody within the first 18 months of life (Byrd, Neistadt, Howard, Brownstein-Evans, & Weitzman, 1999;Nair et al, 1997).…”

“…These areas include maternal psychopathology and maladaptive coping strategies, poor social support, domestic violence, and history of early childhood trauma (Hans, 2002;Singer et al, 1993). Among these risks, maternal psychopathology, including depression, interpersonal sensitivity, and paranoid ideation (Singer et al, 1995(Singer et al, , 2002Woods, Eyler, Behnke, & Conlon, 1993;Zuckerman, Amaro, Bauchner, & Cabral, 1989) have been associated with prenatal cocaine use.…”

Relationship of prenatal cocaine exposure and maternal postpartum psychological distress to child developmental outcome

“…A growing body of well controlled studies have used animal models to document neurotoxic properties of cocaine capable of producing negative developmental effects in exposed fetuses (Spear, 1996;Thadani, 1995). Although the generalizability of animal research to human outcomes is not clear cut (Morishima & Whittington, 1995;Needlman, Frank, Augustyn, & Zuckerman, 1995), studies with human neonates also suggest that in utero exposure to cocaine is associated with atypical neurobehavioral outcomes in newborns (see Singer, Arendt, & Minnes, 1993or Volpe, 1992, for reviews).…”

“…These pathways include direct structural damage to the developing fetal brain through aminergic mechanisms and fetal hypoxemia due to catecholamine mediated placental vascular compromise (Kosofsky, 1991;Webster, Brown-Woodman, Lipson, & Ritchie, 1991). Because of the high prevalence of drug use in poor urban populations, poverty, increased child neglect and abuse, and an impaired social environment with dysfunctional caregiving have also been considered as contributors to negative sequelae for drug exposed children (Hans, Bernstein, & Hensen, 1990;Lief, 1985;Mayes, Granger, Bornstein, & Zuckerman, 1992;Rosen & Johnson, 1982;Singer, Arendt, & Minnes, 1993).…”

Fetal Cocaine Exposure:

“…Findings have been widely divergent and sometimes contradictory. 41 Several studies have reported depressed interactive behavior, impaired responses to environmental stimuli, and deficits in orientation, and in motor and state regulation in cocaine exposed cohorts. Other well designed studies, however, found no significant deficits on the BNBAS.…”