Prenatal Drug Exposure: Infant and Toddler Outcomes

Abstract

This manuscript provides an overview of the current scientific literature on the impact of maternal drug use, specifically opioids and cocaine, during pregnancy on the acute and long-term outcomes of infants and toddlers from birth through age 3 years. Emphasis with regard to opioids is placed on heroin and opioid substitutes used to treat opioid addiction, including methadone, which has long been regarded as the standard of care in pregnancy, and buprenorphine, which is increasingly being investigated and prescribed as an alternative to methadone. Controlled studies comparing methadone at high and low doses, as well as those comparing methadone with buprenorphine, are highlighted and the diagnosis and management of neonatal abstinence syndrome is discussed. Over the past two decades, attention of the scientific and lay communities has also been focused on the potential adverse effects of cocaine and crack cocaine, especially during the height of the cocaine epidemic in the United States. Herein, the findings are summarized from prospective studies comparing cocaine-exposed with non-cocaine-exposed infants and toddlers with respect to anthropometric growth, infant neurobehavior, visual and auditory function, and cognitive, motor, and language development. The potentially stigmatizing label of the so-called "crack baby" preceded the evidence now accumulating from well-designed prospective investigations that have revealed less severe sequelae in the majority of prenatally exposed infants than originally anticipated. In contrast to opioids, which may produce neonatal abstinence syndrome and infant neurobehavioral deficits, prenatal cocaine exposure appears to be associated with what has been described as statistically significant but subtle decrements in neurobehavioral, cognitive, and language function, especially when viewed in the context of other exposures and the caregiving environment which may mediate or moderate the effects. Whether these early findings may herald more significant learning and behavioral problems during school-age and adolescence when the child is inevitably confronted with increasing social and academic challenges is the subject of ongoing longitudinal research.

Systematic Review of Prenatal Cocaine Exposure and Adolescent Development

“…11 This review does not support previous concerns that cognitive and behavior problems might be more prominent during adolescence in response to increased cognitive and social demands. 9 Although 70% of the studies (19 of 27) reported significant findings favoring nonexposed youth, effects were small to medium, and scores were WNL, with uncertain clinical importance. Thus, the associations between PCE and multiple areas of development persist through adolescence but do not increase.…”

“…Prenatal growth is often restricted in utero, resulting in shortened average gestation and lower birth weight. 6,7 Compared with nonexposed children, children with PCE may demonstrate less optimal motor performance, reflexes, and orientation through 3 to 4 weeks postpartum 8 and lower scores on measures of neurobehavioral functioning, 9 attention and emotional expressivity, 10 and speech and language development through ages 4 to 6 years. 11 Effect sizes are often small, particularly after covariates, including prenatal alcohol/tobacco exposure and family/community factors, are introduced.…”

“…15 It is plausible that the small effects found in attention and emotion regulation among children with PCE early in life may increase during adolescence. 9 Although many adolescents are capable of complex reasoning, their decisions are often influenced by psychosocial factors (eg, impulsivity), putting them at risk for adverse developmental outcomes. 16 Adolescence is also a time of neural rewiring and potential recovery from earlier neural assaults (ie, PCE).…”

Neonatal Drug Withdrawal

“…137,138 The normalization of the EEG and normal neurologic development are believed to reflect recovery of normal neurotransmitter concentrations during early infancy. Bandstra et al 139 have comprehensively reviewed outcomes of infants and toddlers who were exposed prenatally to opioids and cocaine.…”

Prenatal Cocaine Exposure and Cardiometabolic Disease Risk Factors in 18 to 20 Year Old African Americans

“…[1][2][3] Reports of PCE being associated with abnormalities of cardiovascular structure and function, intracardiac conduction, and arrhythmias [4][5][6][7][8][9] as well as deficits in neurocognitive development are more varied in their conclusions. [10][11][12][13] Only now are studies that began decades ago able to examine the longer-term effects of PCE among 18-to 20-year-olds.…”