STUDY CLOUDS CRACK-BABY THEORY

CHICAGO (Associated Press) - 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 other
factors, 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.