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.