By Elaine Cassel
About one million children have been born after fetal cocaine exposure since the mid 1980s. Early research indicated that such exposure could cause serious and permanent damage to the child’s attentional, information processing, and learning abilities. A longitudinal study finds proof of long-term cognitive effects.
Cocaine in its many forms—including crack, an especially potent and addictive version—readily crosses into the placenta of a fetus whose mother is a user. Cocaine has a longer life in the tiny fetus because the immature organs of the fetus have difficulty breaking down the substance. Cocaine can also continue to influence a newborn baby through the mother’s milk.
It has long been thought that cocaine had potentially long-lasting effects on a child’s cognition and behavior, in addition to the more readily known effects of low birth weight, respiratory difficulty, and kidney malfunctioning. A study reported in the April 17, 2002 issue of the Journal of the American Medical Association (JAMA), reports outcomes of a two-year study of infants exposed to cocaine in utero. Researchers at Case Western Reserve University in Cleveland followed 415 cocaine-exposed infants from birth to the age of 2. Compared to non-exposed infants, the cocaine babies experienced delays in cognitive development. Previous studies were contradictory and confusing, a fact attributable to poor methodology and research controls.
The new study is the first to document the negative effects of cognitive development using rigorous methods. Researchers measured the mothers’ drug use prenatally as well as the infant meconium, or afterbirth, which provided a physical measure of the amount of drug exposure. The study also controlled for post-birth environmental factors, including stimulation levels at home and intelligence and mental health factors related to the mother. Ninety percent of the original participants were followed to the end of the study.
Infants were seen at the research laboratory at 6, 12, and 24 months and administered the Bayley Mental and Motor Scales of Infant Development (BSI-II) standardized assessments. The Bayley scales measure infant and child memory, language, and problem-solving abilities, as well as gross and fine motor control and coordination.
There were more preterm, low birthweight, and small for gestational age babies among the exposed group. The rate of mental retardation in the exposed group at age 2 was almost 5 times higher than in the general population, and twice as high as in the control group. The percentage of exposed children with cognitive delays was double that of the non-exposed group. Researchers believe that the results could not be attributed to mothers’ exposure to other drugs or to other variables like prenatal care, caregiver or birth mother intelligence, psychological distress, or poor home environment. Researchers predict that the children will continue to have learning problems as they develop and will need special education services at school.
Researchers are concerned that their data will be misused to prosecute pregnant women who use cocaine and to remove their children from them. In 2001, the U.S. Supreme Court ruled against a Charleston, South Carolina municipal hospital's practice of using urine samples from mothers receiving prenatal care to arrest them for drug use and child endangerment, but it did so on a technicality. If hospitals and clinics inform the mother that the samples may be so used, the practice cannot be attacked legally. This measure will not address either the source of the problem—mothers’ addiction to cocaine—or the outcome—children who need intense intervention to develop with some normality.
What will help is if public policy and health care services address the need for drug intervention and treatment, along with prenatal mental and physical health services for at-risk women of childbearing years. If we don’t address the root causes of fetal exposure to cocaine, the babies born after exposure may need public services for a lifetime. And society will be robbed of healthy and productive citizens.
Elaine Cassel, Marymount University and Lord Fairfax Community College