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Letters |

Prenatal Cocaine Exposure as a Risk Factor for Later Developmental Outcomes

Gregg D. Stanwood, PhD; Pat Levitt, PhD
JAMA. 2001;286(1):45-47. doi:10.1001/jama.286.1.45.
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To the Editor: The meta-analysis by Dr Frank and colleagues1 concluded that cocaine exposure in utero does not affect physical or behavioral development in offspring. As pointed out by the authors, many inconsistent observations have been reported in the clinical literature, and confounding factors, such as polydrug use, further complicate the interpretation of these studies.

It was disappointing, however, that the authors did not highlight the results of recent studies in which children have been prospectively followed up. These studies have shown subtle but consistent deficits in cognitive and attentional processes in 6- and 7-year old children,24 effects that may become more prominent as their cognitive and social development continues. Cocaine has potent effects on neurotransmitters with known effects on the development of limbic cortical circuitry.5 Thus, it is not surprising that in utero exposure to cocaine might lead to cognitive and emotional difficulties in older children and even into adulthood—impairments that simply cannot be assessed in younger children nor with crude global measures. Thus, the conclusions drawn by the authors may be premature.


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