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,2- 4
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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