• Lynn T Singer, Robert Arendt, Sonia Minnes, Kathleen Farkas, Ann Salvator, H Lester Kirchner, and Robert Kliegman.
• Department of Pediatrics, Case Western Reserve University, Triangle Bldg, 11400 Euclid Ave, Suite 250-A, Cleveland, OH 44106, USA. lxs5@po.cwru.edu
• JAMA. 2002 Apr 17; 287 (15): 195219601952-60.

ContextMaternal use of cocaine during pregnancy remains a significant public health problem, particularly in urban areas of the United States and among women of low socioeconomic status. Few longitudinal studies have examined cocaine-exposed infants, however, and findings are contradictory because of methodologic limitations.ObjectiveTo assess the effects of prenatal cocaine exposure on child developmental outcomes.DesignLongitudinal, prospective, masked, comparison birth cohort study with recruitment in 1994-1996.SettingObstetric unit of a large US urban teaching hospital.ParticipantsFour hundred fifteen consecutively enrolled infants (218 cocaine-exposed and 197 unexposed) identified from a high-risk, low-socioeconomic status, primarily black (80%) population screened through clinical interview and urine and meconium samples for drug use. The retention rate was 94% at 2 years of age.Main Outcome MeasuresThe Bayley Mental and Motor Scales of Infant Development, assessed at 6.5, 12, and 24 months of corrected age.ResultsControlled for confounding variables, cocaine exposure had significant effects on cognitive development, accounting for a 6-point deficit in Bayley Mental and Motor Scales of Infant Development scores at 2 years, with cocaine-exposed children twice as likely to have significant delay (mental development index <80) (odds ratio, 1.98; 95% confidence interval, 1.21-3.24; P =.006). For motor outcomes, there were no significant cocaine effects.ConclusionsCocaine-exposed children had significant cognitive deficits and a doubling of the rate of developmental delay during the first 2 years of life. Because 2-year outcomes are predictive of later cognitive outcomes, it is possible that these children will continue to have learning difficulties at school age.

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