Article

Systematic Review of Prenatal Cocaine Exposure and Adolescent Development

Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland.
PEDIATRICS (Impact Factor: 5.3). 05/2013; 131(6). DOI: 10.1542/peds.2012-0945
Source: PubMed

ABSTRACT BACKGROUND AND OBJECTIVE:Previous research found that prenatal cocaine exposure (PCE) may increase children's vulnerability to behavior and cognition problems. Maturational changes in brain and social development make adolescence an ideal time to reexamine associations. The objective was to conduct a systematic review of published studies examining associations between PCE and adolescent development (behavior, cognition/school outcomes, physiologic responses, and brain morphology/functioning).METHODS:Articles were obtained from PubMed, PsycInfo, Web of Science, and CINAHL databases through July 2012 with search terms: prenatal drug, substance, or cocaine exposure; adolescence/adolescent; and in utero substance/drug exposure. Criteria for inclusion were nonexposed comparison group, human adolescents aged 11 to 19, peer-reviewed, English-language, and adolescent outcomes.RESULTS:Twenty-seven studies representing 9 cohorts met the criteria. Four outcome categories were identified: behavior, cognition/school performance, brain structure/function, and physiologic responses. Eleven examined behavior; 7 found small but significant differences favoring nonexposed adolescents, with small effect sizes. Eight examined cognition/school performance; 6 reported significantly lower scores on language and memory tasks among adolescents with PCE, with varying effect sizes varied. Eight examined brain structure/function and reported morphologic differences with few functional differences. Three examined physiologic responses with discordant findings. Most studies controlled for other prenatal exposures, caregiving environment, and violence exposure; few examined mechanisms.CONCLUSIONS:Consistent with findings among younger children, PCE increases the risk for small but significantly less favorable adolescent functioning. Although the clinical importance of differences is often unknown, the caregiving environment and violence exposure pose additional threats. Future research should investigate mechanisms linking PCE with adolescent functioning.

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    • "Although there is a well-known association between child's substance use and timing of first sexual intercourse, no studies to date have examined the direct and indirect effects of PCE on the full range of age at initiation of sexual behavior. Children with PCE are vulnerable to early sexual intercourse and associated reproductive health outcomes (such as STIs/HIV and unintended pregnancy) because of the strong association of PCE with early substance use (Delaney-Black et al., 2011; Frank et al., 2011; Minnes et al., 2014; Richardson et al., 2013b) and other risk factors (Ackerman et al., 2010; Buckingham-Howes et al., 2013; Richardson et al., 2011). Thus, exposed individuals may enter the period of adolescence " primed " for earlier substance use and sexual intercourse, and are more likely to engage in these behaviors at a less optimal time than unexposed individuals. "
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