Cognitive Outcomes of Preschool Children With Prenatal Cocaine Exposure

Department of Pediatrics, The Ohio State University, Columbus, Ohio, United States
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 06/2004; 291(20):2448-56. DOI: 10.1001/jama.291.20.2448
Source: PubMed


placental and fetal brain barriers1-3 and has a direct effect on the developing fetal brain through alterations in the central monoamine systems and an indirect effect through maternal vascular disruptions. 4 Brain glucose metabolism is decreased in animal studies of cocaineexposed offspring, also potentially affecting neurodevelopment5 and raising concerns about long-term cognitive outcomes. 6 A number of methodologically sound studies have found a relationship between fetal cocaine exposure and negative child developmental outcomes in the first years of life, 7-15 although others have not. 16,17 A few studies have documented outcomes in the later preschool or early school years. 17-20 Longterm studies are important because cocaine may have “sleeper ” effects that are not detectable until complex functional abilities are measurable. 21,22 Compensatory mechanisms may ameliorate negative effects, 23 while environmental circumstances may exacerbate or minimize the sequelae of early brain insults. 18,24 Findings in studies with Context Because of methodological limitations, the results of the few prospective studies assessing long-term cognitive effects of prenatal cocaine exposure are inconsistent. Objective To assess effects of prenatal cocaine exposure and quality of caregiving environment on 4-year cognitive outcomes. Design Longitudinal, prospective, masked comparison cohort study from birth (September 1994-June 1996) to 4 years. Setting Research laboratory of a US urban county teaching hospital. Participants A total of 415 consecutively enrolled infants identified from a highrisk population screened for drug use through clinical interview, urine, and meconium screens. Ninety-three percent retention for surviving participants at 4 years of age resulted in 376 children (190 cocaine-exposed and 186 nonexposed).

Download full-text


Available from: Lynn T Singer, Oct 07, 2015
23 Reads
  • Source
    • "Environmental factors associated with prenatal drug use, such as poor quality of the home environment, caregiver ongoing substance use and psychological distress, violence exposure (Bada et al., 2007, 2011; Frank et al., 2011), non-kinship adoptive/foster care placement (Linares et al., 2006), negative attachment to caregiver (Warner et al., 2011) and low levels of parental monitoring (Bohnert, Anthony, & Breslau, 2012; Laird, Criss, Pettit, Dodge, & Bates, 2008) may heighten the drug exposed child's vulnerability to maladaptive behavioral development and obscure the long-term effects of PCE. In contrast, positive environmental factors may be protective or compensate for earlier biologic risk factors (Bada et al., 2012; Singer, 2004, 2008). "
    [Show abstract] [Hide abstract]
    ABSTRACT: The effect of prenatal cocaine exposure (PCE) on externalizing behavior and substance use related problems at 15 years of age was examined. Participants consisted of 358 adolescents (183 PCE, 175 non-cocaine exposed (NCE)), primarily African–American and of low socioeconomic status, prospectively enrolled in a longitudinal study from birth. Regression analyses indicated that the amount of PCE was associated with higher externalizing behavioral problems (β = .15, p = .02). Adolescents with PCE were also 2.8 times (95% CI = 1.38–5.56) more likely to have substance use related problems than their NCE counterparts. No differences between PCE adolescents in non-kinship adoptive/foster care (n = 44) and PCE adolescents in maternal/relative care (n = 139) were found in externalizing behavior or in the likelihood of substance use related problems. Findings demonstrate teratologic effects of PCE persisting into adolescence. PCE is a reliable marker for the potential development of problem behaviors in adolescence, including substance use related problems.
    Journal of Adolescence 04/2014; 37(3):269–279. DOI:10.1016/j.adolescence.2014.01.004 · 2.05 Impact Factor
  • Source
    • "In some cases, placement in foster or adoptive care has been found to improve language outcomes for children with PCE compared with children who remained in the care of their biological mothers (Lewis et al., 2004). Children in foster or adoptive care had caregivers with higher vocabulary scores than those of the biological caregivers and attained IQ scores similar to those of children with no cocaine exposure (NCE; Singer et al., 2004). These results suggest that a cocaine-specific effect on language skills may be modified with an enriched environment. "
    [Show abstract] [Hide abstract]
    ABSTRACT: In this study, the authors aimed to examine the long-term effects of prenatal cocaine exposure (PCE) on the language development of 12-year-old children using a prospective design, controlling for confounding prenatal drug exposure and environmental factors. Children who were exposed to cocaine in utero (PCE; n = 183) and children who were not exposed to cocaine (i.e., no cocaine exposure [NCE]; n = 181) were followed prospectively from birth to 12 years of age and were compared on language subtests of the Test of Language Development-Intermediate, Third Edition ( Hammill & Newcomer, 1997b), and phonological processing as measured by the Comprehensive Test of Phonological Processing ( Wagner & Torgesen, 1999). The authors evaluated the relationship of PCE to language development through a multivariate analysis of covariance and regression analyses while controlling for confounders. Results show that PCE has small effects on specific aspects of language, including syntax and phonological processing. The caregiver variables of lower maternal vocabulary, more psychological symptoms, and a poorer home environment also had consistent effects on language and phonological processing scores. These findings suggest that PCE continues to have small, subtle effects on specific aspects of language at age 12 years. Phonological processing skills were significantly related to the reading outcomes of letter-word identification, reading fluency, and reading comprehension, indicating that PCE also has small but lasting effects on the language skills that are related to later literacy skills.
    Journal of Speech Language and Hearing Research 10/2013; 56(5):1662-76. DOI:10.1044/1092-4388(2013/12-0119) · 2.07 Impact Factor
  • Source
    • "). Lifetime history of drug dependence was coded 1 (yes) if participants met DSM-IV criteria for lifetime alcohol, cocaine, or marijuana dependence. Current tobacco use was assessed at the 12 year assessment using the Maternal Post-Partum Interview and Update (Singer et al., 2004). Frequency and number of cigarettes were collected to compute a summary score indicating the average number of cigarettes smoked per day. "
    [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVES: This study examined whether a self-reported history of childhood maltreatment (physical, emotional, and sexual abuse and physical and emotional neglect) is related to poor adult physical health through health risk behaviors (obesity, substance dependence, and smoking), adverse life events, and psychological distress. METHODS: Two hundred and seventy nine (279) women aged 31-54, primarily poor, urban, and African American with a history of substance use during pregnancy, were assessed for perceived physical health status using the Health Status Questionnaire (SF-36) and any reported chronic medical condition. Hierarchical multiple and logistic regression were used to test mediation, as well as to assess relative contributions of multiple mediators on physical health. RESULTS: More than two-thirds (n=195, 70%) of the sample reported at least 1 form of childhood maltreatment, with 42% (n=110) having a lifetime history of substance dependence and 59% (n=162) having a chronic medical condition. Controlling for age, education, and race, childhood maltreatment was related to increased likelihood of lifetime history of substance dependence (OR=1.19, 95% CI=1.01-1.39), more adverse life events (β=.14), and greater psychological distress (β=.21). Psychological distress and adverse life events partially mediated the relationship between childhood maltreatment and perceived physical health, accounting for 42% of the association between childhood maltreatment and perceived physical health. Adverse life events accounted for 25% of the association between childhood maltreatment and chronic medical condition. CONCLUSIONS: Our findings provide additional evidence that the ill health effects associated with childhood maltreatment persist into adulthood. Adverse life events and psychological distress were key mechanisms shaping later physical health consequences associated with childhood maltreatment among relatively young urban women with a history of substance use. PRACTICE IMPLICATIONS: Health care providers should be aware that childhood maltreatment contributes to adult health problems. Interventions aimed at preventing child maltreatment and addressing life stress and psychological distress will improve long-term physical health among abused children, adults with such histories, as well as children who are likely to be affected by maternal history of childhood maltreatment.
    Child abuse & neglect 11/2012; 37(6). DOI:10.1016/j.chiabu.2012.09.008 · 2.34 Impact Factor
Show more