The purpose of this article was to review the findings from existing peer-reviewed experimental studies describing the behavioral and developmental outcomes associated with prenatal exposure to illicit drugs. Forty-six such studies and 460 individual outcomes occurring from birth to 60 months were identified. Only half of these outcomes (49.8%) were statistically significant, indicating adverse effects of prenatal exposure. The greatest number of outcomes were identified for infants younger than 1 month of age and within the neurodevelopmental domain. The contrast between these outcomes derived from experimental studies and those reported in the popular press is discussed.
Get full access to this article
View all access options for this article.
References
1.
Ahmed, M. S., Spong, C. Y., Geringer, J. L., Mou, S. M., & Maulik, D. (1989). Prospective study on cocaine use prior to delivery. Journal of the American Medical Association, 262, 1880.
2.
Allen, L. F., Palomares, R. S., DeForest, P., Sprinkle, B., & Reynolds, C. R. (1991). The effects of intrauterine cocaine exposure: Transient or teratogenic?Archives of Clinical Neuropsychology, 5, 133–146.
3.
Anday, E. K., Cohen, M. E., Kelley, N. E., & Leitner, D. S. (1989). Effect of in utero cocaine exposure on startle and its modification. Developmental Pharmacology Therapy, 12, 137–145.
4.
Barocas, R., Seifer, R., Sameroff, A. J., Andrews, T. A., Croft, R. T., & Ostrow, E. (1991). Social and interpersonal determinants of developmental risk. Developmental Psychology, 27, 479–488.
5.
Bauman, P. S., & Dougherty, F. E. (1983). Drug-addicted mothers' parenting and their children's development. International Journal of the Addictions, 18, 291–302.
6.
Bayley, N. (1969). Bayley scales of infant development.San Antonio: Psychological Corp.
Braungart, J. M., Plomin, R., DeFries, J. C., & Fulker, D. W. (1992). Genetic influence on tester-rated infant temperament as assessed by Bayley's Infant Behavior Record: Nonadoptive and adoptive siblings and twins. Developmental Psychology, 28, 40–47.
9.
Brazelton, T. B. (1984). Neonatal behavioral assessment scale (2nd ed.). Philadelphia: Spastics International.
10.
Brown, E., & Zuckerman, B. (1991). The infant and the drug using mother. Pediatric Annals, 20, 555–563.
11.
Chasnoff, I. J. (1991). Methodological issues studying cocaine use in pregnancy: A problem of definitions. In M. Kibey & K. Asghar (Eds.), Methodological issues in controlled studies of effects of prenatal exposure to drug abuse (National Institute on Drug Abuse Research Monograph No. 114, pp. 55--56) (DHHS Publication No. ADM 91-1837).
12.
Chasnoff, I. J., Burns, K. A., Burns, W. J., & Schnoll, S. H. (1986). Prenatal drug exposure: Effects on neonatal and infant growth and development. Neurobehavioral Toxicology and Teratology, 8, 357–362.
13.
Chasnoff, I. J., Burns, W. J., Hatcher, R. P., & Burns, K. A. (1983). Phencyclidine: Effects on the fetus and neonate. Developmental Pharmacology and Therapy, 6, 404–408.
14.
Chasnoff, I. J., Burns, W. J., Scholl, S. H., & Burns, K. A. (1985). Cocaine use in pregnancy. New England Journal of Medicine, 313, 666–669.
15.
Chasnoff, I. J., Griffith, D. R., Freier, C., & Murray, J. (1992). Cocaine/polydrug use in pregnancy: Two-year follow-up. Pediatrics, 89, 284–289.
16.
Chasnoff, I. J., Griffith, D. R., MacGregor, S., Dirkes, K., & Burns, K. A. (1989). Temporal patterns of cocaine use in pregnancy: Perinatal outcome. Journal of the American Medical Association, 261, 1741–1744.
17.
Chasnoff, I. J., Hatcher, R., & Burns, W. J. (1982). Polydrug and methadone-addicted newborns: A continuum of impairment?Pediatrics, 70, 210–213.
18.
Chasnoff, I. J., Lewis, D. E., Griffith, D. R., & Willey, S. (1989). Cocaine and pregnancy: Clinical and toxicological implications for the neonate. Clinical Chemistry, 35, 1276–1278.
19.
Coles, C. D., Platzman, K. A., Smith, I., James, M. E., & Falek, A. (1992). Effects of cocaine and alcohol use in pregnancy on neonatal growth and neurobehavioral status. Neurotoxicology and Teratology, 14, 23–33.
20.
Corwin, M. J., Lester, B. M., Sepkoski, C., McLaughlin, S., Kayne, H., & Golub, H. L. (1992). Effects of in utero cocaine exposure on newborn acoustical cry characteristics. Pediatrics, 89, 1199–1203.
21.
Deren, S. (1986). Children of substance abusers: A review of the literature. Journal of Substance Abuse Treatment, 3, 77–94.
22.
Deutsch, C. R., & Schumer, F. (1970). Brain-damaged children.New York: Brunner/Mazel.
23.
Dixon, S. D., & Bejar, R. (1989). Echoencephalographic findings in neonates associated with maternal cocaine and methamphetamine use: Incidence and clinical correlates. The Journal of Pediatrics, 115, 770–778.
24.
Doering, P. L., Davidson, C. L., LaFauce, L., & Williams, C. A. (1989). Effects of cocaine on the human fetus: A review of clinical studies. The Annals of Pharmacotherapy, 23, 639–645.
25.
Eisen, L. N., Field, T. M., Bandstra, E. S., Roberts, J. P., Morrow, C., Larson, S. R., & Steele, B. M. (1991). Perinatal cocaine effects on neonatal stress behavior and performance on the Brazelton Scale. Pediatrics, 88, 477–480.
26.
Finnegan, L. P. (1982). Outcome of children born to women dependent upon narcotics. Advances in Alcohol and Substance Abuse, 1, 55–101.
27.
Finnegan, L. P., Mellott, J. M., Williams, L. R., & Wapner, R. J. (1992). Perinatal exposure to cocaine: Human studies. In J. M. Lakoski, M. P. Galloway & F. J. White (Eds.), Cocaine: Pharmacology, physiology, and clinical strategies (pp. 391–409). Boca Raton, FL: CRC Press.
28.
Fried, P. A. (1982). Marijuana use by pregnant women and effects on offspring: An update. Neurobehavioral Toxicology and Teratology, 4, 451–454.
29.
Fried, P. A. (1989). Cigarettes and marijuana: Are there measurable long-term neurobehavioral teratogenic effects?NeuroToxicology, 10, 577–584.
30.
Fried, P. A., & Makin, J. E. (1987). Neonatal behavioral correlates of prenatal exposure to marihuana, cigarettes and alcohol in a low risk population. Neurotoxicology and Teratology, 9, 1–7.
31.
Fried, P. A., O'Connell, C. M., & Watkinson, B. (1992). 60- and 72-month follow-up of children prenatally exposed to marijuana, cigarettes, and alcohol: Cognitive and language assessment. Developmental and Behavioral Pediatrics, 13, 383–391.
32.
Fried, P. A., & Watkinson, B. (1988). 12- and 24-month neurobehavioural follow-up of children prenatally exposed to marihuana, cigarettes, and alcohol. Neurotoxicology and Teratology, 10, 305–313.
33.
Fried, P. A., & Watkinson, B. (1990). 36- and 48-month neurobehavioural follow-up of children prenatally exposed to marijuana, cigarettes, and alcohol. Developmental and Behavioral Pediatrics, 11, 49–58.
34.
Golden, N. L., Kuhnert, B. R., Sokol, R. J., Martier, S., & Williams, T. (1987). Neonatal manifestations of maternal phencyclidine exposure. Journal of Perinatal Medicine, 15, 185–191.
35.
Hans, S. L. (1989). Developmental consequences of prenatal exposure to methadone. Annals of the New York Academy of Sciences, 562, 195–207.
36.
Hans, S. L. (1991). Following drug-exposed infants into middle childhood: Challenges to researchers. In M. Kibey & K. Asghar (Eds.), Methodological issues in controlled studies of effects of prenatal exposure to drug abuse (National Institute on Drug Abuse Research Monograph No. 114, pp. 316–322) (DHHS Publication No. ADM 91-1837). Washington, DC: U.S. Government Printing Office.
37.
Hayes, J. S., Dreher, M. C., & Nugent, J. K. (1988). Newborn outcomes with maternal marihuana use in Jamaican women. Pediatric Nursing, 14, 107–110.
38.
Howard, J. (1989). Cocaine and its effects on the newborn. Developmental Medicine and Child Neurology, 31, 255–263.
39.
Jeremy, R. J., & Bernstein, V. J. (1984). Dyads at risk: Methadone-maintained women and their four-month-old infants. Child Development, 55, 1141–1154.
40.
Johnson, H. L., Diano, A., & Rosen, T. S. (1984). 24-month neurobehavioral follow-up of children of methadone-maintained mothers. Infant Behavior and Development, 7, 115–123.
41.
Kaltenbach, K., Graziani, L. J., & Finnegan, L. P. (1979). Methadone exposure in utero: Developmental status at one and two years of age. Pharmacology Biochemistry and Behavior, 11, 15–17.
42.
Kelley, S. J., Walsh, J. H., & Thompson, K. (1991). Birth outcomes, health problems, and neglect with prenatal exposure to cocaine. Pediatric Nursing, 17, 130–135.
43.
Koren, G., Graham, H., Shear, H., & Einarson, T. (1989). Bias against the null hypothesis: The reproductive hazards of cocaine. The Lancet, 2, 1440–1442.
44.
Koren, G., & Graham, K. (1992). Cocaine in pregnancy: Analysis of fetal risk. Veterinary and Human Toxicology, 34, 263–264.
45.
Kron, R. E., Litt, M., Phoenix, M. D., & Finnegan, L. P. (1976). Neonatal narcotic abstinence: Effects of pharmacotherapeutic agents and maternal drug usage on nutritive sucking behavior. Journal of Pediatrics, 88, 637–641.
46.
Kronstadt, D. (1991). Complex developmental issues of prenatal drug exposure. The Future of Children, 1, 36–56.
47.
Lewin, L. M., Hops, H., Davis, B., & Dishion, T. J. (1993). Multimethod comparison of similarity in school adjustment of siblings and unrelated children. Developmental Psychology, 29, 963–969.
48.
Lifschitz, M. H., Wilson, G. S., Smith, E. O., & Desmond, M. M. (1985). Factors affecting head growth and intellectual function in children of drug addicts. Pediatrics, 75, 269–274.
49.
Lindenberg, C. S., Alexander, E. M., Gendrop, S. C., Nencioli, M., & Williams, D. G. (1991). A review of the literature on cocaine abuse in pregnancy. Nursing Research, 40, 69–75.
50.
Lodge, A., Marcus, M. M., & Ramer, C. M. (1975). Behavioral and electrophysiological characteristics of the addicted neonate. Addictive Diseases: An International Journal, 2, 235–255.
51.
Mayes, L. C., Granger, R. H., Bornstein, M. H., Zuckerman, B. (1992). The problem of cocaine exposure: A rush to judgment. Journal of American Medical Association, 267, 406–408.
52.
McCarthy, D. (1972). McCarthy scales of children's abilities.San Antonio, TX: Psychological Corporation.
53.
Neuspiel, D. R., Hamel, S. C., Hochberg, E., Greene, J., & Campbell, D. (1991). Maternal cocaine use and infant behavior. Neurotoxicology and Teratology, 13, 229–233.
54.
Oro, A. S., & Dixon, S. D. (1987). Perinatal cocaine and methamphetamine exposure: Maternal and neonatal correlates. Journal of Pediatrics, 111, 571–578.
55.
Regan, D., Ehrlich, S., & Finnegan, L. (1987). Infants of drug addicts: At risk for child abuse, neglect, and placement in foster care. Neurotoxicology and Teratology, 9, 315–319.
56.
Richardson, G. A., & Day, N. L. (1991). Maternal and neonatal effects of moderate cocaine use during pregnancy. Neurotoxicology and Teratology, 13, 455–460.
57.
Richardson, G. A., Day, N. L., & Taylor, P.M. (1989). The effect of prenatal alcohol, marijuana, and tobacco exposure on neonatal behavior. Infant Behavior and Development, 12, 199–209.
58.
Rinkel, P. (1992, June). Myths and stereotypes about long-term effects of prenatal alcohol and other drug exposure (PADE). Perinatal Addiction Research and Education UPDATE, pp. 1, 3, 5.
59.
Rodning, C., Beckwith, L., & Howard, J. (1989). Characteristics of attachment organization and play organization in prenatally drug exposed toddlers. Developmental and Psychopathology, 1, 277–289.
60.
Rosen, T. S., & Johnson, H. L. (1982). Children of methadone-maintained mothers: Follow-up to 18 months of age. The Journal of Pediatrics, 101, 192–196.
61.
Sameroff, A. J., & Fiese, B. H. (1990). Transactional regulation and early intervention. In S. J. Meisels & J. P. Shonkoff (Eds.), Handbook of early childhood intervention (pp. 119–149). Cambridge: Cambridge University Press.
62.
Schneider, J. W., & Chasnoff, I. J. (1992). Motor assessment of cocaine/polydrug exposed infants at age 4 months. Neurotoxicology and Teratology, 14, 97–101.
63.
Schutter, L. S., & Brinker, R. P. (1992). Conjuring a new category of disability from prenatal cocaine exposure: Unique biological or caretaking causalities?Topics in Early Childhood Special Education, 11(4), 84–111.
64.
Siegel, S. (1956). Nonparametric statistics for the behavioral sciences.New York: McGraw-Hill.
65.
Singer, L., Arendt, R., & Minnes, S. (1993). Neurodevelopmental effects of cocaine. Clinics in Perinatology, 20, 245–262.
66.
Smith, I. (1992). An ecological perspective: The impact of culture and social environment on drug-exposed children. In Identifying the needs of drug-affected children: Public policy issues (Office of Substance Abuse Prevention Monograph No. 11, pp. 93–108) (DHHS Publication No. ADM 92-1814). Washington, DC: U.S. Government Printing Office.
67.
Strauss, M. E., Lessen-Firestone, J. K., Starr, R. H., & Ostrea, E. M. (1975). Behavior of narcotics-addicted newborns. Child Development, 46, 887–893.
68.
Strauss, M. E., Starr, R. H., Ostrea, E. M., Chavez, C. J., & Stryker, J. C. (1976). Behavioral concomitants of prenatal addiction to narcotics. Journal of Pediatrics, 89, 842–846.
69.
Struthers, J. M., & Hansen, R. L. (1992). Visual recognition memory in drug-exposed infants. Developmental and Behavioral Pediatrics, 13, 108–111.
70.
Thorndike, R., Hagen, E., & Sattler, J. (1985). Stanford-Binet Intelligence Scale (4th ed.). Chicago: Riverside.
71.
Tronick, E. Z., & Beeghly, M. (1992). Effects of prenatal exposure to cocaine on newborn behavior and development: A critical review. In Identifying the needs of drug-affected children: Public policy issues (Office of Substance Abuse Prevention Monograph No. 11, pp. 25–48) (DHHS Publication No. ADM 92-1814). Washington, DC: U.S. Government Printing Office.
72.
van Baar, A. (1990). Development of infants of drug dependent mothers. Journal of Child Psychology and Psychiatry, 31, 911–920.
73.
van Baar, A. L., Fleury, P., Soepatmi, S., Utlee, C. A., & Wesselman, P. J. M. (1989). Neonatal behaviour after drug dependent pregnancy. Archives of Disease in Childhood, 64, 235–240.
74.
van Baar, A. L., Fleury, P., & Utlee, C. A. (1989). Behaviour in first year after drug dependent pregnancy. Archives of Disease in Childhood, 64, 241–245.
75.
Ward, O. B., Kopertowski, D. M., Finnegan, L. P., & Sandberg, D. E. (1989). Gender-identity variations in boys prenatally exposed to opiates. Annals of the New York Academy of Sciences, 562, 365–366.
76.
Weston, D. R., Ivins, B., Zuckerman, B., Jones, C., & Lopez, R. (1989). Drug-exposed babies: Research and clinical issues. Zero to Three, 9(5), 1–7.
77.
Wilson, G. S., McCreary, R., Kean, J., & Baxter, C. (1979). The development of preschool children of heroin-addicted mothers: A controlled study. Pediatrics, 63(1), 135–141.
78.
Zuckerman, B. (1991). Selected methodologic issues in investigations of prenatal effects of cocaine: Lessons from the past. In M. Kibey & K. Asghar (Eds.), Methodological issues in controlled studies of effects of prenatal exposure to drug abuse (National Institute on Drug Abuse Research Monograph No. 114, pp. 45–54) (DHHS Publication No. ADM 91-1837). Washington, DC: U.S. Government Printing Office.
79.
Zuckerman, B. S., Amaro, H., & Cabral, H. (1989). The validity of self-reported marijuana and cocaine use among pregnant adolescents. Journal of Pediatrics, 115, 812–815.
80.
Zuckerman, B., & Bresnahan, K. (1991). Developmental and behavioral consequences of prenatal drug and alcohol exposure. Pediatric Clinic of North America, 38, 1–19.
81.
Zuckerman, B., Frank, D., Hingson, R., Amaro, H., Levenson, S., Kayne, H., Parker, S., Vinci, R., Aboagye, K., Fried, L., Cabral, H., Timeri, R., & Bauchner, H. (1989). Effects of maternal marijuana and cocaine use on fetal growth. New England Journal of Medicine, 320, 762–768.
