Cognitive with outcomes of preschool children prenatal cocaine exposure

被引:166
|
作者
Singer, LT
Minnes, S
Short, E
Arendt, R
Farkas, K
Lewis, B
Klein, N
Russ, S
Min, MO
Kirchner, HL
机构
[1] Case Western Reserve Univ, Sch Med, Dept Gen Med Sci, Cleveland, OH 44106 USA
[2] Case Western Reserve Univ, Sch Med, Dept Pediat, Cleveland, OH 44106 USA
[3] Case Western Reserve Univ, Mandel Sch Appl Social Sci, Cleveland, OH 44106 USA
[4] Case Western Reserve Univ, Dept Psychol, Cleveland, OH 44106 USA
[5] Cleveland State Univ, Dept Educ, Cleveland, OH 44115 USA
[6] Ohio State Univ, Dept Pediat, Columbus, OH 43210 USA
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D O I
10.1001/jama.291.20.2448
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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 high-risk 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). Main Outcome Measure The Wechsler Preschool and Primary Scales of Intelligence-Revised. Results After control for covariates, prenatal cocaine exposure was not related to lower full-scale IQ (cocaine exposed [80.7] vs nonexposed [82.9]; P=.09) scores or summary verbal (cocaine exposed [79.9] vs nonexposed [81.9]; P=.11) or performance (cocaine exposed [85.5] vs nonexposed [87.5]; P=.18) IQ scores at age 4 years. However, prenatal cocaine exposure was related to small but significant deficits on several subscales (mean [SE]): visual-spatial skills (cocaine exposed [7.3 (0.22)] vs nonexposed [8.2 (0.22)]; P=.01), general knowledge (cocaine exposed [6.1 (0.18)] vs nonexposed [6.7 (0.17)]; P=.04), and arithmetic skills (cocaine exposed [6.2 (0.20)] vs nonexposed [6.8 (0.20)]; P=.05). Prenatal cocaine exposure was also associated with a lower likelihood of achievement of IQ above normative means (odds ratio, 0.26 [95% confidence interval, 0.10-0.65]; P=.004). The quality of the caregiving environment was the strongest independent predictor of outcomes. Cocaine-exposed children placed in nonrelative foster or adoptive care lived in homes with more stimulating environments and had caregivers with better vocabulary scores, and they attained full-scale and performance IQ scores (83 and 87, respectively) similar to nonexposed children in biological maternal or relative care (full-scale IQ, 82; performance IQ, 88) and higher than cocaine-exposed children in biological maternal or relative care (full-scale IQ, 79; performance IQ, 84). Conclusions Prenatal cocaine exposure was not associated with lower full-scale, verbal, or performance IQ scores but was associated with an increased risk for specific cognitive impairments and lower likelihood of IQ above the normative mean at 4 years. A better home environment was associated with IQ scores for cocaine-exposed children that are similar to scores in nonexposed children.
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页码:2448 / 2456
页数:9
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