THE IMPACT OF PRENATAL MARIJUANA AND COCAINE USE ON THE INFANT AND CHILD

The prevalence of cocaine use by pregnant women has been estimated by various researchers to range from 8-17%. Women who use cocaine during pregnancy are usually older and black and use more of other drugs. The effects of prenatal cocaine use on a variety of outcomes have not been substantiated. For each outcome discussed, there are as many reports of no effects as there are reports of detrimental effects. The studies that indicate that there are no effects of exposure are generally more sound methodologically. It is also possible that there are additional investigations of prenatal cocaine use that have not been published because of the hesitancy to publish reports in which no effects have been found. The findings regarding obstetric complications are equivocal. Although some investigators have demonstrated significant effects of cocaine use during pregnancy, particularly on abruptio placentae, many of these relationships disappear when factors such as prenatal care and polydrug use are assessed. The same pattern can be noted for the effects of prenatal cocaine exposure on gestational age, growth, and morphology. Significant effects of prenatal cocaine use on these outcomes have been reported by some investigators. However, these results are found generally in studies where polydrug-cocaine users are compared with nondrug-using women. Such comparisons do not control adequately for other factors in the lifestyles of the cocaine-using woman. There are few significant differences when the offspring of cocaine-using women are compared with those of women who use other drugs. It is difficult to evaluate the effects of prenatal cocaine use on either neonatal neurobehavioral outcomes or on long-term growth and development because of the insufficient number of studies and the equivocal findings. Longitudinal studies are needed to disentangle the effects of cocaine use from the effects of the lack of prenatal care, polydrug use, and the increased risks associated with a drug-using life style.