Prenatal Cocaine Exposure Impacts Adolescent Development, but Clinical Relevance is Unclear

During the crack cocaine epidemic there was concern that prenatal cocaine exposure (PCE) would have long-term adverse effects on development. This systematic review examined the impact of PCE on adolescent outcomes. Twenty-seven studies representing nine cohorts were identified and four outcomes of interest were reported: behavior, cognition/school performance, brain structure/function, and physiologic response.

• Eleven studies reported behavioral outcomes such as drug use, victimization, and attention problems. Seven of those studies had statistically significant findings consistent with adverse effects.
• Eight studies reported cognition/school performance. Six had statistically significant findings consistent with adverse effects.
• Eight studies reported results about brain morphology and functioning using neuroimaging. Four studies had statistically significant findings consistent with adverse effects.
• Three studies reported physiologic response variability using cortisol levels. The results were inconsistent but all studies showed alterations in the cortisol response to stress in the PCE groups.
• Most of the differences between those exposed and unexposed to cocaine were small to moderate.

Comments:

This systematic review represents the first effort to synthesize information on studies of PCE effects in adolescence. Seventy percent of the studies had significant findings; however, the authors point out that the clinical relevance of those findings is unclear. These mixed results are consistent with prior reviews of PCE and early (pre-adolescent) development.

Sarah Bagley, MD† and Judith Tsui, MD, MPH

Reference:

Buckingham-Howes S, Berger SS, Scaletti LA, Black MM. Systematic review of prenatal cocaine exposure and adolescent development. Pediatrics. 2013;131(6):e1917–1936.