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Fetal 'Crack' Exposure Effects Questioned

February 1998
By E.J. Mundell

NEW YORK (Reuters) -- Initial reports of permanently damaged "crack babies'' may have been greatly exaggerated, according to pediatric researchers. However, they caution that the long-term impact of fetal cocaine exposure upon child development still remains largely unknown.

Research involving over 300 newborns led experts at the University of Florida in Gainesville, to conclude that "we have few data to warrant the alarm that grew out of earlier reports, often fueled by the media, of the possible devastating effects of prenatal cocaine-exposure.

Their research, which appears in the February issue of the journal Pediatrics, compared the physical and psychological condition of 154 babies born to cocaine-addicted mothers to that of 154 infants born to healthy mothers of matched ethnicity, background and age.

The researchers found that newborns born to mothers with a history of crack use during their third trimester had slightly smaller heads (on average) as well as slightly shorter bodies compared with children of non-cocaine-abusers. These effects remained even after the scientists adjusted for maternal use of other drugs such as alcohol, marijuana, and nicotine.

Study lead author Dr. Fonda Davis Eyler noted, however, that these physical differences were barely noticeable to the naked eye: "if you looked at two different children (one from each group), you wouldn't be able to tell,'' she said.

Standard psychological testing revealed no significant differences in overall intellectual performance among the two groups of newborns. However, according to Eyler, more subtle behavioral differences emerged during subsequent testing. Drug-exposed babies "would be in their alert state less often," she explained, "or they would cry more, or they would just be more difficult to keep in the kind of state to be available, to do the testing."

Still, Eyler, a psychologist, notes that these behavioral differences were, again, less than immediately obvious. "It wouldn't be a baby that you would say, 'Oh my goodness, this mother's going to take (the baby) home and have lots of problems, and everyone's going to notice,'" she said.

However, the Florida researchers caution that no one yet understands the long-term implications of subtle drug-related alterations in physical or mental development. "If, as a group, (the fetally exposed babies) all had a little more difficulty, it makes you wonder if this is a red flag for something that will come out later," Eyler said.

In an effort to discover the long-term effects, if any, of fetal cocaine exposure on child development, she and her colleagues plan to follow the developmental progress of this same cohort of children over their first 8 years of life.

The good news, she says, is that none of the findings in the current study point to extreme damage. "While we don't know what that means long-term, that gives us more hope that these children aren't doomed to be forever disabled," she said. Eyler notes that the very act of naming a child a "crack baby" can, in itself, bring about great harm. She believes all stigmatizing labels "can be a self-fulfilling prophecy. We think they're going to do poorly, we don't expect for them to do well, (and) so we don't push for that."

SOURCE: Pediatrics (1998;101(2):229-237, 237-241)