Prenatal cocaine exposure has been consistently associated with alterations in neonatal behavior and more recently a dose-response relationship has been identified. However, little data are available to address the long-term behavioral effects of prenatal exposures. The specific aim of this report is to evaluate the school age behavior of children prenatally exposed to cocaine/alcohol. Study subjects are singleton infants born to women extensively screened by research staff during pregnancy for alcohol, cigarette, cocaine and other drug use. As indicated, maternal and infant drug testing was performed. Cocaine exposure was positive if history or lab was positive. Substance abuse exposure was also quantified. Six years later, families were contacted. Following informed consent, the child, primary caretaker and, when available, the biologic mother were tested in our research facilities. Behavior was assessed by the Child Behavior Checklist(Internalizing INT and Externalizing EXT Scales). Drug use since the child's birth was assessed by trained researchers using a structured interview. Results: The study sample consisted of 670 singleton children. At the time of data analysis, 4 subjects were known to have expired Of those remaining, 36% could not be located. Only 8% refused participation. Testing was available for 57% of the sample (Prenatal cocaine exposed: N=137). Frequency of prenatal cocaine exposure was available for 314 of the 353 children. Prenatal cocaine exposure was also highly correlated with postnatal use in the child's home(r=.35). However, urine testing of 150 children failed to identify a single child positive for cocaine at follow-up. After controlling for gestation age(GA). prenatal alcohol and cigarette exposure, children prenatally exposed to cocaine did not differ from non-exposed on either the INT or EXT scales. However, when the prenatal cocaine exposure was quantified, there was a positive and significant relationship to INT (r=.12, p=.03) after controlling for GA and other exposures. EXT was also positively related to cocaine exposure (r=.089) but was not significant (p=.12). An N of 314 provides sufficient power (.8) with to detect a correlation of 0.16, corresponding to 2 1/2% of the variance in behavior. Preliminary results of this NIDA-funded study suggest persistent adverse behavioral effects potentially related to prenatal cocaine exposure.
