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PEDIATRICS Vol. 110 No. 6 December 2002, pp. 1182-1192

The Maternal Lifestyle Study: Effects of Substance Exposure During Pregnancy on Neurodevelopmental Outcome in 1-Month-Old Infants

Barry M. Lester, PhD*, Edward Z. Tronick, PhD{ddagger}, Linda LaGasse, PhD*, Ronald Seifer, PhD§, Charles R. Bauer, MD||, Seetha Shankaran, MD, Henrietta S. Bada, MD#, Linda L. Wright, MD**, Vincent L. Smeriglio, PhD{ddagger}{ddagger}, Jing Lu, PhD§§, Loretta P. Finnegan, MD|||| and Penelope L. Maza, PhD¶¶

* Brown Medical School, Women and Infant’s Hospital and Bradley Hospital, Providence, Rhode Island
{ddagger} Harvard University Medical School and Children’s Hospital, Boston, Massachusetts
§ Brown Medical School and Bradley Hospital, Providence, Rhode Island
|| University of Miami School of Medicine, Miami, Florida
Wayne State University School of Medicine, Detroit, Michigan
# University of Tennessee at Memphis, School of Medicine, Memphis, Tennessee
** National Institute of Child Health and Human Development, Bethesda, Maryland
{ddagger}{ddagger} National Institute on Drug Abuse, Bethesda, Maryland
§§ Infant Development Center, Women and Infant’s Hospital and Bradley Hospital, Providence, Rhode Island
|||| Office of Research on Women’s Health, National Institutes of Health, Bethesda, Maryland
¶¶ Administration on Children, Youth and Families, Washington, DC

--> Objective. This was a prospective longitudinal multisite study of the effects of prenatal cocaine and/or opiate exposure on neurodevelopmental outcome in term and preterm infants at 1 month of age.

Methods. The sample included 658 exposed and 730 comparison infants matched on race, gender, and gestational age (11.7% born <33 weeks’ gestational age). Mothers were recruited at 4 urban university-based centers and were mostly black and on public assistance. Exposure was determined by meconium assay and self-report with alcohol, marijuana, and tobacco present in both groups. At 1 month corrected age, infants were tested by masked examiners with the NICU Network Neurobehavioral Scale and acoustical cry analysis. Exposed and comparison groups were compared adjusting for covariates (alcohol, marijuana, tobacco, birth weight, social class, and site). Separate analyses were conducted for level of cocaine exposure.

Results. On the NICU Network Neurobehavioral Scale, cocaine exposure was related to lower arousal, poorer quality of movement and self-regulation, higher excitability, more hypertonia, and more nonoptimal reflexes with most effects maintained after adjustment for covariates. Some effects were associated with heavy cocaine exposure, and effects were also found for opiates, alcohol, marijuana, and birth weight. Acoustic cry characteristics that reflect reactivity, respiratory, and neural control of the cry sound were also compromised by prenatal drug exposure, including cocaine, opiates, alcohol, and marijuana and by birth weight. Fewer cry effects remained after adjustment for covariates.

Conclusions. Cocaine effects are subtle and can be detected when studied in the context of polydrug use and level of cocaine exposure. Effects of other drugs even at low thresholds can also be observed in the context of a polydrug model. The ability to detect these drug effects requires a large sample and neurobehavioral tests that are differentially sensitive to drug effects. Long-term follow-up is necessary to determine whether these differences develop into clinically significant deficits.

Key Words: infants • cocaine • opiates • polydrug use • pregnancy substance abuse • prenatal drug exposure • neurobehavior • NICU Network Neurobehavioral Scale • cry • multisite • heavy exposure • threshold effects • low birth weight • meconium

Abbreviations: MLS, Maternal Lifestyle Study • NICHD, National Institute of Child Health and Human Development • NIDA, National Institute on Drug Abuse • MISU, Maternal Interview of Substance Use • NNNS, NICU Network Neurobehavioral Scale • NBAS, Neonatal Behavioral Assessment Scale • ANOVA, analysis of variance • SES, socioeconomic status

Received for publication Mar 7, 2002; Accepted Jul 19, 2002.




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