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PEDIATRICS Vol. 113 No. 6 June 2004, pp. 1677-1685

The Maternal Lifestyle Study: Cognitive, Motor, and Behavioral Outcomes of Cocaine-Exposed and Opiate-Exposed Infants Through Three Years of Age

Daniel S. Messinger, PhD*, Charles R. Bauer, MD{ddagger}, Abhik Das, PhD§, Ron Seifer, PhD||, Barry M. Lester, PhD, Linda L. Lagasse, PhD, Linda L. Wright, MD##, Seetha Shankaran, MD**, Henrietta S. Bada, MD{dagger}{dagger}, Vincent L. Smeriglio, PhD§§, John C. Langer, PhD§, Marjorie Beeghly, PhD|||| and W. Kenneth Poole, PhD§

* Departments of Psychology and Pediatrics, University of Miami, Coral Gables, Florida
{ddagger} University of Miami School of Medicine, Miami, Florida
§ Research Triangle Institute, Research Triangle Park, North Carolina
|| Brown University School of Medicine and Bradley Hospital, Providence, Rhode Island
Brown University School of Medicine, Women and Infant’s Hospital and Bradley Hospital, Providence, Rhode Island
# National Institute of Child Health and Human Development, Bethesda, Maryland
** Wayne State University School of Medicine, Detroit, Michigan
{ddagger}{ddagger} University of Tennessee at Memphis, School of Medicine, Memphis, Tennessee
§§ National Institute on Drug Abuse, Bethesda, Maryland
|||| Harvard Medical School, Harvard Medical School and Children’s Hospital, Boston, Massachusetts

Objective. To evaluate the direct effects of prenatal cocaine exposure and prenatal opiate exposure on infant mental, motor, and behavioral outcomes longitudinally between 1 and 3 years old.

Methods. As part of a prospective, longitudinal, multisite study, the Bayley Scales of Infant Development II were administered to 1227 infants who were exposed to cocaine (n = 474), opiates (n = 50), cocaine and opiates (n = 48), and neither substance (n = 655) at 1, 2, and 3 years of corrected age by certified, masked examiners. Hierarchic linear modeling of the 1-, 2-, and 3-year scores was conducted using cocaine and opiate exposure as predictors with and without controlling for covariates.

Results. Overall retention was 88.4% and did not differ by cocaine or opiate exposure. Overall (at 1, 2, and 3 years), cocaine-exposed infants scored 1.6 Mental Development Index points below infants who were not exposed to cocaine. Opiate-exposed infants scored 3.8 Psychomotor Development Index points below infants who were not exposed to opiates. Neither the cocaine nor the opiate effect remained significant after controlling for covariates. Neither cocaine nor opiate exposure was associated with the Behavioral Record Score during the examination. Low birth weight and indices of nonoptimal caregiving were associated with lower Mental Development Index, Psychomotor Development Index, and Behavioral Record Score scores for all groups of infants.

Conclusions. In the largest at-risk sample observed longitudinally to date, infant prenatal exposure to cocaine and to opiates was not associated with mental, motor, or behavioral deficits after controlling for birth weight and environmental risks.

Key Words: cocaine • opiates • prenatal exposure • BSID-II • outcome

Abbreviations: BSID-II, Bayley Scales of Infant Development II • MDI, Mental Development Index • PDI, Psychomotor Development Index • SES, socioeconomic status • MLS, Maternal Lifestyle Study • EMIT, enzyme-multiplied immunoassay technique • MISU, Maternal Inventory of Substance Use • BE, benzoylecgonine • HOME, Home Observation for Measurement of the Environment • PPVT-R, Peabody Picture Vocabulary Test-Revised • BRS, Behavioral Rating Scale • HIV, human immunodeficiency virus

Received for publication Feb 27, 2002; Accepted Sep 26, 2003.




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