Published online February 1, 2007
PEDIATRICS Vol. 119 No. 2 February 2007, pp. e348-e359 (doi:10.1542/peds.2006-1404)
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ARTICLE

Impact of Prenatal Cocaine Exposure on Child Behavior Problems Through School Age

Henrietta S. Bada, MD, MPHa, Abhik Das, PhDb, Charles R. Bauer, MDc, Seetha Shankaran, MDd, Barry Lester, PhDe, Linda LaGasse, PhDe, Jane Hammond, PhDb, Linda L. Wright, MDf and Rosemary Higgins, MDf

a Department of Pediatrics, University of Kentucky College of Medicine, Lexington, Kentucky
b Research Triangle Institute International, Research Triangle Park, North Carolina
c Department of Pediatrics, University of Miami School of Medicine, Miami, Florida
d Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan
e Department of Pediatrics, Brown University Medical School, Providence, Rhode Island
f National Institute of Child Health and Human Development, Bethesda, Maryland

OBJECTIVE. We examined the trajectory of childhood behavior problems after prenatal cocaine exposure.

METHODS. The Maternal Lifestyle Study, a longitudinal cohort study, enrolled children between 1993 and 1995 at 4 centers. Prenatal cocaine exposure was determined from mothers who admitted use and/or meconium results. Exposed children were matched with a group of nonexposed children within site and by gestational age, gender, race, and ethnicity. The study began at the 1-month corrected age with a total of 1388 children enrolled. A total of 1056 were assessed for internalizing, externalizing, and total behavior problems at ages 3, 5, and 7 years using the Child Behavior Checklist. Longitudinal hierarchical linear models were used to determine the effect of prenatal cocaine exposure on behavior problem trajectories while controlling for other prenatal exposures; time-varying covariates, including ongoing caregiver use of legal and illegal substances; demographic factors; family violence; and caregiver psychological distress.

RESULTS. High prenatal cocaine exposure was associated with the trajectory of internalizing, externalizing, and total behavior problems; these effects were independent of and less than the significant combined effect of prenatal and postnatal tobacco and alcohol exposures. Caregiver depression and family violence had independent negative influence on all behavior outcomes.

CONCLUSIONS. Prenatal cocaine exposure has a negative impact on the trajectories of childhood behavior outcomes. When they co-occur with prenatal cocaine exposure, prenatal and postnatal tobacco and alcohol exposures have added negative effects on behavior outcomes.

Key Words: child behavior • prenatal exposure • cocaine • tobacco • alcohol

Abbreviations: PCE—prenatal cocaine exposure • MLS—Maternal Lifestyle Study • SES—socioeconomic status • HOME—Home Observation for Measurement of the Environment • BDI—Beck Depression Inventory • CBCL—Child Behavior Checklist • HLM—Hierarchical Linear Models

Accepted Aug 21, 2006.