The maternal lifestyle study: effects of substance exposure during pregnancy on neurodevelopmental outcome in 1-month-old infants.
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.
Lester
Barry M
BM
Brown Medical School, Infant Development Center, Women and Infant's Hospital and Bradley Hospital, Providence, Rhode Island 02905-2499, USA. barry_lester@brown.edu
Tronick
Edward Z
EZ
LaGasse
Linda
L
Seifer
Ronald
R
Bauer
Charles R
CR
Shankaran
Seetha
S
Bada
Henrietta S
HS
Wright
Linda L
LL
Smeriglio
Vincent L
VL
Lu
Jing
J
Finnegan
Loretta P
LP
Maza
Penelope L
PL
D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology; D000704:Analysis of Variance; D002657:Child Development / Q000187:drug effects*; D019970:Cocaine-Related Disorders / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008019:Life Style; D008137:Longitudinal Studies; D008470:Meconium / Q000737:chemistry; D009420:Nervous System / Q000187:drug effects / Q000254:growth & development*; D009293:Opioid-Related Disorders / Q000453:epidemiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011297:Prenatal Exposure Delayed Effects; D011446:Prospective Studies; D012907:Smoking / Q000453:epidemiology