title: Impact of prenatal cocaine exposure on child behavior problems through school age.
abstract: 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.
authors.affiliation: Department of Pediatrics, University of Kentucky College of Medicine, Lexington, Kentucky, USA. hbada2@uky.edu
authors.forename: Henrietta S
authors.initials: HS
authors.lastname: Bada
authors.forename: Abhik
authors.initials: A
authors.lastname: Das
authors.forename: Charles R
authors.initials: CR
authors.lastname: Bauer
authors.forename: Seetha
authors.initials: S
authors.lastname: Shankaran
authors.forename: Barry
authors.initials: B
authors.lastname: Lester
authors.forename: Linda
authors.initials: L
authors.lastname: LaGasse
authors.forename: Jane
authors.initials: J
authors.lastname: Hammond
authors.forename: Linda L
authors.initials: LL
authors.lastname: Wright
authors.forename: Rosemary
authors.initials: R
authors.lastname: Higgins
mesh_terms: D000328:Adult; D002648:Child; D002652:Child Behavior; D002675:Child, Preschool; D019970:Cocaine-Related Disorders; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000139:chemically induced*