title: Volumetric MRI study of brain in children with intrauterine exposure to cocaine, alcohol, tobacco, and marijuana.
abstract: OBJECTIVE
  The objective of this study was to use volumetric MRI to study brain volumes in 10- to 14-year-old children with and without intrauterine exposure to cocaine, alcohol, cigarettes, or marijuana.
  
  
  METHODS
  Volumetric MRI was performed on 35 children (mean age: 12.3 years; 14 with intrauterine exposure to cocaine, 21 with no intrauterine exposure to cocaine) to determine the effect of prenatal drug exposure on volumes of cortical gray matter; white matter; subcortical gray matter; cerebrospinal fluid; and total parenchymal volume. Head circumference was also obtained. Analyses of each individual substance were adjusted for demographic characteristics and the remaining 3 prenatal substance exposures.
  
  
  RESULTS
  Regression analyses adjusted for demographic characteristics showed that children with intrauterine exposure to cocaine had lower mean cortical gray matter and total parenchymal volumes and smaller mean head circumference than comparison children. After adjustment for other prenatal exposures, these volumes remained smaller but lost statistical significance. Similar analyses conducted for prenatal ethanol exposure adjusted for demographics showed significant reduction in mean cortical gray matter; total parenchymal volumes; and head circumference, which remained smaller but lost statistical significance after adjustment for the remaining 3 exposures. Notably, prenatal cigarette exposure was associated with significant reductions in cortical gray matter and total parenchymal volumes and head circumference after adjustment for demographics that retained marginal significance after adjustment for the other 3 exposures. Finally, as the number of exposures to prenatal substances grew, cortical gray matter and total parenchymal volumes and head circumference declined significantly with smallest measures found among children exposed to all 4. CONCLUSIONS; These data suggest that intrauterine exposures to cocaine, alcohol, and cigarettes are individually related to reduced head circumference; cortical gray matter; and total parenchymal volumes as measured by MRI at school age. Adjustment for other substance exposures precludes determination of statistically significant individual substance effect on brain volume in this small sample; however, these substances may act cumulatively during gestation to exert lasting effects on brain size and volume.
authors.affiliation: Developmental Neuroimaging Laboratory, Department of Neurology, Childrens Hospital Boston and Harvard Medical School, Pavilion 154, 300 Longwood Ave, Boston, MA 02115, USA. michael.rivkin@childrens.harvard.edu
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Rivkin
authors.forename: Peter E
authors.initials: PE
authors.lastname: Davis
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Lemaster
authors.forename: Howard J
authors.initials: HJ
authors.lastname: Cabral
authors.forename: Simon K
authors.initials: SK
authors.lastname: Warfield
authors.forename: Robert V
authors.initials: RV
authors.lastname: Mulkern
authors.forename: Caroline D
authors.initials: CD
authors.lastname: Robson
authors.forename: Ruth
authors.initials: R
authors.lastname: Rose-Jacobs
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Frank
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D000437:Alcoholism / Q000150:complications; D001927:Brain Diseases / Q000453:epidemiology / Q000209:etiology / Q000473:pathology*; D016022:Case-Control Studies; D002648:Child; D019970:Cocaine-Related Disorders / Q000150:complications; D002658:Developmental Disabilities / Q000139:chemically induced* / Q000453:epidemiology / Q000473:pathology; D005260:Female; D006801:Humans; D015994:Incidence; D016014:Linear Models; D008279:Magnetic Resonance Imaging; D008297:Male; D002189:Marijuana Abuse / Q000150:complications; D018811:Maternal Exposure / Q000009:adverse effects*; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D011336:Probability; D011379:Prognosis; D012016:Reference Values; D018570:Risk Assessment; D017678:Sex Distribution; D012907:Smoking / Q000009:adverse effects; D019966:Substance-Related Disorders / Q000150:complications* / Q000175:diagnosis