title: Systematic review of prenatal cocaine exposure and adolescent development.
abstract: OBJECTIVE
  Previous research found that prenatal cocaine exposure (PCE) may increase children's vulnerability to behavior and cognition problems. Maturational changes in brain and social development make adolescence an ideal time to reexamine associations. The objective was to conduct a systematic review of published studies examining associations between PCE and adolescent development (behavior, cognition/school outcomes, physiologic responses, and brain morphology/functioning).
  
  
  METHODS
  Articles were obtained from PubMed, PsycInfo, Web of Science, and CINAHL databases through July 2012 with search terms: prenatal drug, substance, or cocaine exposure; adolescence/adolescent; and in utero substance/drug exposure. Criteria for inclusion were nonexposed comparison group, human adolescents aged 11 to 19, peer-reviewed, English-language, and adolescent outcomes.
  
  
  RESULTS
  Twenty-seven studies representing 9 cohorts met the criteria. Four outcome categories were identified: behavior, cognition/school performance, brain structure/function, and physiologic responses. Eleven examined behavior; 7 found small but significant differences favoring nonexposed adolescents, with small effect sizes. Eight examined cognition/school performance; 6 reported significantly lower scores on language and memory tasks among adolescents with PCE, with varying effect sizes varied. Eight examined brain structure/function and reported morphologic differences with few functional differences. Three examined physiologic responses with discordant findings. Most studies controlled for other prenatal exposures, caregiving environment, and violence exposure; few examined mechanisms.
  
  
  CONCLUSIONS
  Consistent with findings among younger children, PCE increases the risk for small but significantly less favorable adolescent functioning. Although the clinical importance of differences is often unknown, the caregiving environment and violence exposure pose additional threats. Future research should investigate mechanisms linking PCE with adolescent functioning.
authors.affiliation: Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA. mblack@peds.umaryland.edu
authors.forename: Stacy
authors.initials: S
authors.lastname: Buckingham-Howes
authors.forename: Sarah Shafer
authors.initials: SS
authors.lastname: Berger
authors.forename: Laura A
authors.initials: LA
authors.lastname: Scaletti
authors.forename: Maureen M
authors.initials: MM
authors.lastname: Black
mesh_terms: D000293:Adolescent; D041923:Adolescent Development / Q000187:drug effects*; D003042:Cocaine / Q000009:adverse effects*; D019970:Cocaine-Related Disorders / Q000453:epidemiology*; D005260:Female; D006801:Humans; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000453:epidemiology*
chemical_list: D003042:Cocaine
keywords: adolescent development; prenatal cocaine exposure