JULY 30, 2005

Putting the crack baby myth to bed

Researchers fail to link cocaine use
and neonatal outcomes

Ever wonder what became of crack babies? In the 1980s, media coverage in Canada and the US horrified the public with stories of cocaine and crack cocaine's toxic effects on children in the womb. Addicted newborns, brain-damaged neonates and disturbed toddlers were all said to be part of an 'epidemic' caused by the rising incidence of drug use during pregnancy. But Canadian and US researchers claim that the hysteria over crack babies was more a product of the media than of scientific data.

Cocaine addiction increased in the 80s and, in Canada, "There was a huge concern that we would see another thalidomide [incident] with birth defects and neurodevelopmental impairment," recalls Dr Gideon Koren, Professor of Pediatrics at the University of Toronto and Director of Motherisk — a program that counsels women on drug safety and other pregnancy related issues. "In Toronto, we did a study 12 years ago measuring hair levels of cocaine in babies and found that 6% of women used cocaine in their last three months of pregnancy. This translates into 5,000 exposed babies a year in the Greater Toronto area," he says. However, further research by Dr Koren — now, a staunch critic of the crack baby myth — found no link between birth defects and in utero exposure to cocaine.

University of Florida researchers Dr Fonda Eyler, PhD, a developmental psychologist, and Dr Marylou Behnke, MD, a neonatologist, were appalled at the number of uncontrolled case studies they found. "People were seeing children with problems, then asking about drug use, finding a few who had been exposed to cocaine and making the assumption that there was a cause and effect relationship," says Dr Eyler.

During a presentation at the annual meeting of the Society for Research in Child Development in Atlanta this April, Dr Eyler finally put the crack baby myth soundly to sleep. Since 1993, she and Dr Behnke have been following 154 children exposed to cocaine in utero and 154 unexposed kids who were matched on race, parity, socio-economic status and prenatal care.

"We did extensive physical and neurologic exams at birth and found no group differences," says Dr Eyler. There were no developmental or cognitive differences found in these kids at age three either. These results can be found in the April 12 issue of the Journal of Pediatric Psychology. At the meeting, the researchers presented a preliminary analysis of the kids at ages five to seven which also failed to detect any major differences in overall development or IQ.

"Our research has shown that you can't look at the exposure of one child and predict where that child will be. We have children with a lot of exposure in gifted classes, and children with no exposure not doing well. It could be that the groups are both at risk just because of their poverty," Dr Eyler surmises. She stresses that attention should be focused on treating each child individually and on the home environment, rather than on prior cocaine exposure. Another obvious intervention would be to offer these mothers treatment for their addiction. In fact, all the study participants were offered treatment but few accepted — not surprising since Florida strongly favours prosecution over drug treatment and may remove children permanently from mothers going into rehab. The study itself had to receive special dispensation from the US federal government in order to resist state subpoenas of the medical records of the drug-using participants.

For U of T's Dr Koren, the primary danger of the crack baby myth is the stigma faced by children with prenatal exposure to cocaine. As a pediatrician, he takes exposure as an indication that the family may need help. "Because the environment isn't optimal, it's important to monitor the child more often to identify areas of lack of challenge. The earlier you intervene, the better the outcome. Call it secondary prevention."



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