The Maternal Lifestyle Study: effects of substance exposure during pregnancy on neurodevelopmental outcome in 1-month-old infants
Abstract
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.
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The NNNS is sensitive to effects of intrauterine drug exposure but also captures the normative range of behaviors.
“The exam is sensitive to effects of intrauterine drug exposure22, 23 but also captures the normative range of behaviors.”
From Maternal Smoking during Pregnancy and Newborn Neurobehavior: Effects at 10 to 27 Days (2009) · cites this paper as [22]
The effect sizes are comparable or stronger than those seen following exposure to other drugs of abuse including cocaine and heroin.
“These effect sizes are comparable or stronger than those seen following exposure to other drugs of abuse including cocaine and heroin,22”
From Maternal Smoking during Pregnancy and Newborn Neurobehavior: Effects at 10 to 27 Days (2009) · cites this paper as [22]
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- Authors
- Lester, B. M., Tronick, E. Z., LaGasse, L., Seifer, R., Bauer, C. R., Shankaran, S., Bada, H. S., Wright, L. L., Smeriglio, V. L., Lu, J., Finnegan, L. P., & Maza, P. L.
- Affiliations
- Brown University (US)
- Boston Children's Hospital (US)
- Bradley Hospital (US)
- University of Miami (US)
- Wayne State University (US)
- University of Tennessee Health Science Center (US)
- National Institutes of Health (US)
- National Institute on Drug Abuse (US)
- Administration on Children, Youth and Families, Washington, DC
- ORCID
- Venue
- PEDIATRICS
- Publisher
- American Academy of Pediatrics (AAP)
- Published
- 2002-12-01
- Volume
- 110
- Issue
- 6
- Pages
- 1182-1192
- ISSN
- 0031-4005 (ISSN-L)
- 1098-4275
- OpenAlex
- W2026831947
- Cited by
- 317
- References
- 72
- Citations by year
- 2026: 5 · 2025: 1 · 2024: 12 · 2023: 11 · 2022: 6 · 2021: 8 · 2020: 7 · 2019: 12 · 2018: 13 · 2017: 8 · 2016: 11 · 2015: 14 · 2014: 25 · 2013: 17 · 2012: 27
- FWCI
- 8.71
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- PEDIATRICS (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute on Drug Abuse
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (U10HD21385, U10HD 21397, U10‐HD‐27904, U10HD021397, U10HD027904, U10HD027856, N01HD2-3159, U10HD021385, U10 HD27856)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Substance Exposure Effects
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Development and Preterm Care
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Keywords
- prenatal cocaine exposure, prenatal drug exposure, neurodevelopmental outcomes, infant neurobehavior, NICU Network Neurobehavioral Scale, polydrug use, birth weight, preterm infants, maternal substance use, self-regulation, excitability, hypertonia
- MeSH terms
- Adult, Alcohol Drinking, Analysis of Variance, Child Development, Female, Humans, Infant, Newborn, Life Style, Longitudinal Studies, Meconium, Opioid-Related Disorders, Nervous System, Pregnancy, Pregnancy Complications, Prenatal Exposure Delayed Effects, Prospective Studies, Smoking, Cocaine-Related Disorders
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