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Published on: August 25, 2014
Prenatal cocaine exposures and dose-related cocaine effects on infant tone and behavior
Claudia A Chiriboga1, Louise Kuhn, Gail A Wasserman
1Division of Pediatric Neurology, Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, USA. cac3@columbia.edu
Insights
Prenatal cocaine exposure is linked to infant neurological issues like abnormal tone and posture, and lower orientation scores at six months. These effects appear dose-dependent, impacting infant neurodevelopment.
Area of Science:
- Neuroscience
- Developmental Pediatrics
- Toxicology
Background:
- Prenatal cocaine exposure is known to disrupt monoaminergic development in experimental models.
- Human studies on clinical correlates of prenatal cocaine exposure are numerous, but few examine dose-related neurologic effects beyond infancy.
Purpose of the Study:
- To determine if prenatal cocaine exposure adversely affects infant neurologic, developmental, and behavioral outcomes.
- To investigate whether these effects are dose-dependent.
Main Methods:
- Infants were enrolled at birth, with drug exposure confirmed via hair, urine, and meconium biomarkers.
- A cohort of 286 infants underwent blinded neurological and developmental assessments at 6 months using standardized scales.
Main Results:
- Abnormalities in infant tone and posture, such as extensor posture and persistent fisting, increased significantly with higher maternal hair cocaine levels.
- These neurological findings showed a dose-dependent relationship with prenatal cocaine exposure, persisting after adjustments.
- While no association was found with overall developmental scores, lower orientation scores were linked to prenatal cocaine exposure.
Conclusions:
- Prenatal cocaine exposure at 6 months of age is associated with specific neurological abnormalities (tone, posture) and reduced orientation.
- Disruptions in fetal monoaminergic systems due to cocaine exposure may underlie the observed neurological and behavioral symptoms.
- Further research is needed to ascertain if these infant findings predict later neurobehavioral problems.
Background:
In experimental models, prenatal cocaine exposure has been found to perturb monoaminergic development. In humans, numerous studies have sought clinical correlates, but few have focused on dose-related effects, especially as regards neurologic function beyond the neonatal period.
Objective:
To assess whether prenatal cocaine exposure has adverse effects on infant neurologic, developmental and behavioral outcomes and whether any effects are dose-dependent.
Design/Methods:
Infants (398) were enrolled at birth from an urban hospital. Drug exposure was ascertained with biomarkers in hair (n=395), urine (n=170) and meconium (n=109). Children were followed prospectively and 286 (72%) were evaluated blind to drug exposure at 6 months of age with the Bayley scales, Fagan Scale of Infant Intelligence and a standardized neurological examination.
Results:
Certain neurological findings increased significantly by the amount of cocaine detected in maternal hair, e.g. abnormality of tone, as indicated by extensor posture was detected among 28% of cocaine-unexposed infants, 43% of infants exposed to lower and 48% exposed to higher cocaine levels in maternal hair (p<0.009). Persistent fisting increased in a similar dose-dependent manner. These associations persisted in adjusted analyses. Prenatal cocaine exposure was not associated with developmental scores (mental, motor or novelty preference) but was associated with lower orientation scores in adjusted analyses.
Conclusions:
At 6 months of age, prenatal cocaine exposure was associated with abnormalities of tone and posture and with lower orientation scores. Perturbations in monoaminergic systems by cocaine exposure during fetal development may explain the observed neurological and behavioral symptoms. Whether such findings in infancy increase the risk of later neurobehavioral problems requires further study.
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