Study on prenatal exposure to cocaine surprises researchers

“Drugs are bad”

“You’ll rot your brain if you use drugs”

“You’re a bad person if you use drugs”

Aside from the questionable wisdom of telling someone they’re a bad person for using drugs, I think society has pushed this message long enough that virtually everyone has gotten the memo.  Of course telling people that does nothing to affect the rate of drug usage.  People are going to use drugs, and some people will become habitual users.  Even pregnant women use drugs, which everyone knows causes horrible defects and problems with their babies, right?   Not so fast, say some researchers:

Jaimee Drakewood hurried in from the rain, eager to get to her final appointment at Children’s Hospital of Philadelphia.

Ever since her birth 23 years ago, a team of researchers has been tracking every aspect of her development – gauging her progress as an infant, measuring her IQ as a preschooler, even peering into her adolescent brain using an MRI machine.

Now, after nearly a quarter century, the federally funded study was ending, and the question the researchers had been asking was answered.

Did cocaine harm the long-term development of children like Jaimee, who were exposed to the drug in their mother’s womb?

The researchers had expected the answer would be a resounding yes. But it wasn’t. Another factor would prove far more critical.

A crack epidemic was raging in Philadelphia in 1989 when Hallam Hurt, then chair of neonatology at Albert Einstein Medical Center on North Broad Street, began a study to evaluate the effects of in-utero cocaine exposure on babies. In maternity wards in Philadelphia and elsewhere, caregivers were seeing more mothers hooked on cheap, smokable crack cocaine. A 1989 study in Philadelphia found that nearly one in six newborns at city hospitals had mothers who tested positive for cocaine.

Troubling stories were circulating about the so-called crack babies. They had small heads and were easily agitated and prone to tremors and bad muscle tone, according to reports, many of which were anecdotal. Worse, the babies seemed aloof and avoided eye contact. Some social workers predicted a lost generation – kids with a host of learning and emotional deficits who would overwhelm school systems and not be able to hold a job or form meaningful relationships. The “crack baby” image became symbolic of bad mothering, and some cocaine-using mothers had their babies taken from them or, in a few cases, were arrested.

It was amid that climate that Hurt organized a study of 224 near-term or full-term babies born at Einstein between 1989 and 1992 – half with mothers who used cocaine during pregnancy and half who were not exposed to the drug in utero. All the babies came from low-income families, and nearly all were African Americans.

Hurt hoped the study would inform doctors and nurses caring for cocaine-exposed babies and even guide policies for drug prevention, treatment, and follow-up interventions. But she never anticipated that the study, funded by the National Institute on Drug Abuse, would become one of the largest and longest-running studies of in-utero cocaine exposure.

One mother who signed up was Jaimee’s mom, Karen Drakewood. She was on an all-night crack binge in a drug house near her home in the city’s West Oak Lane section when she went into labor. Jaimee was born Jan. 13, 1990, weighing an even 7 pounds.

“Jaimee was beautiful when she was born. A head full of hair. She looked like a porcelain doll,” Karen Drakewood, now 51, said recently in her Overbrook kitchen. “She was perfect.”

But Drakewood knew looks could be deceiving.

“My worst fear was that Jaimee would be slow, mentally retarded, or something like that because of me doing drugs,” she said. She agreed to enroll her baby in the cocaine study at Einstein. Drakewood promised herself that she would turn her life around for the sake of Jaimee and her older daughter, but she soon went back to smoking crack.

Hurt arrived early at Children’s Hospital one morning in June to give a talk on her team’s findings to coworkers. After nearly 25 years of studying the effects of cocaine and publishing or presenting dozens of findings, it wasn’t easy to summarize it in a PowerPoint presentation. The study received nearly $7.9 million in federal funding over the years, as well as $130,000 from the Einstein Society.

Hurt, who had taken her team from Einstein to Children’s in 2003, began her lecture with quotations from the media around the time the study began. A social worker on TV predicted that a crack baby would grow up to “have an IQ of perhaps 50.” A print article quoted a psychologist as saying “crack was interfering with the central core of what it is to be human,” and yet another article predicted that crack babies were “doomed to a life of uncertain suffering, of probable deviance, of permanent inferiority.”

Hurt, who is also a professor of pediatrics at the University of Pennsylvania, is always quick to point out that cocaine can have devastating effects on pregnancy. The drug can cause a problematic rise in a pregnant woman’s blood pressure, trigger premature labor, and may be linked to a dangerous condition in which the placenta tears away from the uterine wall. Babies born prematurely, no matter the cause, are at risk for a host of medical and developmental problems. On top of that, a parent’s drug use can create a chaotic home life for a child.

Hurt’s study enrolled only full-term babies so the possible effects of prematurity did not skew the results. The babies were then evaluated periodically, beginning at six months and then every six or 12 months on through young adulthood. Their mothers agreed to be tested for drug use throughout the study.

The researchers consistently found no significant differences between the cocaine-exposed children and the controls. At age 4, for instance, the average IQ of the cocaine-exposed children was 79.0 and the average IQ for the nonexposed children was 81.9. Both numbers are well below the average of 90 to 109 for U.S. children in the same age group. When it came to school readiness at age 6, about 25 percent of children in each group scored in the abnormal range on tests for math and letter and word recognition.

“We went looking for the effects of cocaine,” Hurt said. But after a time “we began to ask, ‘Was there something else going on?’ ”

While the cocaine-exposed children and a group of nonexposed controls performed about the same on tests, both groups lagged on developmental and intellectual measures compared to the norm. Hurt and her team began to think the “something else” was poverty.

 

The rest is here.

 

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Study on prenatal exposure to cocaine surprises researchers
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