Prenatal substance abuse continues to be a significant problem in this country and poses important health risks for the developing fetus. The primary care pediatrician’s role in addressing prenatal substance exposure includes prevention, identification of exposure, recognition of medical issues for the exposed newborn infant, protection of the infant, and follow-up of the exposed infant. This report will provide information for the most common drugs involved in prenatal exposure: nicotine, alcohol, marijuana, opiates, cocaine, and methamphetamine.

Substance abuse has been a worldwide problem at all levels of society since ancient times. Attention has been directed toward the use of legal and illegal substances by pregnant women over the past several decades. Almost all drugs are known to cross the placenta and have some effect on the fetus. The effects on the human fetus of prenatal cigarette use have been identified and studied since the 1960s,1 the effects of alcohol and opiate use have been studied since the 1970s,2,4 and the effects a variety of other illicit drugs have been studied since the 1980s.5,7 This report reviews data regarding the prevalence of exposure and available technologies for identifying exposure as well as current information regarding short- and long-term outcomes of exposed infants, with the aim of facilitating pediatricians in fulfilling their role in the promotion and maintenance of infant and child health.

Prevalence estimates for prenatal substance use vary widely and have been difficult to establish. Differences are likely attributable to such things as the use of different sampling methods and drug-detection methods, screening women in different settings, and obtaining data at different points in time. For example, prevalence will vary depending on whether history or testing of biological specimens is used; whether the biological specimen is hair, urine, or meconium; and whether the specimens are merely screened for drugs or screened and confirmed with additional testing. There also will be differences depending on whether the sample being investigated is a community sample or a targeted sample, such as women who are in drug treatment or are incarcerated. Lastly, prevalence must be interpreted in light of the fact that the use of specific drugs waxes and wanes over time nationwide as the popularity of certain substances changes.

Although a variety of prevalence studies have been conducted over the past 2 decades, there is 1 national survey that regularly provides information on trends in substance abuse among pregnant women. The National Survey on Drug Use and Health (formerly called the National Household Survey on Drug Abuse), sponsored by the Substance Abuse and Mental Health Services Administration (http://www.oas.samhsa.gov/nhsda.htm), is an annual survey providing national and state level information on the use of alcohol, tobacco, and illicit drugs in a sample of more than 67 000 noninstitutionalized people older than 12 years. Data are combined into 2-year epochs and include reported drug use for pregnant women between the ages of 15 and 44 years. Current illegal drug use among pregnant women remained relatively stable from 2007–2008 (5.1%) to 2009–2010 (4.4%). These average prevalence rates are significantly lower than reported current illicit drug use rates for nonpregnant women (10.9%). Importantly, the rate of current drug use among the youngest and possibly the most vulnerable pregnant women was highest (16.2% for 15- to 17-year-olds, compared with 7.4% among 18- to 25-year-olds and 1.9% among 26- to 44-year-olds). Table 1 summarizes these data along with information regarding current alcohol use, binge drinking, and cigarette use by pregnant and nonpregnant women. An additional important finding from this survey was that the rate of cigarette smoking for those 15 to 17 years of age actually was higher for pregnant women than for nonpregnant women (22.7% vs 13.4%, respectively). This report details many sociodemographic variables related to drug use in the American population, and the reader is referred to the Substance Abuse and Mental Health Services Administration Web site for the full report (http://www.oas.samhsa.gov/nhsda.htm).

TABLE 1

Comparison of Drug Use Among Women 15 to 44 Years of Age by Pregnancy Status: 2009–2010

Pregnant Women, %Nonpregnant Women, %
Illicit drug use 4.4 10.9 
Alcohol use 10.8 54.7 
Binge drinking 3.7 24.6 
Cigarette use 16.3 26.7 
Pregnant Women, %Nonpregnant Women, %
Illicit drug use 4.4 10.9 
Alcohol use 10.8 54.7 
Binge drinking 3.7 24.6 
Cigarette use 16.3 26.7 

Two basic methods are used to identify drug users: self-report or biological specimens. Although no single approach can accurately determine the presence or amount of drug used during pregnancy, it is more likely that fetal exposure will be identified if a biological specimen is collected along with a structured interview.8 

Self-reported history is an inexpensive and practical method for identifying prenatal drug exposure and is the only method available in which information can be obtained regarding the timing of the drug use during pregnancy and the amount used. Unfortunately, self-report suffers from problems with the veracity of the informant and recall accuracy.9,10 Histories obtained by trusted, nonjudgmental individuals or via computerized survey forms; questions referring back to the previous trimester or prepregnancy usage, not current use; and pregnancy calendars used to assist recollection each improve the accuracy of the information obtained.11,13 

Several biological specimens can be used to screen for drug exposure. Each specimen has its own individual variations with regard to the window of detection, the specific drug metabolites used for identification, methods of adulteration of the sample, and analytical techniques, thus altering the sensitivity and specificity for each drug of interest. The most common analytical method used for screening biological specimens is an immunoassay designed to screen out drug-free samples. Threshold values generally are set high to minimize false-positive test results but may be too high to detect low-dose or remote exposure. Because immunoassay is a relatively nonspecific test, positive results require confirmation by using gas chromatography/mass spectrometry. In addition, confirmation of the presence of a drug is not always associated with drug abuse. Alternative explanations include passive exposure to the drug, ingestion of other products contaminated with the drug, or use of prescription medications that either contain the drug or are metabolized to the drug.14 Thus, careful patient histories remain essential to the process of identification.

The 3 most commonly used specimens to establish drug exposure during the prenatal and perinatal period are urine, meconium, and hair; however, none is accepted as a “gold standard.” Urine has been the most frequently tested biological specimen because of its ease of collection. Urine testing identifies only recent drug use, because threshold levels of drug metabolites generally can be detected in urine only for several days. A notable exception to this is marijuana, the metabolites of which can be excreted for as long as 10 days in the urine of regular users15 or up to 30 days in chronic, heavy users. Urine is a good medium as well for the detection of nicotine, opiate, cocaine, and amphetamine exposure.16,17 

Meconium is also easy to collect noninvasively. It is hypothesized that drugs accumulate in meconium throughout pregnancy, and thus, meconium is thought to reflect exposure during the second and third trimester of pregnancy when meconium forms. However, use of meconium to determine the timing or extent of exposure during pregnancy is controversial18 because of a lack of studies regarding the effects of the timing and quantity of the postpartum specimen collection as well as the effects of urine or transitional stool contamination of the meconium samples.19 Meconium has been used for the detection of nicotine, alcohol, marijuana, opiate, cocaine, and amphetamine exposure.16,20 

Hair is easy to collect, although some people decline this sampling method because of cosmetic concerns and societal taboos. Drugs become trapped within the hair and, thus, can reflect drug use over a long period of time. Unfortunately, using hair to determine timing and quantity of exposure also is controversial. In addition, environmental contamination, natural hair colors and textures, cosmetic hair processing, and volume of the hair sample available all affect the rational interpretation of the results.21,24 Hair is useful for the detection of nicotine, opiate, cocaine, and amphetamine exposure.16,25 

Other biological specimens have been studied for use in the detection of in utero drug exposure but are not commonly used in the clinical setting. These include such specimens as cord blood, human milk, amniotic fluid, and umbilical cord tissue.8,19,26 In the case of umbilical cord tissue, drug class-specific immunoassays for amphetamines, opiates, cocaine, and cannabinoids appear to be as reliable as meconium testing, with the additional benefit of availability of the tissue at the time of birth.27 

Beginning in the early 1980s, states began to enact legislation in response to the increasingly popular use of “crack” cocaine in our society. Such laws required the reporting of women who used drugs during pregnancy to the legal system through states’ child abuse statutes. In 2003, the Keeping Children and Families Safe Act (Public Law 108-36) was passed by Congress, requiring physicians to notify their state child protective services agency of any infant identified as affected by illegal substances at birth or experiencing drug withdrawal. Currently, issues of whether to use biological specimens to screen for drug abuse; whether to screen the mother, her infant, or both; and which women and infants to screen are issues complicated by legal, ethical, social, and scientific concerns. Each of these concerns must be taken into account as obstetricians, neonatologists, and pediatricians work to develop protocols for identifying prenatal drug exposure. For example, there is no biological specimen that, when obtained randomly, identifies prenatal drug use with 100% accuracy; hence, a negative drug screening result does not ensure that the pregnancy was drug free. Targeted screening of high-risk women is problematic, because it can be biased toward women of racial or ethnic minorities and those who are economically disadvantaged or socially disenfranchised. Universal screening of pregnant women is impractical and not cost-effective.28,30 Finally, testing of biological specimens when the maternal history is positive for drug use increases medical costs and does not necessarily provide information that guides the medical care of the infant.31 

Drugs can affect the fetus in multiple ways. Early in gestation, during the embryonic stage, drugs can have significant teratogenic effects. However, during the fetal period, after major structural development is complete, drugs have more subtle effects, including abnormal growth and/or maturation, alterations in neurotransmitters and their receptors, and brain organization. These are considered to be the direct effects of drugs. However, drugs also can exert a pharmacologic effect on the mother and, thus, indirectly affect the fetus. For example, nicotine acts on nicotinic cholinergic receptors within the mesolimbic pathway, and neuropathways activated by alcohol enhance inhibitory γ-aminobutyric acid (GABA) receptors and reduce glutamate receptor activity. Drugs of abuse mimic naturally occurring neurotransmitters, such that marijuana acts as anandamides, opiates act as endorphins, and cocaine and stimulants act within the mesolimbic dopaminergic pathways to increase dopamine and serotonin within the synapses.32 Other indirect effects of drugs of abuse on the fetus include altered delivery of substrate to the fetus for nutritional purposes, either because of placental insufficiency or altered maternal health behaviors attributable to the mother’s addiction. These altered behaviors, which include poor nutrition, decreased access/compliance with health care, increased exposure to violence, and increased risk of mental illness and infection, may place the fetus at risk.33 

Nicotine concentrations are higher in the fetal compartment (placenta, amniotic fluid, fetal serum) compared with maternal serum concentrations.34,36 Nicotine is only 1 of more than 4000 compounds to which the fetus is exposed through maternal smoking. Of these, ∼30 compounds have been associated with adverse health outcomes. Although the exact mechanisms by which nicotine produces adverse fetal effects are unknown, it is likely that hypoxia, undernourishment of the fetus, and direct vasoconstrictor effects on the placental and umbilical vessels all play a role.37,38 Nicotine also has been shown to have significant deleterious effects on brain development, including alterations in brain metabolism and neurotransmitter systems and abnormal brain development.39,43 Additional toxicity from compounds in smoke, such as cyanide and cadmium, contribute to toxicity.44,48 

Ethanol easily crosses the placenta into the fetus, with a significant concentration of the drug identified in the amniotic fluid as well as in maternal and fetal blood.49,50 A variety of mechanisms explaining the effects of alcohol on the fetus have been hypothesized. These include direct teratogenic effects during the embryonic and fetal stage of development as well as toxic effects of alcohol on the placenta, altered prostaglandin and protein synthesis, hormonal alterations, nutritional effects, altered neurotransmitter levels in the brain, altered brain morphology and neuronal development, and hypoxia (thought to be attributable to decreased placental blood flow and alterations in vascular tone in the umbilical vessels).51,69 

Although the main chemical compound in marijuana, δ-9-tetrahydrocannabinol (THC), crosses the placenta rapidly, its major metabolite, 11-nor-9-carboxy-THC, does not.70 Unlike other drugs, the placenta appears to limit fetal exposure to marijuana, as fetal THC concentrations have been documented to be lower than maternal concentrations in studies of various animal species.15,70,72 The deleterious effects of marijuana on the fetus are thought to be attributable to complex pharmacologic actions on developing biological systems, altered uterine blood flow, and altered maternal health behaviors.73,75 Similar to other drugs, marijuana has been shown to alter brain neurotransmitters as well as brain biochemistry, resulting in decreased protein, nucleic acid, and lipid synthesis.74,76,79 Marijuana can remain in the body for up to 30 days, thus prolonging fetal exposure. In addition, smoking marijuana produces as much as 5 times the amount of carbon monoxide as does cigarette smoking, perhaps altering fetal oxygenation.80 

In humans, opiates rapidly cross the placenta, with drug equilibration between the mother and the fetus.81 Opiates have been shown to decrease brain growth and cell development in animals, but studies of their effects on neurotransmitter levels and opioid receptors have produced mixed results.82,89 

Pharmacologic studies of cocaine in animal models using a variety of species have demonstrated that cocaine easily crosses both the placenta and the blood-brain barrier and can have significant teratogenic effects on the developing fetus, directly and indirectly.90 Cocaine’s teratogenic effects most likely result from interference with the neurotrophic roles of monoaminergic transmitters during brain development,91,94 which can significantly affect cortical neuronal development and may lead to morphologic abnormalities in several brain structures, including the frontal cingulate cortex.94 It also appears that the development of areas of the brain that regulate attention and executive functioning are particularly vulnerable to cocaine. Thus, functions such as arousal, attention, and memory may be adversely affected by prenatal cocaine exposure.89,91,95,97 Furthermore, insults to the nervous system during neurogenesis, before homeostatic regulatory mechanisms are fully developed, differ from those on mature systems. Thus, cocaine exposure occurring during development of the nervous system might be expected to result in permanent changes in brain structure and function, which can produce altered responsiveness to environmental or pharmacologic challenges later in life.98 

Methamphetamine is a member of a group of sympathomimetic drugs that stimulate the central nervous system. It readily passes through the placenta and the blood-brain barrier and can have significant effects on the fetus.99,101 After a single dose of methamphetamine to pregnant mice, levels of substance in the fetal brain were found to be similar to those found in human infants after prenatal methamphetamine exposure, with accumulation and distribution of the drug most likely dependent on the monoaminergic transport system. It is possible that the mechanism of action of methamphetamine is an interaction with and alteration of these neurotransmitter systems in the developing fetal brain100 as well as alterations in brain morphogenesis.102 

Fetal tobacco exposure has been a known risk factor for low birth weight and intrauterine growth restriction for more than 50 years,103 with decreasing birth weight shown to be related to the number of cigarettes smoked.104,107 Importantly, by 24 months of age, most studies no longer demonstrate an effect of fetal tobacco exposure on somatic growth parameters of prenatally exposed infants.108,-114 Growth restriction is 1 of the hallmarks of prenatal alcohol exposure and must be present to establish a diagnosis of fetal alcohol syndrome.3,115 However, even moderate amounts of alcohol use during pregnancy is associated with a decrease in size at birth.116,119 In general, marijuana has not been associated with fetal growth restriction, particularly after controlling for other prenatal drug exposures.109,120,-122 Fetal growth effects are reported in studies of prenatal opiate exposure; however, confounding variables known to be associated with poor growth, such as multiple drug use and low socioeconomic status, were not well controlled in many of the studies.123 Using data from the Maternal Lifestyle Study, Bada et al124 reported lower birth weight in opiate-exposed newborn infants born at ≥33 weeks’ gestation, independent of use of other drugs, prenatal care, or other medical risk factors. An independent effect of prenatal cocaine exposure on intrauterine growth has been the most consistent finding across studies of prenatally exposed infants.122,125,-130 Early studies on prenatal methamphetamine exposure131 as well as recent studies132 reveal independent effects of the drug on fetal growth. However, the literature available is limited at this time. Several reviews on the effects of prenatal drug exposure on growth contain additional details.133,135 

Nicotine has been associated with oral facial clefts in exposed newborn infants,136,140 although the data are relatively weak. There is a vast literature on the teratogenic effects of prenatal alcohol exposure after the first description of fetal alcohol syndrome in 1973.3 The American Academy of Pediatrics (AAP) policy statement “Fetal Alcohol Syndrome and Alcohol-Related Neurodevelopmental Disorders” contains more information.141 No clear teratogenic effect of marijuana or opiates is documented in exposed newborn infants.142 Original reports regarding cocaine teratogenicity have not been further documented.133,143 Studies of fetal methamphetamine exposure in humans are limited. However, Little et al131 reported no increase in the frequency of major anomalies in a small sample of exposed infants when compared with nonexposed infants.

No convincing studies are available that document a neonatal withdrawal syndrome for prenatal nicotine exposure. Although several authors describe abnormal newborn behavior of exposed infants immediately after delivery, the findings are more consistent with drug toxicity, which steadily improves over time,144,145 as opposed to an abstinence syndrome, in which clinical signs would escalate over time as the drug is metabolized and eliminated from the body. There is 1 report of withdrawal from prenatal alcohol exposure in infants with fetal alcohol syndrome born to mothers who drank heavily during pregnancy,146 but withdrawal symptoms have not been reported in longitudinal studies available in the extant literature. Neonatal abstinence symptoms have not been observed in marijuana-exposed infants, although abnormal newborn behavior has been reported with some similarities to that associated with narcotic exposure.147 An opiate withdrawal syndrome was first described by Finnegan et al148 in 1975. Neonatal abstinence syndrome includes a combination of physiologic and neurobehavioral signs that include such things as sweating, irritability, increased muscle tone and activity, feeding problems, diarrhea, and seizures. Infants with neonatal abstinence syndrome often require prolonged hospitalization and treatment with medication. Methadone exposure has been associated with more severe withdrawal than has exposure to heroin.149 Early reports regarding buprenorphine, a more recent alternative to methadone, suggest minimal to mild withdrawal in exposed neonates. A large multicenter trial evaluating buprenorphine’s effect on exposed infants documented decreased morphine dose, hospital length of stay, and length of treatment.150,152 There has been no substantiation of early reports regarding cocaine withdrawal.153 Currently, no prospective studies of withdrawal in methamphetamine-exposed infants are available. A retrospective study by Smith et al154 reported withdrawal symptoms in 49% of their sample of 294 methamphetamine-exposed newborn infants. However, only 4% required pharmacologic intervention. The AAP clinical report on neonatal drug withdrawal contains in-depth information on neonatal drug withdrawal, including treatment options.155 

Abnormalities of newborn neurobehavior, including impaired orientation and autonomic regulation156 and abnormalities of muscle tone,144,147,157 have been identified in a number of prenatal nicotine exposure studies. Poor habituation and low levels of arousal along with motor abnormalities have been identified in women who drank alcohol heavily during their pregnancy.80,158 Prenatal marijuana exposure is associated with increased startles and tremors in the newborn.120 Abnormal neurobehavior in opiate-exposed newborn infants is related to neonatal abstinence (see earlier section on Withdrawal). Using the Brazelton Newborn Behavioral Assessment Scale,159 reported effects of prenatal cocaine exposure on infants have included irritability and lability of state, decreased behavioral and autonomic regulation, and poor alertness and orientation.160 Recent data from the Infant Development, Environment, and Lifestyle multicenter study on the effects of prenatal methamphetamine exposure documented abnormal neurobehavioral patterns in exposed newborn infants consisting of poor movement quality, decreased arousal, and increased stress.161 

Few sources are available documenting the prevalence of drug use during breastfeeding. Lacking recent data, the 1988 National Maternal and Infant Health Survey (http://www.cdc.gov/nchs/about/major/nmihs/abnmihs.htm) revealed that the prevalence of drug use during pregnancy was comparable to the prevalence of use among women who breastfed their infants. Women who used various amounts of alcohol or marijuana and moderate amounts of cocaine during their pregnancy were not deterred from breastfeeding their infants. Thus, the pediatrician is faced with weighing the risks of exposing an infant to drugs during breastfeeding against the many known benefits of breastfeeding.162 For women who are abstinent at the time of delivery or who are participating in a supervised treatment program and choose to breastfeed, close postpartum follow-up of the mother and infant are essential.

For most street drugs, including marijuana, opiates, cocaine, and methamphetamine, the risks to the infant of ongoing, active use by the mother outweigh the benefits of breastfeeding, because most street drugs have been shown to have some effect on the breastfeeding infant.163,166 In addition, the dose of drug being used and the contaminants within the drug are unknown for most street drugs. Nicotine is secreted into human milk167,168 and has been associated with decreased milk production, decreased weight gain of the infant, and exposure of the infant to environmental tobacco smoke.169,171 Alcohol is concentrated in human milk. Heavy alcohol use has been shown to be associated with decreased milk supply and neurobehavioral effects on the infant.172,174 However, for nicotine and alcohol, the benefits of breastfeeding in the face of limited use of these drugs outweigh the potential risks. Marijuana has an affinity for lipids and accumulates in human milk,175 as can cocaine26 and amphetamines.101,165 Although the AAP considers the use of marijuana, opiates, cocaine, and methamphetamine to be a contraindication to breastfeeding, supervised methadone use not only is considered to be compatible with breastfeeding, with no effect on the infant or on lactation, but also is a potential benefit in reducing the symptoms associated with neonatal abstinence syndrome. Several available reviews provide more detailed information with regard to breastfeeding and substance abuse.162,176 The reader is also referred to the AAP policy statement “Breastfeeding and the Use of Human Milk.”177 

The effects of prenatal tobacco exposure on long-term growth are not clear-cut. Reports in the literature of effects on height and weight178,181 have not been substantiated by research teams able to control for other drug use in the sample.109,117,182,183 Recent studies, some of which include adolescents, have suggested that the effect on growth might be attributable to a disproportionate weight for height, such that prenatally exposed children were more likely to be obese as evidenced by a higher BMI, increased Ponderal index, and increased skinfold thickness.113,183,184 A robust and extensive literature is available documenting the effects of prenatal alcohol exposure on long-term growth. Although poor growth is 1 of the hallmarks of fetal alcohol syndrome, it is the least sensitive of the diagnostic criteria.185 No independent effect of prenatal marijuana exposure on growth has been documented throughout early childhood and adolescence.109,182,184 Long-term effects on growth have not been documented in the opiate-exposed child.186 The available literature on the effect of prenatal cocaine exposure on growth throughout childhood is not conclusive. Although several studies document the negative effects of prenatal cocaine exposure on postnatal growth,187,189 others do not.126,190,191 No studies are available linking prenatal methamphetamine exposure to postnatal growth problems. However, 1 study of unspecified amphetamine use suggests that in utero exposure may be associated with poor growth throughout early childhood.192 

After controlling for a variety of potentially confounding socioeconomic, psychosocial, family, and health variables, a number of studies have identified independent effects of prenatal tobacco exposure on long-term behavioral outcomes extending from early childhood into adulthood. For example, impulsivity and attention problems have been identified in children prenatally exposed to nicotine.193,195 In addition, prenatal tobacco exposure has been associated with hyperactivity196 and negative197 and externalizing behaviors in children,198,200 which appear to continue through adolescence and into adulthood in the form of higher rates of delinquency, criminal behavior, and substance abuse.201,206 Prenatal alcohol exposure is linked with significant attention problems in offspring207,210 as well as adaptive behavior problems spanning early childhood to adulthood.211 Problems identified included disrupted school experiences, delinquent and criminal behavior, and substance abuse. Kelly et al212 published an in-depth review of the effects of prenatal alcohol exposure on social behavior. Inattention and impulsivity at 10 years of age have been associated with prenatal marijuana exposure.213 Hyperactivity and short attention span have been noted in toddlers prenatally exposed to opiates,214 and older exposed children have demonstrated memory and perceptual problems.215 Caregiver reports of child behavior problems in preschool-aged216 and elementary school-aged children217,218 have not been related to cocaine exposure, except in combination with other risk factors.219,221 However, in longitudinal modeling of caregiver reports at 3, 5, and 7 years of age, the multisite Maternal Lifestyles Study revealed that prenatal cocaine exposure had an independent negative effect on trajectories of behavior problems.222 There have been teacher reports of behavior problems in prenatally exposed children,223 although again, findings have not been consistent across studies,190 and some have been moderated by other risks.224 There also have been reports in this age group of deficits in attention processing190 and an increase in symptoms of attention-deficit/hyperactivity disorder and oppositional defiant disorder self-reported by the exposed children.217,218 To date, no studies are available that link prenatal methamphetamine exposure with long-term behavioral problems. However, 1 study of unspecified amphetamine use during pregnancy suggests a possible association with externalizing behaviors and peer problems.225,226 

The link between prenatal nicotine exposure and impaired cognition is not nearly as strong as the link with behavioral problems. However, studies of both young and older children prenatally exposed to nicotine have revealed abnormalities in learning and memory227,228 and slightly lower IQ scores.201,229,231 Prenatal alcohol exposure frequently is cited as the most common, preventable cause of nongenetic intellectual disability. Although IQ scores are lower in alcohol-exposed offspring,207,232 they can be variable. Additionally, prenatal alcohol exposure has been associated with poorer memory and executive functioning skills.233 Marijuana has not been shown to affect general IQ, but it has been associated with deficits in problem-solving skills that require sustained attention and visual memory, analysis, and integration230,231,234,236 and with subtle deficits in learning and memory.237 Longitudinal studies of prenatal opiate exposure have not produced consistent findings with regard to developmental sequelae. Although developmental scores tend to be lower in exposed infants, these differences no longer exist when appropriate medical and environmental controls are included in the analyses.238,240 With little exception,241 prenatal cocaine exposure has not predicted overall development, IQ, or school readiness among toddlers, elementary school-aged children, or middle school-aged children.190,242,250 However, several studies have revealed alterations in various aspects of executive functioning,221,241 including visual-motor ability,244 attention,251,253 and working memory.254 To date, limited data are available revealing an association between prenatal methamphetamine exposure and IQ.255 

Poor language development in early childhood after prenatal nicotine exposure has been reported,227,256,257 as have poor language and reading abilities in 9- to 12-year-olds.258 Prenatal alcohol exposure has been shown to interfere with the development and use of language,259 possibly leading to long-term problems in social interaction.260 No effect of prenatal marijuana exposure on language development has been identified in children through 12 years of age.227,258 Subtle language delays have been associated with prenatal cocaine exposure.256,261,262 Currently, no data are available relating the prenatal use of opiates or methamphetamine to language development in exposed offspring.

The literature available evaluating academic achievement is limited. In nicotine-exposed children, Batstra et al200 identified poorer performance on arithmetic and spelling tasks that were part of standardized Dutch achievement tests. Howell et al232 reported poorer performance in mathematics on achievement tests in adolescents who had been exposed prenatally to alcohol. Streissguth et al263 describe a variety of significant academic and school problems related to prenatal alcohol exposure, primarily associated with deficits in reading and math skills throughout the school years.263,266 Prenatal marijuana exposure has been associated with academic underachievement, particularly in the areas of reading and spelling.267 School achievement is not an area that has been studied adequately with regard to prenatal opiate exposure. Reported effects of cocaine exposure on school achievement are variable. In the longitudinal Maternal Lifestyle Study, 7-year-old children with prenatal cocaine exposure had a 79% increased odds of having an individualized educational plan (adjusted for IQ),268 and Morrow et al249 found 2.8 times the risk of learning disabilities among children with prenatal cocaine exposure compared with their peers who were not exposed to drugs prenatally. However, other studies do not support significant cocaine effects on school achievement.190,269 No data are available for the effects of methamphetamine on school achievement. Cernerud et al270 reported on 65 children prenatally exposed to amphetamines. At 14 to 15 years of age, the children in their cohort scored significantly lower on mathematics tests than did their classmates who were not exposed to amphetamines prenatally and had a higher rate of grade retention than the Swedish norm.

A limited number of studies are available that have investigated the association between prenatal substance exposure and subsequent drug abuse in exposed offspring. These studies did not document cause and effect, and it remains to be determined how much of the association can be linked to prenatal exposure versus socioeconomic, environmental, and genetic influences. Studies available for prenatal nicotine exposure suggest an increased risk of early experimentation271 and abuse of nicotine in exposed offspring.272,273 Brennan et al274 reported an association of prenatal nicotine exposure with higher rates of hospitalization for substance abuse in adult offspring. Mounting clinical data support an increased risk of ethanol abuse later in life after prenatal exposure.275,277 Prenatal marijuana exposure has been associated with an increased risk for marijuana and cigarette use in exposed offspring.273 Insufficient data are available to draw any conclusions relative to the affects of prenatal opiate, cocaine, or methamphetamine exposure on the risk for tobacco, problem alcohol, or illicit drug use later in life.

Although methodologic differences between studies and limited data in the extant literature make generalization of the results for several of the drugs difficult, some summary statements can be made by using the current knowledge base (Table 2).

TABLE 2

Summary of Effects of Prenatal Drug Exposure

NicotineAlcoholMarijuanaOpiatesCocaineMethamphetamine
Short-term effects/birth outcome       
 Fetal growth Effect  Strong effect  No effect  Effect  Effect  Effect  
 Anomalies No consensus on effect  Strong effect  No effect  No effect  No effect  No effect  
 Withdrawal No effect  No effect  No effect  Strong effect  No effect  * 
 Neurobehavior Effect  Effect  Effect  Effect  Effect  Effect  
Long-term effects       
 Growth No consensus on effect Strong effect  No effect  No effect  No consensus on effect * 
 Behavior Effect  Strong effect  Effect  Effect  Effect  * 
 Cognition Effect  Strong effect  Effect  No consensus on effect Effect  * 
 Language Effect  Effect  No effect  * Effect  * 
 Achievement Effect  Strong effect  Effect  * No consensus on effect * 
NicotineAlcoholMarijuanaOpiatesCocaineMethamphetamine
Short-term effects/birth outcome       
 Fetal growth Effect  Strong effect  No effect  Effect  Effect  Effect  
 Anomalies No consensus on effect  Strong effect  No effect  No effect  No effect  No effect  
 Withdrawal No effect  No effect  No effect  Strong effect  No effect  * 
 Neurobehavior Effect  Effect  Effect  Effect  Effect  Effect  
Long-term effects       
 Growth No consensus on effect Strong effect  No effect  No effect  No consensus on effect * 
 Behavior Effect  Strong effect  Effect  Effect  Effect  * 
 Cognition Effect  Strong effect  Effect  No consensus on effect Effect  * 
 Language Effect  Effect  No effect  * Effect  * 
 Achievement Effect  Strong effect  Effect  * No consensus on effect * 
*

Limited or no data available.

The negative effect of prenatal nicotine exposure on fetal growth has been known for decades; however, longitudinal studies do not reveal a consistent effect on long-term growth. Clinical studies have failed to reach a consensus regarding congenital anomalies, and there is no evidence of a withdrawal syndrome in the newborn infant. Recent studies document a negative effect of prenatal exposure on infant neurobehavior as well as on long-term behavior, cognition, language, and achievement.

Alcohol remains the most widely studied prenatal drug of abuse, and the evidence is strong for fetal growth problems, congenital anomalies, and abnormal infant neurobehavior. There has been no convincing evidence of a neonatal withdrawal syndrome. Ongoing longitudinal studies continue to document long-term effects on growth, behavior, cognition, language, and achievement, and alcohol is the most common identifiable teratogen associated with intellectual disability.

Although there have been studies revealing subtle abnormalities in infant neurobehavior related to prenatal marijuana exposure, there have been no significant effects documented for fetal growth, congenital anomalies, or withdrawal. Long-term studies reveal effects of prenatal exposure on behavior, cognition, and achievement but not on language or growth.

The most significant effect of prenatal opiate exposure is neonatal abstinence syndrome. There have been documented effects on fetal growth (but not on long-term growth) and infant neurobehavior as well as long-term effects on behavior. There is not a consensus as to the effects of prenatal opiate exposure on cognition, and few data are available regarding language and achievement.

Prenatal cocaine exposure has a negative effect on fetal growth and subtle effects on infant neurobehavior. However, there is little evidence to support an association with congenital anomalies or withdrawal. There is not a consensus regarding the effects of prenatal cocaine exposure on either long-term growth or achievement; however, there are documented long-term effects on behavior and subtle effects on language. Although there is little evidence to support an effect on overall cognition, a number of studies have documented effects on specific areas of executive function.

Studies on prenatal methamphetamine exposure are still in their infancy. Early studies have documented an effect of prenatal exposure on fetal growth and infant neurobehavior but no association with congenital anomalies and no data regarding infant withdrawal or any long-term effects.

Marylou Behnke, MD

Vincent C. Smith, MD

Sharon Levy, MD, Chairperson

Seth D. Ammerman, MD

Pamela Kathern Gonzalez, MD

Sheryl Ann Ryan, MD

Lorena M. Siqueira, MD, MSPH

Vincent C. Smith, MD

Marylou Behnke, MD

Patricia K. Kokotailo, MD, MPH

Janet F. Williams, MD, Immediate Past Chairperson

Vivian B. Faden, PhD – National Institute on Alcohol Abuse and Alcoholism

Deborah Simkin, MD – American Academy of Child and Adolescent Psychiatry

Renee Jarrett

James Baumberger

Lu-Ann Papile, MD, Chairperson

Jill E. Baley, MD

William Benitz, MD

Waldemar A. Carlo, MD

James J. Cummings, MD

Eric Eichenwald, MD

Praveen Kumar, MD

Richard A. Polin, MD

Rosemarie C. Tan, MD, PhD

Kasper S. Wang, MD

Kristi L. Watterberg, MD

CAPT Wanda D. Barfield, MD, MPH – Centers for Disease Control and Prevention

Ann L. Jefferies, MD – Canadian Pediatric Society

George A. Macones, MD – American College of Obstetricians and Gynecologists

Erin L. Keels APRN, MS, NNP-BC – National Association of Neonatal Nurses

Tonse N. K. Raju, MD, DCH – National Institutes of Health

Jim Couto, MA

     
  • AAP

    American Academy of Pediatrics

  •  
  • THC

    tetrahydrocannabinol

This document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors. All authors have filed conflict of interest statements with the American Academy of Pediatrics. Any conflicts have been resolved through a process approved by the Board of Directors. The American Academy of Pediatrics has neither solicited nor accepted any commercial involvement in the development of the content of this publication.

The guidance in this report does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.

All technical reports from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.

1
Becker
RF
,
Little
CR
,
King
JE
.
Experimental studies on nicotine absorption in rats during pregnancy. 3. Effect of subcutaneous injection of small chronic doses upon mother, fetus, and neonate
.
Am J Obstet Gynecol
.
1968
;
100
(
7
):
957
968
[PubMed]
2
Jones
KL
,
Smith
DW
.
Recognition of the fetal alcohol syndrome in early infancy
.
Lancet
.
1973
;
302
(
7836
):
999
1001
[PubMed]
3
Jones
KL
,
Smith
DW
,
Ulleland
CN
,
Streissguth
P
.
Pattern of malformation in offspring of chronic alcoholic mothers
.
Lancet
.
1973
;
1
(
7815
):
1267
1271
[PubMed]
4
Finnegan
LP
.
Pathophysiological and behavioural effects of the transplacental transfer of narcotic drugs to the foetuses and neonates of narcotic-dependent mothers
.
Bull Narc
.
1979
;
31
(
3-4
):
1
58
[PubMed]
5
Chasnoff
IJ
,
Burns
WJ
,
Schnoll
SH
,
Burns
KA
.
Cocaine use in pregnancy
.
N Engl J Med
.
1985
;
313
(
11
):
666
669
[PubMed]
6
Oro
AS
,
Dixon
SD
.
Perinatal cocaine and methamphetamine exposure: maternal and neonatal correlates
.
J Pediatr
.
1987
;
111
(
4
):
571
578
[PubMed]
7
Fried
PA
.
Postnatal consequences of maternal marijuana use in humans
.
Ann N Y Acad Sci
.
1989
;
562
:
123
132
[PubMed]
8
Eyler
FD
,
Behnke
M
,
Wobie
K
,
Garvan
CW
,
Tebbett
I
.
Relative ability of biologic specimens and interviews to detect prenatal cocaine use
.
Neurotoxicol Teratol
.
2005
;
27
(
4
):
677
687
[PubMed]
9
Harrell
AV
.
Validation of self-report: the research record
.
NIDA Res Monogr
.
1985
;
57
:
12
21
[PubMed]
10
Maisto
SA
,
McKay
JR
,
Connors
GJ
.
Self-report issues in substance abuse: state of the art and future directions
.
Behav Assess
.
1990
;
12
(
1
):
117
134
11
Day
NL
,
Wagener
DK
,
Taylor
PM
.
Measurement of substance use during pregnancy: methodologic issues
.
NIDA Res Monogr
.
1985
;
59
:
36
47
[PubMed]
12
Magura
S
,
Moses
B
.
Assessing Risk and Measuring Change in Families: The Family Risk Scales
.
Washington, DC
:
Child Welfare League of America
;
1987
13
Jacobson
SW
,
Chiodo
LM
,
Sokol
RJ
,
Jacobson
JL
.
Validity of maternal report of prenatal alcohol, cocaine, and smoking in relation to neurobehavioral outcome
.
Pediatrics
.
2002
;
109
(
5
):
815
825
[PubMed]
14
Kwong
TC
,
Shearer
D
.
Detection of drug use during pregnancy
.
Obstet Gynecol Clin North Am
.
1998
;
25
(
1
):
43
64
[PubMed]
15
Lee
MJ
.
Marihuana and tobacco use in pregnancy
.
Obstet Gynecol Clin North Am
.
1998
;
25
(
1
):
65
83
[PubMed]
16
Lozano
J
,
García-Algar
O
,
Vall
O
,
de la Torre
R
,
Scaravelli
G
,
Pichini
S
.
Biological matrices for the evaluation of in utero exposure to drugs of abuse
.
Ther Drug Monit
.
2007
;
29
(
6
):
711
734
[PubMed]
17
Chiu
HT
,
Isaac Wu
HD
,
Kuo
HW
.
The relationship between self-reported tobacco exposure and cotinines in urine and blood for pregnant women
.
Sci Total Environ
.
2008
;
406
(
1-2
):
331
336
[PubMed]
18
Lester
BM
,
ElSohly
M
,
Wright
LL
, et al
.
The Maternal Lifestyle Study: drug use by meconium toxicology and maternal self-report
.
Pediatrics
.
2001
;
107
(
2
):
309
317
[PubMed]
19
Casanova
OQ
,
Lombardero
N
,
Behnke
M
,
Eyler
FD
,
Conlon
M
,
Bertholf
RL
.
Detection of cocaine exposure in the neonate. Analyses of urine, meconium, and amniotic fluid from mothers and infants exposed to cocaine
.
Arch Pathol Lab Med
.
1994
;
118
(
10
):
988
993
[PubMed]
20
Köhler
E
,
Avenarius
S
,
Rabsilber
A
,
Gerloff
C
,
Jorch
G
.
Assessment of prenatal tobacco smoke exposure by determining nicotine and its metabolites in meconium
.
Hum Exp Toxicol
.
2007
;
26
(
6
):
535
544
[PubMed]
21
Bailey
DN
.
Drug screening in an unconventional matrix: hair analysis
.
[editorial; comment]
JAMA
.
1989
;
262
(
23
):
3331
[PubMed]
22
Joseph
RE
 Jr
,
Su
TP
,
Cone
EJ
.
In vitro binding studies of drugs to hair: influence of melanin and lipids on cocaine binding to Caucasoid and Africoid hair
.
J Anal Toxicol
.
1996
;
20
(
6
):
338
344
[PubMed]
23
Jurado
C
,
Kintz
P
,
Menéndez
M
,
Repetto
M
.
Influence of the cosmetic treatment of hair on drug testing
.
Int J Legal Med
.
1997
;
110
(
3
):
159
163
[PubMed]
24
Henderson
GL
,
Harkey
MR
,
Zhou
C
,
Jones
RT
,
Jacob
P
 III
.
Incorporation of isotopically labeled cocaine into human hair: race as a factor
.
J Anal Toxicol
.
1998
;
22
(
2
):
156
165
[PubMed]
25
Jacqz-Aigrain
E
,
Zhang
D
,
Maillard
G
,
Luton
D
,
André
J
,
Oury
JF
.
Maternal smoking during pregnancy and nicotine and cotinine concentrations in maternal and neonatal hair
.
BJOG
.
2002
;
109
(
8
):
909
911
[PubMed]
26
Winecker
RE
,
Goldberger
BA
,
Tebbett
IR
, et al
.
Detection of cocaine and its metabolites in breast milk
.
J Forensic Sci
.
2001
;
46
(
5
):
1221
1223
[PubMed]
27
Montgomery
D
,
Plate
C
,
Alder
SC
,
Jones
M
,
Jones
J
,
Christensen
RD
.
Testing for fetal exposure to illicit drugs using umbilical cord tissue vs meconium
.
J Perinatol
.
2006
;
26
(
1
):
11
14
[PubMed]
28
Hansen
RL
,
Evans
AT
,
Gillogley
KM
,
Hughes
CS
,
Krener
PG
.
Perinatal toxicology screening
.
J Perinatol
.
1992
;
12
(
3
):
220
224
[PubMed]
29
Behnke
M
,
Eyler
FD
,
Conlon
M
,
Woods
NS
,
Casanova
OQ
.
Multiple risk factors do not identify cocaine use in rural obstetrical patients
.
Neurotoxicol Teratol
.
1994
;
16
(
5
):
479
484
[PubMed]
30
Ellsworth
MA
,
Stevens
TP
,
D’Angio
CT
.
Infant race affects application of clinical guidelines when screening for drugs of abuse in newborns
.
Pediatrics
.
2010
;
125
(
6
). Available at: www.pediatrics.org/cgi/content/full/125/6/e1379
[PubMed]
31
Behnke
M
,
Eyler
FD
,
Conlon
M
,
Casanova
OQ
,
Woods
NS
.
How fetal cocaine exposure increases neonatal hospital costs
.
Pediatrics
.
1997
;
99
(
2
):
204
208
[PubMed]
32
Stahl
SM
.
Essential Psychopharmacology: Neuroscience Basis and Practical Application
, 2nd ed.
New York, NY
:
Cambridge Press
;
2000
33
Bauer
CR
,
Shankaran
S
,
Bada
HS
, et al
.
The Maternal Lifestyle Study: drug exposure during pregnancy and short-term maternal outcomes
.
Am J Obstet Gynecol
.
2002
;
186
(
3
):
487
495
[PubMed]
34
Mosier
HD
 Jr
,
Jansons
RA
.
Distribution and fate of nicotine in the rat fetus
.
Teratology
.
1972
;
6
(
3
):
303
311
[PubMed]
35
Luck
W
,
Nau
H
,
Hansen
R
,
Steldinger
R
.
Extent of nicotine and cotinine transfer to the human fetus, placenta and amniotic fluid of smoking mothers
.
Dev Pharmacol Ther
.
1985
;
8
(
6
):
384
395
[PubMed]
36
Koren
G
.
Fetal toxicology of environmental tobacco smoke
.
Curr Opin Pediatr
.
1995
;
7
(
2
):
128
131
[PubMed]
37
Lehtovirta
P
,
Forss
M
.
The acute effect of smoking on intervillous blood flow of the placenta
.
Br J Obstet Gynaecol
.
1978
;
85
(
10
):
729
731
[PubMed]
38
Ahlsten
G
,
Ewald
U
,
Tuvemo
T
.
Maternal smoking reduces prostacyclin formation in human umbilical arteries. A study on strictly selected pregnancies
.
Acta Obstet Gynecol Scand
.
1986
;
65
(
6
):
645
649
[PubMed]
39
Joschko
MA
,
Dreosti
IE
,
Tulsi
RS
.
The teratogenic effects of nicotine in vitro in rats: a light and electron microscope study
.
Neurotoxicol Teratol
.
1991
;
13
(
3
):
307
316
[PubMed]
40
Lichtensteiger
W
,
Schlumpf
M.
Prenatal nicotine exposure: biochemical and neuroendocrine bases of behavioral dysfunction
.
Dev Brain Dysfunc
.
1993
;
6
(
4–5
):
279
304
41
Seidler
FJ
,
Albright
ES
,
Lappi
SE
,
Slotkin
TA
.
In search of a mechanism for receptor-mediated neurobehavioral teratogenesis by nicotine: catecholamine release by nicotine in immature rat brain regions
.
Brain Res Dev Brain Res
.
1994
;
82
(
1-2
):
1
8
[PubMed]
42
Slotkin
TA
.
Fetal nicotine or cocaine exposure: which one is worse?
J Pharmacol Exp Ther
.
1998
;
285
(
3
):
931
945
[PubMed]
43
Hellström-Lindahl
E
,
Seiger A
,
Kjaeldgaard
A
,
Nordberg
A
.
Nicotine-induced alterations in the expression of nicotinic receptors in primary cultures from human prenatal brain
.
Neuroscience
.
2001
;
105
(
3
):
527
534
[PubMed]
44
Holsclaw
DS
 Jr
,
Topham
AL
.
The effects of smoking on fetal, neonatal, and childhood development
.
Pediatr Ann
.
1978
;
7
(
3
):
201
222
[PubMed]
45
Abel
EL
.
Smoking and pregnancy
.
J Psychoactive Drugs
.
1984
;
16
(
4
):
327
338
[PubMed]
46
Hazelhoff Roelfzema
W
,
Roelofsen
AM
,
Copius Peereboom-Stegeman
JH
.
Light microscopic aspects of the rat placenta after chronic cadmium administration
.
Sci Total Environ
.
1985
;
42
(
1-2
):
181
184
[PubMed]
47
Aaronson
LS
,
Macnee
CL
.
Tobacco, alcohol, and caffeine use during pregnancy
.
J Obstet Gynecol Neonatal Nurs
.
1989
;
18
(
4
):
279
287
[PubMed]
48
Floyd
RL
,
Zahniser
SC
,
Gunter
EP
,
Kendrick
JS
.
Smoking during pregnancy: prevalence, effects, and intervention strategies
.
Birth
.
1991
;
18
(
1
):
48
53
[PubMed]
49
Brien
JF
,
Clarke
DW
,
Smith
GN
,
Richardson
B
,
Patrick
J
.
Disposition of acute, multiple-dose ethanol in the near-term pregnant ewe
.
Am J Obstet Gynecol
.
1987
;
157
(
1
):
204
211
[PubMed]
50
Szeto
HH
.
Kinetics of drug transfer to the fetus
.
Clin Obstet Gynecol
.
1993
;
36
(
2
):
246
254
[PubMed]
51
Sulik
KK
,
Johnston
MC
,
Webb
MA
.
Fetal alcohol syndrome: embryogenesis in a mouse model
.
Science
.
1981
;
214
(
4523
):
936
938
[PubMed]
52
West
JR
,
Hodges
CA
,
Black
AC
 Jr
.
Prenatal exposure to ethanol alters the organization of hippocampal mossy fibers in rats
.
Science
.
1981
;
211
(
4485
):
957
959
[PubMed]
53
Kennedy
LA
.
The pathogenesis of brain abnormalities in the fetal alcohol syndrome: an integrating hypothesis
.
Teratology
.
1984
;
29
(
3
):
363
368
[PubMed]
54
Fisher
SE
.
Selective fetal malnutrition: the fetal alcohol syndrome
.
J Am Coll Nutr
.
1988
;
7
(
2
):
101
106
[PubMed]
55
Hoff
SF
.
Synaptogenesis in the hippocampal dentate gyrus: effects of in utero ethanol exposure
.
Brain Res Bull
.
1988
;
21
(
1
):
47
54
[PubMed]
56
Clarren
SK
,
Astley
SJ
,
Bowden
DM
, et al
.
Neuroanatomic and neurochemical abnormalities in nonhuman primate infants exposed to weekly doses of ethanol during gestation
.
Alcohol Clin Exp Res
.
1990
;
14
(
5
):
674
683
[PubMed]
57
Druse
MJ
,
Tajuddin
N
,
Kuo
A
,
Connerty
M
.
Effects of in utero ethanol exposure on the developing dopaminergic system in rats
.
J Neurosci Res
.
1990
;
27
(
2
):
233
240
[PubMed]
58
Jollie
WP
.
Effects of sustained dietary ethanol on the ultrastructure of the visceral yolk-sac placenta of the rat
.
Teratology
.
1990
;
42
(
5
):
541
552
[PubMed]
59
Michaelis
EK
.
Fetal alcohol exposure: cellular toxicity and molecular events involved in toxicity
.
Alcohol Clin Exp Res
.
1990
;
14
(
6
):
819
826
[PubMed]
60
Schenker
S
,
Becker
HC
,
Randall
CL
,
Phillips
DK
,
Baskin
GS
,
Henderson
GI
.
Fetal alcohol syndrome: current status of pathogenesis
.
Alcohol Clin Exp Res
.
1990
;
14
(
5
):
635
647
[PubMed]
61
West
JR
,
Goodlett
CR
,
Bonthius
DJ
,
Hamre
KM
,
Marcussen
BL
.
Cell population depletion associated with fetal alcohol brain damage: mechanisms of BAC-dependent cell loss
.
Alcohol Clin Exp Res
.
1990
;
14
(
6
):
813
818
[PubMed]
62
Wigal
SB
,
Amsel
A
,
Wilcox
RE
.
Fetal ethanol exposure diminishes hippocampal beta-adrenergic receptor density while sparing muscarinic receptors during development
.
Brain Res Dev Brain Res
.
1990
;
55
(
2
):
161
169
[PubMed]
63
Brien
JF
,
Smith
GN
.
Effects of alcohol (ethanol) on the fetus
.
J Dev Physiol
.
1991
;
15
(
1
):
21
32
[PubMed]
64
Ledig
M
,
Megias-Megias
L
,
Tholey
G
.
Maternal alcohol exposure before and during pregnancy: effect on development of neurons and glial cells in culture
.
Alcohol Alcohol
.
1991
;
26
(
2
):
169
176
[PubMed]
65
Miller
MW
,
Nowakowski
RS
.
Effect of prenatal exposure to ethanol on the cell cycle kinetics and growth fraction in the proliferative zones of fetal rat cerebral cortex
.
Alcohol Clin Exp Res
.
1991
;
15
(
2
):
229
232
[PubMed]
66
Smith
GN
,
Patrick
J
,
Sinervo
KR
,
Brien
JF
.
Effects of ethanol exposure on the embryo-fetus: experimental considerations, mechanisms, and the role of prostaglandins
.
Can J Physiol Pharmacol
.
1991
;
69
(
5
):
550
569
[PubMed]
67
Gressens
P
,
Lammens
M
,
Picard
JJ
,
Evrard
P
.
Ethanol-induced disturbances of gliogenesis and neuronogenesis in the developing murine brain: an in vitro and in vivo immunohistochemical and ultrastructural study
.
Alcohol Alcohol
.
1992
;
27
(
3
):
219
226
[PubMed]
68
Kotch
LE
,
Sulik
KK
.
Experimental fetal alcohol syndrome: proposed pathogenic basis for a variety of associated facial and brain anomalies
.
Am J Med Genet
.
1992
;
44
(
2
):
168
176
[PubMed]
69
Miller
MW
,
Robertson
S
.
Prenatal exposure to ethanol alters the postnatal development and transformation of radial glia to astrocytes in the cortex
.
J Comp Neurol
.
1993
;
337
(
2
):
253
266
[PubMed]
70
Bailey
JR
,
Cunny
HC
,
Paule
MG
,
Slikker
W
 Jr
.
Fetal disposition of delta 9-tetrahydrocannabinol (THC) during late pregnancy in the rhesus monkey
.
Toxicol Appl Pharmacol
.
1987
;
90
(
2
):
315
321
[PubMed]
71
Abrams
RM
,
Cook
CE
,
Davis
KH
,
Niederreither
K
,
Jaeger
MJ
,
Szeto
HH
.
Plasma delta-9-tetrahydrocannabinol in pregnant sheep and fetus after inhalation of smoke from a marijuana cigarette
.
Alcohol Drug Res
.
1985-1986
;
6
(
5
):
361
369
[PubMed]
72
Hutchings
DE
,
Martin
BR
,
Gamagaris
Z
,
Miller
N
,
Fico
T
.
Plasma concentrations of delta-9-tetrahydrocannabinol in dams and fetuses following acute or multiple prenatal dosing in rats
.
Life Sci
.
1989
;
44
(
11
):
697
701
[PubMed]
73
Murthy
NV
,
Melville
GN
,
Wynter
HH
.
Contractile responses of uterine smooth muscle to acetylcholine and marihuana extract
.
Int J Gynaecol Obstet
.
1983
;
21
(
3
):
223
226
[PubMed]
74
Dalterio
SL
.
Cannabinoid exposure: effects on development
.
Neurobehav Toxicol Teratol
.
1986
;
8
(
4
):
345
352
[PubMed]
75
Fisher
SE
,
Atkinson
M
,
Chang
B
.
Effect of delta-9-tetrahydrocannabinol on the in vitro uptake of alpha-amino isobutyric acid by term human placental slices
.
Pediatr Res
.
1987
;
21
(
1
):
104
107
[PubMed]
76
Walters
DE
,
Carr
LA
.
Changes in brain catecholamine mechanisms following perinatal exposure to marihuana
.
Pharmacol Biochem Behav
.
1986
;
25
(
4
):
763
768
[PubMed]
77
Morgan
B
,
Brake
SC
,
Hutchings
DE
,
Miller
N
,
Gamagaris
Z
.
Delta-9-tetrahydrocannabinol during pregnancy in the rat: effects on development of RNA, DNA, and protein in offspring brain
.
Pharmacol Biochem Behav
.
1988
;
31
(
2
):
365
369
[PubMed]
78
Walters
DE
,
Carr
LA
.
Perinatal exposure to cannabinoids alters neurochemical development in rat brain
.
Pharmacol Biochem Behav
.
1988
;
29
(
1
):
213
216
[PubMed]
79
Rodríguez de Fonseca
F
,
Cebeira
M
,
Fernández-Ruiz
JJ
,
Navarro
M
,
Ramos
JA
.
Effects of pre- and perinatal exposure to hashish extracts on the ontogeny of brain dopaminergic neurons
.
Neuroscience
.
1991
;
43
(
2-3
):
713
723
[PubMed]
80
Chiriboga
CA
.
Fetal alcohol and drug effects
.
Neurologist
.
2003
;
9
(
6
):
267
279
[PubMed]
81
Gerdin
E
,
Rane
A
,
Lindberg
B
.
Transplacental transfer of morphine in man
.
J Perinat Med
.
1990
;
18
(
4
):
305
312
[PubMed]
82
Zagon
IS
,
McLaughlin
PJ
,
Weaver
DJ
,
Zagon
E
.
Opiates, endorphins and the developing organism: a comprehensive bibliography
.
Neurosci Biobehav Rev
.
1982
;
6
(
4
):
439
479
[PubMed]
83
Lee
CC
,
Chiang
CN
.
Maternal-fetal transfer of abused substances: pharmacokinetic and pharmacodynamic data
.
NIDA Res Monogr
.
1985
;
60
:
110
147
[PubMed]
84
Wang
C
,
Pasulka
P
,
Perry
B
,
Pizzi
WJ
,
Schnoll
SH
.
Effect of perinatal exposure to methadone on brain opioid and alpha 2-adrenergic receptors
.
Neurobehav Toxicol Teratol
.
1986
;
8
(
4
):
399
402
[PubMed]
85
Hammer
RP
 Jr
,
Ricalde
AA
,
Seatriz
JV
.
Effects of opiates on brain development
.
Neurotoxicology
.
1989
;
10
(
3
):
475
483
[PubMed]
86
Ricalde
AA
,
Hammer
RP
 Jr
.
Perinatal opiate treatment delays growth of cortical dendrites
.
Neurosci Lett
.
1990
;
115
(
2-3
):
137
143
[PubMed]
87
Hauser
KF
,
Stiene-Martin
A
.
Characterization of opioid-dependent glial development in dissociated and organotypic cultures of mouse central nervous system: critical periods and target specificity
.
Brain Res Dev Brain Res
.
1991
;
62
(
2
):
245
255
[PubMed]
88
Zagon
IS
,
McLaughlin
PJ
.
The perinatal opioid syndrome: laboratory findings and clinical implications
. In:
Sonderegger
TB
, ed.
Perinatal Substance Abuse: Research Findings and Clinical Implications
.
Baltimore, MD
:
Johns Hopkins University Press
;
1992
:
207
223
89
Malanga
CJ
 III
,
Kosofsky
BE
.
Mechanisms of action of drugs of abuse on the developing fetal brain
.
Clin Perinatol
.
1999
;
26
(
1
):
17
37, v–vi
[PubMed]
90
Mayes
LC
.
Neurobiology of prenatal cocaine exposure effect on developing monoamine systems
.
Infant Ment Health J
.
1994
;
15
(
2
):
121
133
91
Dow-Edwards
DL
.
Developmental toxicity of cocaine: mechanisms of action
. In:
Lewis
M
,
Bendersky
M
, eds.
Mothers, Babies, and Cocaine: The Role of Toxins in Development
.
Hillsdale, NJ
:
Lawrence Erlbaum Associates Inc
;
1995
:
5
17
92
Levitt
P
,
Harvey
JA
,
Friedman
E
,
Simansky
K
,
Murphy
EH
.
New evidence for neurotransmitter influences on brain development
.
Trends Neurosci
.
1997
;
20
(
6
):
269
274
[PubMed]
93
Whitaker-Azmitia
PM
.
Role of the neurotrophic properties of serotonin in the delay of brain maturation induced by cocaine
.
Ann N Y Acad Sci
.
1998
;
846
:
158
164
[PubMed]
94
Harvey
JA
.
Cocaine effects on the developing brain: current status
.
Neurosci Biobehav Rev
.
2004
;
27
(
8
):
751
764
[PubMed]
95
Lauder
JM
.
Discussion: neuroteratology of cocaine relationship to developing monoamine systems
.
NIDA Res Monogr
.
1991
;
114
:
233
247
96
Woods
JR
 Jr
.
Adverse consequences of prenatal illicit drug exposure
.
Curr Opin Obstet Gynecol
.
1996
;
8
(
6
):
403
411
[PubMed]
97
Mayes
LC
.
Developing brain and in utero cocaine exposure: effects on neural ontogeny
.
Dev Psychopathol
.
1999
;
11
(
4
):
685
714
[PubMed]
98
Stanwood
GD
,
Levitt
P
.
Drug exposure early in life: functional repercussions of changing neuropharmacology during sensitive periods of brain development
.
Curr Opin Pharmacol
.
2004
;
4
(
1
):
65
71
[PubMed]
99
Burchfield
DJ
,
Lucas
VW
,
Abrams
RM
,
Miller
RL
,
DeVane
CL
.
Disposition and pharmacodynamics of methamphetamine in pregnant sheep
.
JAMA
.
1991
;
265
(
15
):
1968
1973
[PubMed]
100
Won
L
,
Bubula
N
,
McCoy
H
,
Heller
A
.
Methamphetamine concentrations in fetal and maternal brain following prenatal exposure
.
Neurotoxicol Teratol
.
2001
;
23
(
4
):
349
354
[PubMed]
101
Golub
M
,
Costa
L
,
Crofton
K
, et al
.
NTP-CERHR Expert Panel Report on the reproductive and developmental toxicity of amphetamine and methamphetamine
.
Birth Defects Res B Dev Reprod Toxicol
.
2005
;
74
(
6
):
471
584
[PubMed]
102
Cui
C
,
Sakata-Haga
H
,
Ohta
K
, et al
.
Histological brain alterations following prenatal methamphetamine exposure in rats
.
Congenit Anom (Kyoto)
.
2006
;
46
(
4
):
180
187
[PubMed]
103
Simpson
WJ
.
A preliminary report on cigarette smoking and the incidence of prematurity
.
Am J Obstet Gynecol
.
1957
;
73
(
4
):
807
815
[PubMed]
104
Yerushalmy
J
.
The relationship of parents’ cigarette smoking to outcome of pregnancy—implications as to the problem of inferring causation from observed associations
.
Am J Epidemiol
.
1971
;
93
(
6
):
443
456
[PubMed]
105
Persson
PH
,
Grennert
L
,
Gennser
G
,
Kullander
S
.
A study of smoking and pregnancy with special references to fetal growth
.
Acta Obstet Gynecol Scand Suppl
.
1978
;
78
(
S78
):
33
39
[PubMed]
106
Olsen
J
.
Cigarette smoking in pregnancy and fetal growth. Does the type of tobacco play a role?
Int J Epidemiol
.
1992
;
21
(
2
):
279
284
[PubMed]
107
Zarén
B
,
Lindmark
G
,
Gebre-Medhin
M
.
Maternal smoking and body composition of the newborn
.
Acta Paediatr
.
1996
;
85
(
2
):
213
219
[PubMed]
108
Hoff
C
,
Wertelecki
W
,
Blackburn
WR
,
Mendenhall
H
,
Wiseman
H
,
Stumpe
A
.
Trend associations of smoking with maternal, fetal, and neonatal morbidity
.
Obstet Gynecol
.
1986
;
68
(
3
):
317
321
[PubMed]
109
Day
N
,
Cornelius
M
,
Goldschmidt
L
,
Richardson
G
,
Robles
N
,
Taylor
P
.
The effects of prenatal tobacco and marijuana use on offspring growth from birth through 3 years of age
.
Neurotoxicol Teratol
.
1992
;
14
(
6
):
407
414
[PubMed]
110
Barnett
E
.
Race differences in the proportion of low birth weight attributable to maternal cigarette smoking in a low-income population
.
Am J Health Promot
.
1995
;
10
(
2
):
105
110
[PubMed]
111
Lightwood
JM
,
Phibbs
CS
,
Glantz
SA
.
Short-term health and economic benefits of smoking cessation: low birth weight
.
Pediatrics
.
1999
;
104
(
6
):
1312
1320
[PubMed]
112
DiFranza
JR
,
Aligne
CA
,
Weitzman
M
.
Prenatal and postnatal environmental tobacco smoke exposure and children’s health
.
Pediatrics
.
2004
;
113
(
suppl 4
):
1007
1015
[PubMed]
113
Fried
PA
,
Watkinson
B
,
Gray
R
.
Growth from birth to early adolescence in offspring prenatally exposed to cigarettes and marijuana
.
Neurotoxicol Teratol
.
1999
;
21
(
5
):
513
525
[PubMed]
114
Fenercioglu
AK
,
Tamer
I
,
Karatekin
G
,
Nuhoglu
A
.
Impaired postnatal growth of infants prenatally exposed to cigarette smoking
.
Tohoku J Exp Med
.
2009
;
218
(
3
):
221
228
[PubMed]
115
Mills
JL
,
Graubard
BI
,
Harley
EE
,
Rhoads
GG
,
Berendes
HW
.
Maternal alcohol consumption and birth weight. How much drinking during pregnancy is safe?
JAMA
.
1984
;
252
(
14
):
1875
1879
[PubMed]
116
Streissguth
AP
,
Martin
DC
,
Martin
JC
,
Barr
HM
.
The Seattle longitudinal prospective study on alcohol and pregnancy
.
Neurobehav Toxicol Teratol
.
1981
;
3
(
2
):
223
233
[PubMed]
117
Fried
PA
,
O’Connell
CM
.
A comparison of the effects of prenatal exposure to tobacco, alcohol, cannabis and caffeine on birth size and subsequent growth
.
Neurotoxicol Teratol
.
1987
;
9
(
2
):
79
85
[PubMed]
118
Greene
T
,
Ernhart
CB
,
Sokol
RJ
, et al
.
Prenatal alcohol exposure and preschool physical growth: a longitudinal analysis
.
Alcohol Clin Exp Res
.
1991
;
15
(
6
):
905
913
[PubMed]
119
Jacobson
JL
,
Jacobson
SW
,
Sokol
RJ
.
Effects of prenatal exposure to alcohol, smoking, and illicit drugs on postpartum somatic growth
.
Alcohol Clin Exp Res
.
1994
;
18
(
2
):
317
323
[PubMed]
120
Fried
PA
.
Marijuana use during pregnancy: consequences for the offspring
.
Semin Perinatol
.
1991
;
15
(
4
):
280
287
[PubMed]
121
English
DR
,
Hulse
GK
,
Milne
E
,
Holman
CD
,
Bower
CI
.
Maternal cannabis use and birth weight: a meta-analysis
.
Addiction
.
1997
;
92
(
11
):
1553
1560
[PubMed]
122
Eyler
FD
,
Behnke
M
,
Conlon
M
,
Woods
NS
,
Wobie
K
.
Birth outcome from a prospective, matched study of prenatal crack/cocaine use: I. Interactive and dose effects on health and growth
.
Pediatrics
.
1998
;
101
(
2
):
229
237
[PubMed]
123
Hulse
GK
,
Milne
E
,
English
DR
,
Holman
CD
.
The relationship between maternal use of heroin and methadone and infant birth weight
.
Addiction
.
1997
;
92
(
11
):
1571
1579
[PubMed]
124
Bada
HS
,
Das
A
,
Bauer
CR
, et al
.
Gestational cocaine exposure and intrauterine growth: maternal lifestyle study
.
Obstet Gynecol
.
2002
;
100
(
5 pt 1
):
916
924
[PubMed]
125
Chouteau
M
,
Namerow
PB
,
Leppert
P
.
The effect of cocaine abuse on birth weight and gestational age
.
Obstet Gynecol
.
1988
;
72
(
3 pt 1
):
351
354
[PubMed]
126
Amaro
H
,
Zuckerman
B
,
Cabral
H
.
Drug use among adolescent mothers: profile of risk
.
Pediatrics
.
1989
;
84
(
1
):
144
151
[PubMed]
127
Zuckerman
B
,
Frank
DA
,
Hingson
R
, et al
.
Effects of maternal marijuana and cocaine use on fetal growth
.
N Engl J Med
.
1989
;
320
(
12
):
762
768
[PubMed]
128
Zuckerman
B
,
Frank
DA
.
Prenatal cocaine exposure: nine years later
.
[editorial; comment]
J Pediatr
.
1994
;
124
(
5 pt 1
):
731
733
[PubMed]
129
Richardson
GA
.
Prenatal cocaine exposure. A longitudinal study of development
.
Ann N Y Acad Sci
.
1998
;
846
:
144
152
[PubMed]
130
Bauer
CR
,
Langer
JC
,
Shankaran
S
, et al
.
Acute neonatal effects of cocaine exposure during pregnancy
.
Arch Pediatr Adolesc Med
.
2005
;
159
(
9
):
824
834
[PubMed]
131
Little
BB
,
Snell
LM
,
Gilstrap
LC
 III
.
Methamphetamine abuse during pregnancy: outcome and fetal effects
.
Obstet Gynecol
.
1988
;
72
(
4
):
541
544
[PubMed]
132
Nguyen
D
,
Smith
LM
,
Lagasse
LL
, et al
.
Intrauterine growth of infants exposed to prenatal methamphetamine: results from the infant development, environment, and lifestyle study
.
J Pediatr
.
2010
;
157
(
2
):
337
339
[PubMed]
133
Bauer
CR
.
Perinatal effects of prenatal drug exposure. Neonatal aspects
.
Clin Perinatol
.
1999
;
26
(
1
):
87
106
[PubMed]
134
Cornelius
MD
,
Day
NL
.
The effects of tobacco use during and after pregnancy on exposed children
.
Alcohol Res Health
.
2000
;
24
(
4
):
242
249
[PubMed]
135
Nordstrom-Klee
B
,
Delaney-Black
V
,
Covington
C
,
Ager
J
,
Sokol
R
.
Growth from birth onwards of children prenatally exposed to drugs: a literature review
.
Neurotoxicol Teratol
.
2002
;
24
(
4
):
481
488
[PubMed]
136
Wyszynski
DF
,
Duffy
DL
,
Beaty
TH
.
Maternal cigarette smoking and oral clefts: a meta-analysis
.
Cleft Palate Craniofac J
.
1997
;
34
(
3
):
206
210
[PubMed]
137
Wyszynski
DF
,
Wu
T
.
Use of US birth certificate data to estimate the risk of maternal cigarette smoking for oral clefting
.
Cleft Palate Craniofac J
.
2002
;
39
(
2
):
188
192
[PubMed]
138
Lammer
EJ
,
Shaw
GM
,
Iovannisci
DM
,
Van Waes
J
,
Finnell
RH
.
Maternal smoking and the risk of orofacial clefts: Susceptibility with NAT1 and NAT2 polymorphisms
.
Epidemiology
.
2004
;
15
(
2
):
150
156
[PubMed]
139
Little
J
,
Cardy
A
,
Arslan
MT
,
Gilmour
M
,
Mossey
PA
United Kingdom-based case-control study
.
Smoking and orofacial clefts: a United Kingdom-based case-control study
.
Cleft Palate Craniofac J
.
2004
;
41
(
4
):
381
386
[PubMed]
140
Little
J
,
Cardy
A
,
Munger
RG
.
Tobacco smoking and oral clefts: a meta-analysis
.
Bull World Health Organ
.
2004
;
82
(
3
):
213
218
[PubMed]
141
American Academy of Pediatrics, Committee on Substance Abuse and Committee on Children With Disabilities
.
Fetal alcohol syndrome and alcohol-related neurodevelopmental disorders
.
Pediatrics
.
2000
;
106
(
2 pt 1
):
358
361
[PubMed]
142
Astley
SJ
,
Clarren
SK
,
Little
RE
,
Sampson
PD
,
Daling
JR
.
Analysis of facial shape in children gestationally exposed to marijuana, alcohol, and/or cocaine
.
Pediatrics
.
1992
;
89
(
1
):
67
77
[PubMed]
143
Behnke
M
,
Eyler
FD
,
Garvan
CW
,
Wobie
K
.
The search for congenital malformations in newborns with fetal cocaine exposure
.
Pediatrics
.
2001
;
107
(
5
). Available at: www.pediatrics.org/cgi/content/full/107/5/e74
[PubMed]
144
Law
KL
,
Stroud
LR
,
LaGasse
LL
,
Niaura
R
,
Liu
J
,
Lester
BM
.
Smoking during pregnancy and newborn neurobehavior
.
Pediatrics
.
2003
;
111
(
6 pt 1
):
1318
1323
[PubMed]
145
Godding
V
,
Bonnier
C
,
Fiasse
L
, et al
.
Does in utero exposure to heavy maternal smoking induce nicotine withdrawal symptoms in neonates?
Pediatr Res
.
2004
;
55
(
4
):
645
651
[PubMed]
146
Pierog
S
,
Chandavasu
O
,
Wexler
I
.
Withdrawal symptoms in infants with the fetal alcohol syndrome
.
J Pediatr
.
1977
;
90
(
4
):
630
633
[PubMed]
147
Fried
PA
,
Makin
JE
.
Neonatal behavioural correlates of prenatal exposure to marihuana, cigarettes and alcohol in a low risk population
.
Neurotoxicol Teratol
.
1987
;
9
(
1
):
1
7
[PubMed]
148
Finnegan
LP
,
Connaughton
JF
 Jr
,
Kron
RE
,
Emich
JP
.
Neonatal abstinence syndrome: assessment and management
.
Addict Dis
.
1975
;
2
(
1-2
):
141
158
[PubMed]
149
Chasnoff
IJ
,
Hatcher
R
,
Burns
WJ
.
Polydrug- and methadone-addicted newborns: a continuum of impairment?
Pediatrics
.
1982
;
70
(
2
):
210
213
[PubMed]
150
Fischer
G
,
Johnson
RE
,
Eder
H
, et al
.
Treatment of opioid-dependent pregnant women with buprenorphine
.
Addiction
.
2000
;
95
(
2
):
239
244
[PubMed]
151
Johnson
RE
,
Jones
HE
,
Fischer
G
.
Use of buprenorphine in pregnancy: patient management and effects on the neonate
.
Drug Alcohol Depend
.
2003
;
70
(
suppl 2
):
S87
S101
[PubMed]
152
Jones
HE
,
Kaltenbach
K
,
Heil
SH
, et al
.
Neonatal abstinence syndrome after methadone or buprenorphine exposure
.
N Engl J Med
.
2010
;
363
(
24
):
2320
2331
153
Eyler
FD
,
Behnke
M
,
Garvan
CW
,
Woods
NS
,
Wobie
K
,
Conlon
M
.
Newborn evaluations of toxicity and withdrawal related to prenatal cocaine exposure
.
Neurotoxicol Teratol
.
2001
;
23
(
5
):
399
411
[PubMed]
154
Smith
L
,
Yonekura
ML
,
Wallace
T
,
Berman
N
,
Kuo
J
,
Berkowitz
C
.
Effects of prenatal methamphetamine exposure on fetal growth and drug withdrawal symptoms in infants born at term
.
J Dev Behav Pediatr
.
2003
;
24
(
1
):
17
23
[PubMed]
155
Hudak
ML
,
Tan
RC
American Academy of Pediatrics, Committee on Drugs, Committee on Fetus and Newborn
.
Clinical report: neonatal drug withdrawal
.
Pediatrics
.
1998
;
101
(
6
):
1079
1088
156
Picone
TA
,
Allen
LH
,
Olsen
PN
,
Ferris
ME
.
Pregnancy outcome in North American women. II. Effects of diet, cigarette smoking, stress, and weight gain on placentas, and on neonatal physical and behavioral characteristics
.
Am J Clin Nutr
.
1982
;
36
(
6
):
1214
1224
[PubMed]
157
Dempsey
DA
,
Hajnal
BL
,
Partridge
JC
, et al
.
Tone abnormalities are associated with maternal cigarette smoking during pregnancy in in utero cocaine-exposed infants
.
Pediatrics
.
2000
;
106
(
1 pt 1
):
79
85
[PubMed]
158
Streissguth
AP
,
Barr
HM
,
Martin
DC
.
Maternal alcohol use and neonatal habituation assessed with the Brazelton scale
.
Child Dev
.
1983
;
54
(
5
):
1109
1118
[PubMed]
159
Brazelton
TB
.
Neonatal Behavioral Assessment Scale
, 2nd ed.
Philadelphia, PA
:
JB Lippincott Co
;
1984
160
Eyler
FD
,
Behnke
M
.
Early development of infants exposed to drugs prenatally
.
Clin Perinatol
.
1999
;
26
(
1
):
107
150, vii
[PubMed]
161
Smith
LM
,
Lagasse
LL
,
Derauf
C
, et al
.
Prenatal methamphetamine use and neonatal neurobehavioral outcome
.
Neurotoxicol Teratol
.
2008
;
30
(
1
):
20
28
[PubMed]
162
Howard
CR
,
Lawrence
RA
.
Breast-feeding and drug exposure
.
Obstet Gynecol Clin North Am
.
1998
;
25
(
1
):
195
217
[PubMed]
163
Cobrinik
RW
,
Hood
RT
 Jr
,
Chusid
E
.
The effect of maternal narcotic addiction on the newborn infant; review of literature and report of 22 cases
.
Pediatrics
.
1959
;
24
(
2
):
288
304
[PubMed]
164
Perez-Reyes
M
,
Wall
ME
.
Presence of delta9-tetrahydrocannabinol in human milk
.
N Engl J Med
.
1982
;
307
(
13
):
819
820
[PubMed]
165
Steiner
E
,
Villén
T
,
Hallberg
M
,
Rane
A
.
Amphetamine secretion in breast milk
.
Eur J Clin Pharmacol
.
1984
;
27
(
1
):
123
124
[PubMed]
166
Chasnoff
IJ
,
Lewis
DE
,
Squires
L
.
Cocaine intoxication in a breast-fed infant
.
Pediatrics
.
1987
;
80
(
6
):
836
838
[PubMed]
167
Ferguson
BB
,
Wilson
DJ
,
Schaffner
W
.
Determination of nicotine concentrations in human milk
.
Am J Dis Child
.
1976
;
130
(
8
):
837
839
[PubMed]
168
Steldinger
R
,
Luck
W
,
Nau
H
.
Half lives of nicotine in milk of smoking mothers: implications for nursing
.
J Perinat Med
.
1988
;
16
(
3
):
261
262
[PubMed]
169
Luck
W
,
Nau
H
.
Nicotine and cotinine concentrations in serum and urine of infants exposed via passive smoking or milk from smoking mothers
.
J Pediatr
.
1985
;
107
(
5
):
816
820
[PubMed]
170
Schwartz-Bickenbach
D
,
Schulte-Hobein
B
,
Abt
S
,
Plum
C
,
Nau
H
.
Smoking and passive smoking during pregnancy and early infancy: effects on birth weight, lactation period, and cotinine concentrations in mother’s milk and infant’s urine
.
Toxicol Lett
.
1987
;
35
(
1
):
73
81
[PubMed]
171
Hopkinson
JM
,
Schanler
RJ
,
Fraley
JK
,
Garza
C
.
Milk production by mothers of premature infants: influence of cigarette smoking
.
Pediatrics
.
1992
;
90
(
6
):
934
938
[PubMed]
172
Cobo
E
.
Effect of different doses of ethanol on the milk-ejecting reflex in lactating women
.
Am J Obstet Gynecol
.
1973
;
115
(
6
):
817
821
[PubMed]
173
Little
RE
,
Anderson
KW
,
Ervin
CH
,
Worthington-Roberts
B
,
Clarren
SK
.
Maternal alcohol use during breast-feeding and infant mental and motor development at one year
.
N Engl J Med
.
1989
;
321
(
7
):
425
430
[PubMed]
174
Anderson
PO
.
Alcohol and breastfeeding
.
J Hum Lact
.
1995
;
11
(
4
):
321
323
[PubMed]
175
Jakubovic
A
,
Tait
RM
,
McGeer
PL
.
Excretion of THC and its metabolites in ewes’ milk
.
Toxicol Appl Pharmacol
.
1974
;
28
(
1
):
38
43
[PubMed]
176
American Academy of Pediatrics Committee on Drugs
.
Transfer of drugs and other chemicals into human milk
.
Pediatrics
.
2001
;
108
(
3
):
776
789
[PubMed]
177
Gartner
LM
,
Morton
J
,
Lawrence
RA
, et al
American Academy of Pediatrics Section on Breastfeeding
.
Breastfeeding and the use of human milk
.
Pediatrics
.
2005
;
115
(
2
):
496
506
[PubMed]
178
Dunn
HG
,
McBurney
AK
,
Ingram
S
,
Hunter
CM
.
Maternal cigarette smoking during pregnancy and the child’s subsequent development: I. Physical growth to the age of 6 1/2 years
.
Can J Public Health
.
1976
;
67
(
6
):
499
505
[PubMed]
179
Naeye
RL
.
Influence of maternal cigarette smoking during pregnancy on fetal and childhood growth
.
Obstet Gynecol
.
1981
;
57
(
1
):
18
21
[PubMed]
180
Rantakallio
P
.
A follow-up study up to the age of 14 of children whose mothers smoked during pregnancy
.
Acta Paediatr Scand
.
1983
;
72
(
5
):
747
753
[PubMed]
181
Fogelman
KR
,
Manor
O
.
Smoking in pregnancy and development into early adulthood
.
BMJ
.
1988
;
297
(
6658
):
1233
1236
[PubMed]
182
Day
NL
,
Richardson
GA
,
Geva
D
,
Robles
N
.
Alcohol, marijuana, and tobacco: effects of prenatal exposure on offspring growth and morphology at age six
.
Alcohol Clin Exp Res
.
1994
;
18
(
4
):
786
794
[PubMed]
183
Vik
T
,
Jacobsen
G
,
Vatten
L
,
Bakketeig
LS
.
Pre- and post-natal growth in children of women who smoked in pregnancy
.
Early Hum Dev
.
1996
;
45
(
3
):
245
255
[PubMed]
184
Fried
PA
,
James
DS
,
Watkinson
B
.
Growth and pubertal milestones during adolescence in offspring prenatally exposed to cigarettes and marihuana
.
Neurotoxicol Teratol
.
2001
;
23
(
5
):
431
436
[PubMed]
185
Davies
JK
,
Bledsoe
JM
.
Prenatal alcohol and drug exposures in adoption
.
Pediatr Clin North Am
.
2005
;
52
(
5
):
1369
1393, vii
[PubMed]
186
Shankaran
S
,
Lester
BM
,
Das
A
, et al
.
Impact of maternal substance use during pregnancy on childhood outcome
.
Semin Fetal Neonatal Med
.
2007
;
12
(
2
):
143
150
[PubMed]
187
Hurt
H
,
Brodsky
NL
,
Betancourt
L
,
Braitman
LE
,
Malmud
E
,
Giannetta
J
.
Cocaine-exposed children: follow-up through 30 months
.
J Dev Behav Pediatr
.
1995
;
16
(
1
):
29
35
[PubMed]
188
Covington
CY
,
Nordstrom-Klee
B
,
Ager
J
,
Sokol
R
,
Delaney-Black
V
.
Birth to age 7 growth of children prenatally exposed to drugs: a prospective cohort study
.
Neurotoxicol Teratol
.
2002
;
24
(
4
):
489
496
[PubMed]
189
Minnes
S
,
Robin
NH
,
Alt
AA
, et al
.
Dysmorphic and anthropometric outcomes in 6-year-old prenatally cocaine-exposed children
.
Neurotoxicol Teratol
.
2006
;
28
(
1
):
28
38
[PubMed]
190
Richardson
GA
,
Conroy
ML
,
Day
NL
.
Prenatal cocaine exposure: effects on the development of school-age children
.
Neurotoxicol Teratol
.
1996
;
18
(
6
):
627
634
[PubMed]
191
Kilbride
H
,
Castor
C
,
Hoffman
E
,
Fuger
KL
.
Thirty-six-month outcome of prenatal cocaine exposure for term or near-term infants: impact of early case management
.
J Dev Behav Pediatr
.
2000
;
21
(
1
):
19
26
[PubMed]
192
Eriksson
M
,
Jonsson
B
,
Steneroth
G
,
Zetterström
R
.
Cross-sectional growth of children whose mothers abused amphetamines during pregnancy
.
Acta Paediatr
.
1994
;
83
(
6
):
612
617
[PubMed]
193
Kristjansson
EA
,
Fried
PA
,
Watkinson
B
.
Maternal smoking during pregnancy affects children’s vigilance performance
.
Drug Alcohol Depend
.
1989
;
24
(
1
):
11
19
[PubMed]
194
Fried
PA
,
Watkinson
B
,
Gray
R
.
A follow-up study of attentional behavior in 6-year-old children exposed prenatally to marihuana, cigarettes, and alcohol
.
Neurotoxicol Teratol
.
1992
;
14
(
5
):
299
311
[PubMed]
195
Thapar
A
,
Fowler
T
,
Rice
F
, et al
.
Maternal smoking during pregnancy and attention deficit hyperactivity disorder symptoms in offspring
.
Am J Psychiatry
.
2003
;
160
(
11
):
1985
1989
[PubMed]
196
Kotimaa
AJ
,
Moilanen
I
,
Taanila
A
, et al
.
Maternal smoking and hyperactivity in 8-year-old children
.
J Am Acad Child Adolesc Psychiatry
.
2003
;
42
(
7
):
826
833
[PubMed]
197
Brook
JS
,
Brook
DW
,
Whiteman
M
.
The influence of maternal smoking during pregnancy on the toddler’s negativity
.
Arch Pediatr Adolesc Med
.
2000
;
154
(
4
):
381
385
[PubMed]
198
Day
NL
,
Richardson
GA
,
Goldschmidt
L
,
Cornelius
MD
.
Effects of prenatal tobacco exposure on preschoolers’ behavior
.
J Dev Behav Pediatr
.
2000
;
21
(
3
):
180
188
[PubMed]
199
Wakschlag
LS
,
Hans
SL
.
Maternal smoking during pregnancy and conduct problems in high-risk youth: a developmental framework
.
Dev Psychopathol
.
2002
;
14
(
2
):
351
369
[PubMed]
200
Batstra
L
,
Hadders-Algra
M
,
Neeleman
J
.
Effect of antenatal exposure to maternal smoking on behavioural problems and academic achievement in childhood: prospective evidence from a Dutch birth cohort
.
Early Hum Dev
.
2003
;
75
(
1-2
):
21
33
[PubMed]
201
Naeye
RL
.
Cognitive and behavioral abnormalities in children whose mothers smoked cigarettes during pregnancy
.
J Dev Behav Pediatr
.
1992
;
13
(
6
):
425
428
[PubMed]
202
Fergusson
DM
,
Horwood
LJ
,
Lynskey
MT
.
Maternal smoking before and after pregnancy: effects on behavioral outcomes in middle childhood
.
Pediatrics
.
1993
;
92
(
6
):
815
822
[PubMed]
203
Fergusson
DM
,
Woodward
LJ
,
Horwood
LJ
.
Maternal smoking during pregnancy and psychiatric adjustment in late adolescence
.
Arch Gen Psychiatry
.
1998
;
55
(
8
):
721
727
[PubMed]
204
Williams
GM
,
O’Callaghan
M
,
Najman
JM
, et al
.
Maternal cigarette smoking and child psychiatric morbidity: a longitudinal study
.
Pediatrics
.
1998
;
102
(
1
). Available at: www.pediatrics.org/cgi/content/full/102/1/e11
[PubMed]
205
Räsänen
P
,
Hakko
H
,
Isohanni
M
,
Hodgins
S
,
Järvelin
MR
,
Tiihonen
J
.
Maternal smoking during pregnancy and risk of criminal behavior among adult male offspring in the Northern Finland 1966 Birth Cohort
.
Am J Psychiatry
.
1999
;
156
(
6
):
857
862
[PubMed]
206
Weissman
MM
,
Warner
V
,
Wickramaratne
PJ
,
Kandel
DB
.
Maternal smoking during pregnancy and psychopathology in offspring followed to adulthood
.
J Am Acad Child Adolesc Psychiatry
.
1999
;
38
(
7
):
892
899
[PubMed]
207
Nanson
JL
,
Hiscock
M
.
Attention deficits in children exposed to alcohol prenatally
.
Alcohol Clin Exp Res
.
1990
;
14
(
5
):
656
661
[PubMed]
208
Streissguth
AP
,
Sampson
PD
,
Olson
HC
, et al
.
Maternal drinking during pregnancy: attention and short-term memory in 14-year-old offspring—a longitudinal prospective study
.
Alcohol Clin Exp Res
.
1994
;
18
(
1
):
202
218
[PubMed]
209
Streissguth
AP
,
Bookstein
FL
,
Sampson
PD
,
Barr
HM
.
Attention: prenatal alcohol and continuities of vigilance and attentional problems from 4 through 14 years
.
Dev Psychopathol
.
1995
;
7
(
3
):
419
446
210
Coles
CD
,
Platzman
KA
,
Raskind-Hood
CL
,
Brown
RT
,
Falek
A
,
Smith
IE
.
A comparison of children affected by prenatal alcohol exposure and attention deficit, hyperactivity disorder
.
Alcohol Clin Exp Res
.
1997
;
21
(
1
):
150
161
[PubMed]
211
Streissguth
AP
,
Bookstein
FL
,
Barr
HM
,
Sampson
PD
,
O’Malley
K
,
Young
JK
.
Risk factors for adverse life outcomes in fetal alcohol syndrome and fetal alcohol effects
.
J Dev Behav Pediatr
.
2004
;
25
(
4
):
228
238
[PubMed]
212
Kelly
SJ
,
Day
N
,
Streissguth
AP
.
Effects of prenatal alcohol exposure on social behavior in humans and other species
.
Neurotoxicol Teratol
.
2000
;
22
(
2
):
143
149
[PubMed]
213
Goldschmidt
L
,
Day
NL
,
Richardson
GA
.
Effects of prenatal marijuana exposure on child behavior problems at age 10
.
Neurotoxicol Teratol
.
2000
;
22
(
3
):
325
336
[PubMed]
214
Rosen
TS
,
Johnson
HL
.
Long-term effects of prenatal methadone maintenance
.
NIDA Res Monogr
.
1985
;
59
:
73
83
[PubMed]
215
Lifschltz
MH
,
Wilson
GS
.
Patterns of growth and development in narcotic-exposed children
.
NIDA Res Monogr
.
1991
;
114
:
323
339
[PubMed]
216
Warner
TD
,
Behnke
M
,
Hou
W
,
Garvan
CW
,
Wobie
K
,
Eyler
FD
.
Predicting caregiver-reported behavior problems in cocaine-exposed children at 3 years
.
J Dev Behav Pediatr
.
2006
;
27
(
2
):
83
92
[PubMed]
217
Accornero
VH
,
Anthony
JC
,
Morrow
CE
,
Xue
L
,
Bandstra
ES
.
Prenatal cocaine exposure: an examination of childhood externalizing and internalizing behavior problems at age 7 years
.
Epidemiol Psichiatr Soc
.
2006
;
15
(
1
):
20
29
[PubMed]
218
Linares
TJ
,
Singer
LT
,
Kirchner
HL
, et al
.
Mental health outcomes of cocaine-exposed children at 6 years of age
.
J Pediatr Psychol
.
2006
;
31
(
1
):
85
97
[PubMed]
219
Sood
BG
,
Nordstrom Bailey
B
,
Covington
C
, et al
.
Gender and alcohol moderate caregiver reported child behavior after prenatal cocaine
.
Neurotoxicol Teratol
.
2005
;
27
(
2
):
191
201
[PubMed]
220
Bendersky
M
,
Bennett
D
,
Lewis
M
.
Aggression at age 5 as a function of prenatal exposure to cocaine, gender, and environmental risk
.
J Pediatr Psychol
.
2006
;
31
(
1
):
71
84
[PubMed]
221
Dennis
T
,
Bendersky
M
,
Ramsay
D
,
Lewis
M
.
Reactivity and regulation in children prenatally exposed to cocaine
.
Dev Psychol
.
2006
;
42
(
4
):
688
697
[PubMed]
222
Bada
HS
,
Das
A
,
Bauer
CR
, et al
.
Impact of prenatal cocaine exposure on child behavior problems through school age
.
Pediatrics
.
2007
;
119
(
2
). Available at: www.pediatrics.org/cgi/content/full/119/2/e348
[PubMed]
223
Delaney-Black
V
,
Covington
C
,
Templin
T
, et al
.
Teacher-assessed behavior of children prenatally exposed to cocaine
.
Pediatrics
.
2000
;
106
(
4
):
782
791
[PubMed]
224
Nordstrom Bailey
B
,
Sood
BG
,
Sokol
RJ
, et al
.
Gender and alcohol moderate prenatal cocaine effects on teacher-report of child behavior
.
Neurotoxicol Teratol
.
2005
;
27
(
2
):
181
189
[PubMed]
225
Eriksson
M
,
Billing
L
,
Steneroth
G
,
Zetterström
R
.
Health and development of 8-year-old children whose mothers abused amphetamine during pregnancy
.
Acta Paediatr Scand
.
1989
;
78
(
6
):
944
949
[PubMed]
226
Billing
L
,
Eriksson
M
,
Jonsson
B
,
Steneroth
G
,
Zetterström
R
.
The influence of environmental factors on behavioural problems in 8-year-old children exposed to amphetamine during fetal life
.
Child Abuse Negl
.
1994
;
18
(
1
):
3
9
[PubMed]
227
Fried
PA
,
O’Connell
CM
,
Watkinson
B
.
60- and 72-month follow-up of children prenatally exposed to marijuana, cigarettes, and alcohol: cognitive and language assessment
.
J Dev Behav Pediatr
.
1992
;
13
(
6
):
383
391
[PubMed]
228
Cornelius
MD
,
Ryan
CM
,
Day
NL
,
Goldschmidt
L
,
Willford
JA
.
Prenatal tobacco effects on neuropsychological outcomes among preadolescents
.
J Dev Behav Pediatr
.
2001
;
22
(
4
):
217
225
[PubMed]
229
Olds
DL
,
Henderson
CR
 Jr
,
Tatelbaum
R
.
Intellectual impairment in children of women who smoke cigarettes during pregnancy
.
Pediatrics
.
1994
;
93
(
2
):
221
227
[PubMed]
230
Fried
PA
.
Adolescents prenatally exposed to marijuana: examination of facets of complex behaviors and comparisons with the influence of in utero cigarettes
.
J Clin Pharmacol
.
2002
;
42
(
suppl 11
):
97S
102S
[PubMed]
231
Fried
PA
,
Watkinson
B
,
Gray
R
.
Differential effects on cognitive functioning in 13- to 16-year-olds prenatally exposed to cigarettes and marihuana
.
Neurotoxicol Teratol
.
2003
;
25
(
4
):
427
436
[PubMed]
232
Howell
KK
,
Lynch
ME
,
Platzman
KA
,
Smith
GH
,
Coles
CD
.
Prenatal alcohol exposure and ability, academic achievement, and school functioning in adolescence: a longitudinal follow-up
.
J Pediatr Psychol
.
2006
;
31
(
1
):
116
126
[PubMed]
233
Kodituwakku
PW
,
Kalberg
W
,
May
PA
.
The effects of prenatal alcohol exposure on executive functioning
.
Alcohol Res Health
.
2001
;
25
(
3
):
192
198
[PubMed]
234
Fried
PA
,
Watkinson
B
,
Gray
R
.
Differential effects on cognitive functioning in 9- to 12-year olds prenatally exposed to cigarettes and marihuana
.
Neurotoxicol Teratol
.
1998
;
20
(
3
):
293
306
[PubMed]
235
Fried
PA
,
Smith
AM
.
A literature review of the consequences of prenatal marihuana exposure. An emerging theme of a deficiency in aspects of executive function
.
Neurotoxicol Teratol
.
2001
;
23
(
1
):
1
11
[PubMed]
236
Fried
PA
,
Watkinson
B
.
Differential effects on facets of attention in adolescents prenatally exposed to cigarettes and marihuana
.
Neurotoxicol Teratol
.
2001
;
23
(
5
):
421
430
[PubMed]
237
Richardson
GA
,
Ryan
C
,
Willford
J
,
Day
NL
,
Goldschmidt
L
.
Prenatal alcohol and marijuana exposure: effects on neuropsychological outcomes at 10 years
.
Neurotoxicol Teratol
.
2002
;
24
(
3
):
309
320
[PubMed]
238
Lifschitz
MH
,
Wilson
GS
,
Smith
EO
,
Desmond
MM
.
Factors affecting head growth and intellectual function in children of drug addicts
.
Pediatrics
.
1985
;
75
(
2
):
269
274
[PubMed]
239
Kaltenbach
K
,
Finnegan
LP
.
Children exposed to methadone in utero: assessment of developmental and cognitive ability
.
Ann N Y Acad Sci
.
1989
;
562
:
360
362
240
Kaltenbach
KA
,
Finnegan
LP
.
Prenatal narcotic exposure: perinatal and developmental effects
.
Neurotoxicology
.
1989
;
10
(
3
):
597
604
[PubMed]
241
Bennett
DS
,
Bendersky
M
,
Lewis
M
.
Children’s intellectual and emotional-behavioral adjustment at 4 years as a function of cocaine exposure, maternal characteristics, and environmental risk
.
Dev Psychol
.
2002
;
38
(
5
):
648
658
[PubMed]
242
Wasserman
GA
,
Kline
JK
,
Bateman
DA
, et al
.
Prenatal cocaine exposure and school-age intelligence
.
Drug Alcohol Depend
.
1998
;
50
(
3
):
203
210
[PubMed]
243
Hurt
H
,
Malmud
E
,
Betancourt
LM
,
Brodsky
NL
,
Giannetta
JM
.
A prospective comparison of developmental outcome of children with in utero cocaine exposure and controls using the Battelle Developmental Inventory
.
J Dev Behav Pediatr
.
2001
;
22
(
1
):
27
34
[PubMed]
244
Arendt
RE
,
Short
EJ
,
Singer
LT
, et al
.
Children prenatally exposed to cocaine: developmental outcomes and environmental risks at seven years of age
.
J Dev Behav Pediatr
.
2004
;
25
(
2
):
83
90
[PubMed]
245
Messinger
DS
,
Bauer
CR
,
Das
A
, et al
.
The maternal lifestyle study: cognitive, motor, and behavioral outcomes of cocaine-exposed and opiate-exposed infants through three years of age
.
Pediatrics
.
2004
;
113
(
6
):
1677
1685
[PubMed]
246
Pulsifer
MB
,
Radonovich
K
,
Belcher
HM
,
Butz
AM
.
Intelligence and school readiness in preschool children with prenatal drug exposure
.
Child Neuropsychol
.
2004
;
10
(
2
):
89
101
[PubMed]
247
Singer
LT
,
Minnes
S
,
Short
E
, et al
.
Cognitive outcomes of preschool children with prenatal cocaine exposure
.
JAMA
.
2004
;
291
(
20
):
2448
2456
[PubMed]
248
Frank
DA
,
Rose-Jacobs
R
,
Beeghly
M
,
Wilbur
M
,
Bellinger
D
,
Cabral
H
.
Level of prenatal cocaine exposure and 48-month IQ: importance of preschool enrichment
.
Neurotoxicol Teratol
.
2005
;
27
(
1
):
15
28
[PubMed]
249
Morrow
CE
,
Culbertson
JL
,
Accornero
VH
,
Xue
L
,
Anthony
JC
,
Bandstra
ES
.
Learning disabilities and intellectual functioning in school-aged children with prenatal cocaine exposure
.
Dev Neuropsychol
.
2006
;
30
(
3
):
905
931
[PubMed]
250
Hurt
H
,
Betancourt
LM
,
Malmud
EK
, et al
.
Children with and without gestational cocaine exposure: a neurocognitive systems analysis
.
Neurotoxicol Teratol
.
2009
;
31
(
6
):
334
341
[PubMed]
251
Leech
SL
,
Richardson
GA
,
Goldschmidt
L
,
Day
NL
.
Prenatal substance exposure: effects on attention and impulsivity of 6-year-olds
.
Neurotoxicol Teratol
.
1999
;
21
(
2
):
109
118
[PubMed]
252
Bandstra
ES
,
Morrow
CE
,
Anthony
JC
,
Accornero
VH
,
Fried
PA
.
Longitudinal investigation of task persistence and sustained attention in children with prenatal cocaine exposure
.
Neurotoxicol Teratol
.
2001
;
23
(
6
):
545
559
[PubMed]
253
Savage
J
,
Brodsky
NL
,
Malmud
E
,
Giannetta
JM
,
Hurt
H
.
Attentional functioning and impulse control in cocaine-exposed and control children at age ten years
.
J Dev Behav Pediatr
.
2005
;
26
(
1
):
42
47
[PubMed]
254
Mayes
L
,
Snyder
PJ
,
Langlois
E
,
Hunter
N
.
Visuospatial working memory in school-aged children exposed in utero to cocaine
.
Child Neuropsychol
.
2007
;
13
(
3
):
205
218
[PubMed]
255
Chang
L
,
Smith
LM
,
LoPresti
C
, et al
.
Smaller subcortical volumes and cognitive deficits in children with prenatal methamphetamine exposure
.
Psychiatry Res
.
2004
;
132
(
2
):
95
106
[PubMed]
256
Delaney-Black
V
,
Covington
C
,
Templin
T
, et al
.
Expressive language development of children exposed to cocaine prenatally: literature review and report of a prospective cohort study
.
J Commun Disord
.
2000
;
33
(
6
):
463
480, quiz 480–481
[PubMed]
257
Fried
PA
,
Watkinson
B
.
36- and 48-month neurobehavioral follow-up of children prenatally exposed to marijuana, cigarettes, and alcohol
.
J Dev Behav Pediatr
.
1990
;
11
(
2
):
49
58
[PubMed]
258
Fried
PA
,
Watkinson
B
,
Siegel
LS
.
Reading and language in 9- to 12-year olds prenatally exposed to cigarettes and marijuana
.
Neurotoxicol Teratol
.
1997
;
19
(
3
):
171
183
[PubMed]
259
Mattson
SN
,
Riley
EP
.
A review of the neurobehavioral deficits in children with fetal alcohol syndrome or prenatal exposure to alcohol
.
Alcohol Clin Exp Res
.
1998
;
22
(
2
):
279
294
[PubMed]
260
Coggins
TE
,
Timler
GR
,
Olswang
LB
.
A state of double jeopardy: impact of prenatal alcohol exposure and adverse environments on the social communicative abilities of school-age children with fetal alcohol spectrum disorder
.
Lang Speech Hear Serv Sch
.
2007
;
38
(
2
):
117
127
[PubMed]
261
Bandstra
ES
,
Morrow
CE
,
Vogel
AL
, et al
.
Longitudinal influence of prenatal cocaine exposure on child language functioning
.
Neurotoxicol Teratol
.
2002
;
24
(
3
):
297
308
[PubMed]
262
Lewis
BA
,
Singer
LT
,
Short
EJ
, et al
.
Four-year language outcomes of children exposed to cocaine in utero
.
Neurotoxicol Teratol
.
2004
;
26
(
5
):
617
627
[PubMed]
263
Streissguth
AP
,
Barr
HM
,
Sampson
PD
.
Moderate prenatal alcohol exposure: effects on child IQ and learning problems at age 7 1/2 years
.
Alcohol Clin Exp Res
.
1990
;
14
(
5
):
662
669
[PubMed]
264
Coles
CD
,
Brown
RT
,
Smith
IE
,
Platzman
KA
,
Erickson
S
,
Falek
A
.
Effects of prenatal alcohol exposure at school age. I. Physical and cognitive development
.
Neurotoxicol Teratol
.
1991
;
13
(
4
):
357
367
[PubMed]
265
Goldschmidt
L
,
Richardson
GA
,
Stoffer
DS
,
Geva
D
,
Day
NL
.
Prenatal alcohol exposure and academic achievement at age six: a nonlinear fit
.
Alcohol Clin Exp Res
.
1996
;
20
(
4
):
763
770
[PubMed]
266
Olson
HC
,
Streissguth
AP
,
Sampson
PD
,
Barr
HM
,
Bookstein
FL
,
Thiede
K
.
Association of prenatal alcohol exposure with behavioral and learning problems in early adolescence
.
J Am Acad Child Adolesc Psychiatry
.
1997
;
36
(
9
):
1187
1194
[PubMed]
267
Goldschmidt
L
,
Richardson
GA
,
Cornelius
MD
,
Day
NL
.
Prenatal marijuana and alcohol exposure and academic achievement at age 10
.
Neurotoxicol Teratol
.
2004
;
26
(
4
):
521
532
[PubMed]
268
Levine
TP
,
Liu
J
,
Das
A
, et al
.
Effects of prenatal cocaine exposure on special education in school-aged children
.
Pediatrics
.
2008
;
122
(
1
). Available at: www.pediatrics.org/cgi/content/full/122/1/e83
[PubMed]
269
Hurt
H
,
Brodsky
NL
,
Roth
H
,
Malmud
E
,
Giannetta
JM
.
School performance of children with gestational cocaine exposure
.
Neurotoxicol Teratol
.
2005
;
27
(
2
):
203
211
[PubMed]
270
Cernerud
L
,
Eriksson
M
,
Jonsson
B
,
Steneroth
G
,
Zetterström
R
.
Amphetamine addiction during pregnancy: 14-year follow-up of growth and school performance
.
Acta Paediatr
.
1996
;
85
(
2
):
204
208
[PubMed]
271
Cornelius
MD
,
Leech
SL
,
Goldschmidt
L
,
Day
NL
.
Prenatal tobacco exposure: is it a risk factor for early tobacco experimentation?
Nicotine Tob Res
.
2000
;
2
(
1
):
45
52
[PubMed]
272
Buka
SL
,
Shenassa
ED
,
Niaura
R
.
Elevated risk of tobacco dependence among offspring of mothers who smoked during pregnancy: a 30-year prospective study
.
Am J Psychiatry
.
2003
;
160
(
11
):
1978
1984
[PubMed]
273
Porath
AJ
,
Fried
PA
.
Effects of prenatal cigarette and marijuana exposure on drug use among offspring
.
Neurotoxicol Teratol
.
2005
;
27
(
2
):
267
277
[PubMed]
274
Brennan
PA
,
Grekin
ER
,
Mortensen
EL
,
Mednick
SA
.
Relationship of maternal smoking during pregnancy with criminal arrest and hospitalization for substance abuse in male and female adult offspring
.
Am J Psychiatry
.
2002
;
159
(
1
):
48
54
[PubMed]
275
Baer
JS
,
Barr
HM
,
Bookstein
FL
,
Sampson
PD
,
Streissguth
AP
.
Prenatal alcohol exposure and family history of alcoholism in the etiology of adolescent alcohol problems
.
J Stud Alcohol
.
1998
;
59
(
5
):
533
543
[PubMed]
276
Yates
WR
,
Cadoret
RJ
,
Troughton
EP
,
Stewart
M
,
Giunta
TS
.
Effect of fetal alcohol exposure on adult symptoms of nicotine, alcohol, and drug dependence
.
Alcohol Clin Exp Res
.
1998
;
22
(
4
):
914
920
[PubMed]
277
Alati
R
,
Al Mamun
A
,
Williams
GM
,
O’Callaghan
M
,
Najman
JM
,
Bor
W
.
In utero alcohol exposure and prediction of alcohol disorders in early adulthood: a birth cohort study
.
Arch Gen Psychiatry
.
2006
;
63
(
9
):
1009
1016
[PubMed]