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Slow Development in "Crack Babies" May Be Caused by Conditions of Urban Poverty, Says New Study


September-October 1997

So-called "crack babies," a term used in the mid-1980s to describe babies exposed to cocaine in the womb, have the same developmental problems as poor inner-city children without prenatal exposure to cocaine, say researchers at the Albert Einstein Medical Center (AEMC) in Philadelphia (Susan FitzGerald, "`Crack Baby' Fears May Have Been Overstated," Washington Post, September 16, 1997, Health section, p. 10).

Hallam Hurt, MD, chairman of neonatology at AEMC, directed the study funded by the National Institute on Drug Abuse. The study found that both groups scored well below the norm on cognitive development tests. However, the researchers said slower development in both groups may be caused by symptoms of urban poverty, such as lack of access to prenatal medical care and poor nutrition. In addition, it is difficult to attribute developmental problems to cocaine primarily since women who use cocaine during pregnancy are also more likely to smoke cigarettes and marijuana, drink alcohol, and have sexually transmitted diseases.

"Much of the early thinking on cocaine's effects on neurological development grew more out of anecdotal reports than scientific studies," the Washington Post reported. In the mid 1980s, when the reporting of the crack epidemic was at its zenith, doctors and researchers warned that "crack babies" may suffer from severe learning and behavior problems. "The crack baby epidemic became a powerful symbol as the nation marched forward on its war against drugs," the Post reported. "Everybody bought the story of the crack baby and that just snowballed and took on a life of its own," said Donald Hutchings, an expert on the toxic effects of drugs on fetal development, at New York State Psychiatric Institute. [In his book, Smoke and Mirrors, Dan Baum describes the reporting on the "crack baby" epidemic during the 1980s and how evidence was available at the time that suggested prenatal care is a better predictor of a baby's health than whether the mother smoked crack during her pregnancy (pp. 218-219, 267-272) (See "Book Reviews," NewsBriefs, Summer 1996). For example, Florida health officials concluded in 1985, "It is safer for a baby to be born to a drug-abusing, anemic, or a diabetic mother who visits the doctor throughout her pregnancy than to be born to a normal woman who does not" (Lynn Paltrow, "When Becoming Pregnant Is a Crime," Criminal Justice Ethics, Winter/Spring 1990). -- RCT]

It is believed that a mother's use of cocaine during pregnancy can affect the fetus by allowing the drug to cross the placenta and affect the fetus' brain, or by causing blood vessels to constrict, which would hinder the supply of oxygen and nutrients to the fetus. "It's sort of hard to believe that something as powerful as [cocaine] doesn't have a profound effect on the fetus," said Keith Scott, a researcher at the University of Miami's Linda Ray Intervention Center.

However, "Their cognitive development is normal when you control for environmental and other factors," said Ira Chasnoff, MD, a University of Illinois School of Medicine researcher. Chasnoff has been studying children with prenatal cocaine exposure since the early 1980s.

Some researchers worry that the "crack baby" stigma may hinder children as they grow older. AEMC's Hallam Hurt said, "Our fear is that these children won't be given a fair chance."

Articles in the scientific literature: Hallam Hurt, MD, et al., "Play behavior in toddlers with in utero cocaine exposure: a prospective, masked, controlled study," Journal of Developmental Behavioral Pediatrics, 1996, no. 17, pp. 373-379; Hallam Hurt, MD, et al., "Cocaine-exposed children: follow-up through 30 months," Journal of Developmental Behavioral Pediatrics, 1995, no. 16, pp. 29-35; Hallam Hurt, MD, et al., "Natal status of infants of cocaine users and control subjects: a prospective comparison," Journal of Perinatology, 1995, no. 15, pp. 297-304; Hallam Hurt, MD, "A prospective evaluation of early language development in children with in utero cocaine exposure and in control subjects," Journal of Pediatrics, 1997, no. 130, pp. 310-312.

Hallam Hurt, MD - (215) 456-7253.