Prenatal cocaine: the effects go on

Abstract

The possibility that cocaine exposure in utero can result in some long-term neurodevelopmental effects has long been entertained. Given the fact that such children may well spend their early years in unfortunate environments, however, it is difficult to tease out the relative contributions of pre- and post-natal insults.In the current issue of The Journal, Lester et al report some fascinating observations in a cohort of children with documented prenatal cocaine exposure who have been followed for 11 years. These investigators used a standard procedure to induce psychological stress in a group of 11 year olds, some with prenatal cocaine exposure and some without. They measured the cortisol response to this stress in these children.The children with cocaine exposure had a blunted cortisol response, which the authors hypothesize could be a risk factor for later development of psychopathology. Because this cohort had been followed carefully over time, however, the investigators were also able to address the contribution of a variety of other potential confounders to this blunted response. Of these, exposure to domestic violence appeared to be a strong contributor to the observed blunted response.These observations are valuable in two ways. They clearly point the way to future studies of pathophysiology, by implicating dysfunction of the hypothalamic pituitary axis in the psychopathology that may follow prenatal cocaine exposure. They also remind us, however, that even if we cannot correct the prenatal insult, it is important to insure a healthy environment postnatally.Article page 288 ▸ The possibility that cocaine exposure in utero can result in some long-term neurodevelopmental effects has long been entertained. Given the fact that such children may well spend their early years in unfortunate environments, however, it is difficult to tease out the relative contributions of pre- and post-natal insults. In the current issue of The Journal, Lester et al report some fascinating observations in a cohort of children with documented prenatal cocaine exposure who have been followed for 11 years. These investigators used a standard procedure to induce psychological stress in a group of 11 year olds, some with prenatal cocaine exposure and some without. They measured the cortisol response to this stress in these children. The children with cocaine exposure had a blunted cortisol response, which the authors hypothesize could be a risk factor for later development of psychopathology. Because this cohort had been followed carefully over time, however, the investigators were also able to address the contribution of a variety of other potential confounders to this blunted response. Of these, exposure to domestic violence appeared to be a strong contributor to the observed blunted response. These observations are valuable in two ways. They clearly point the way to future studies of pathophysiology, by implicating dysfunction of the hypothalamic pituitary axis in the psychopathology that may follow prenatal cocaine exposure. They also remind us, however, that even if we cannot correct the prenatal insult, it is important to insure a healthy environment postnatally. Article page 288 ▸ Prenatal Cocaine Exposure Related to Cortisol Stress Reactivity in 11-Year-Old ChildrenThe Journal of PediatricsVol. 157Issue 2PreviewDetermine the association between prenatal cocaine exposure and postnatal environmental adversity on salivary cortisol stress reactivity in school-aged children. Full-Text PDF