Intrauterine cocaine, lead, and nicotine exposure and fetal growth.

Intrauterine tobacco, lead, and cocaine exposure often co-occur and may affect fetal growth and development, yet studies of gestational cocaine effects have not adequately measured lead or tobacco. In this anonymous survey, blood lead and urine cotinine levels were determined and mothers were queried about tobacco use. Eighteen cocaine-exposed mother-infant dyads had higher lead and cotinine levels than 46 random nonexposed dyads, regardless of reported cigarette smoking. Crude growth decrements in cocaine-exposed newborns were attenuated after control for lead and cotinine. Future studies of gestational cocaine effects should measure other toxic exposures with more precision.