The puzzle of cocaine's effects following maternal use during pregnancy: are there reconcilable differences?

This is a selective review of the clinical and epidemiological literature. It attempts to reconcile disparate and contradictory findings dealing with the morphologic, growth, and neurobehavioral effects reported to occur in neonates and young children exposed prenatally to cocaine. A history of cocaine use in the United States is briefly presented followed by impressionistic observations of some of the events that transpired during the cocaine epidemic of the 1980s. Based on the collective research findings, it is tentatively suggested that the teratogenic effects of prenatal cocaine may be produced only in those infants exposed to the highest doses reported in the literature. It remains unknown, however, whether or not these effects may be dependent on the concurrent abuse of alcohol and/or cigarettes. As to growth and neurobehavioral outcomes, effects attributable primarily to cocaine alone and not other substances of abuse appear to be only marginal and transitory. The data to support these conclusions are particularly tenuous and are thus offered only as working hypotheses. Because of the intractable methodological and interpretive problems inherent in human developmental research on substance abuse, any attempt to draw definitive conclusion is admittedly premature. Because these methodological problems also complicate the efforts of ongoing studies, answers to these persistent questions may not be readily forthcoming.