Exposure to crack cocaine in the womb does not increase the risk of later criminal behavior or school dropout — although the drug may have some lasting effects on behavior and development, according to a new review of the research.
Contrary to fears that emerged in the late 1980s and early ’90s about “crack babies” growing up to be either profoundly disabled or prone to unchecked criminality, the review, which was published in Pediatrics, found only subtle differences in the behavior of these children and of those who weren’t exposed to the drug while in the womb. In most cases, even when the children performed less well than their nonexposed peers, the test results remained within the normal range.
“The ‘crack-baby’ scare from the ’80s was overstated and was not substantiated,” says the study’s lead author Maureen Black, professor of pediatrics and epidemiology at the University of Maryland School of Medicine.
The research included around 5,000 11- to 19-year-olds involved in 27 studies from nine different groups of prenatally cocaine-exposed children and children from similarly disadvantaged neighborhoods who weren’t exposed.
Eleven studies explored behavioral problems and nearly two-thirds of these found differences between the cocaine-exposed youth and the others. However, all of the differences were small and within the normal range — and two studies that looked at illegal behaviors such as juvenile delinquency, property damage and violence found no effect of the in utero cocaine.
“We did not find any differences that were of clinical importance,” says Black. “There were not more kids dropping out of school. They were not more likely to be arrested.”
Eight studies focused on academic performance, and 74% of these found that the exposed children did slightly worse in school, particularly on language and memory-related tests. But such differences paled in comparison to those seen with fetal-alcohol-spectrum disorders, which are the leading known cause of intellectual disability.
“[Fetal-alcohol syndrome] is way worse,” Black says. “Without a doubt. There are facial abnormalities, mental retardation — it is a major disorder.” Although only around 1% of pregnant women use cocaine, 19% drink alcohol during the first trimester and 22% smoke cigarettes, according to the Substance Abuse and Mental Health Services Administration. Like cocaine, cigarette smoking is linked to an increased risk of miscarriage, stillbirth, low birth weight and prematurity.
Eight imaging studies included in the review showed some differences in cocaine-exposed teens in various parts of the brain. However, as the authors write, these “rarely translated into behavioral differences.” In other words, it wasn’t clear whether these differences actually mattered.
In fact, social and cultural assumptions about the deficits that “crack babies” experience may do even more harm than the drug itself. One study, for example, found that the behavior of normal 2-year-olds was misinterpreted as pathological by students who had been told that they were “crack babies” compared with those told as ordinary toddlers — and these types of misinterpretations of normal behavior as “bad” can lead to harsh treatment.
“We get concerned that if you label a child that way — particularly for someone who is not very well-informed — they will behave as though, Well, there’s no hope for that child. After all, that’s a ‘crack baby,’” Black says, “It’s inaccurate and prejudicial.”
Some states, in fact, actually prosecute pregnant women for exposing their infants to drugs (but not alcohol) in the womb — a policy that has been shown to reduce prenatal care. Not receiving proper prenatal care can potentially be more damaging to the child than the drug.
With the rise in methamphetamine use in the 2000s and prescription painkillers in the 2010s, researchers hope not to repeat the experience of creating a negative stereotype that leads to social misperceptions and such punitive policies that can worsen drug-related damage. While addressing drug-and-alcohol use during pregnancy can lower risk of developmental problems, such strategies should also incorporate methods for recognizing the social and economic reasons that expectant moms turn to drugs or alcohol in the first place. Around two-thirds of the women who used cocaine while pregnant experienced child abuse and most lived in poor, distressed and violent neighborhoods. Most also misused multiple drugs, including alcohol and cigarettes.
“There has not been a strong emergence of clinically relevant findings [for prenatal cocaine exposure] during adolescence … What is evident are the pervasive effects of poverty on both [exposed] and non-exposed youth,” the authors write.
And to improve outcomes for children who are born after being exposed to cocaine in utero, they say that the same factors that support other children — warm, close parental relationships, sufficient economic resources and a safe home — are critical. “The most important element in determining these kids’ skills in adolescence is the care-giving environment,” Black says.