Prenatal cocaine exposure or PCE occurs when a child is exposed in utero to cocaine taken by the pregnant mother.  We know that cocaine exposure during pregnancy can negatively affect the pregnancy; women who use cocaine during pregnancy are at increased risk for preterm delivery and low birthweight.  We know much less about the effects of cocaine on the developing fetal brain.

Information on the long-term effects of PCE has been difficult to interpret. Because prenatal cocaine exposure often occurs along with exposure to other drugs and psychosocial and environmental factors (e.g., poverty, teen pregnancy, limited social supports) which may negatively affect a child’s development and well-being, it has been difficult to distinguish the direct effects of cocaine on the fetal brain from the effects of the environment to which the developing child is exposed.

Thus far no specific disorder or condition has been found to result from prenatal cocaine exposure.  In studies which have focused on children prenatally exposed to cocaine up to six years of age, the associations between PCE and growth, cognitive ability, academic achievement, and language functioning were small and were ameliorated by environmental variables (Ackerman et al, 2010). These studies did show, however, that PCE had significant negative associations with sustained attention and behavioral self-regulation.

In a recent study, researchers were able to assess a large group of neonates (N = 152) with resting-state functional magnetic resonance imaging.  Because imaging was carried out in children shortly after birth, this type of analysis would minimize the effects of environmental variables on the brain and would give a more detailed view of the effects of PCE on the developing brain.

In this sample, 45 infants had prenatal exposure only to cocaine, 43 had prenatal exposure to drugs other than cocaine, and 64 had no known prenatal drug exposure. The researchers observed that infants exposed to any drug had disruptions in connectivity within the amygdala–frontal, insula–frontal, and insula–sensorimotor circuits. Moreover, they detected a cocaine-specific effect within a subregion of the amygdala–frontal network.

This amygdala-frontal pathway is thought to play an important role in regulation of arousal and mood, which may underlie the behavioral dysregulation observed in older children and adolescents with PCE.

Ruta Nonacs, MD PhD

Ackerman JP, Riggins T, Black MM.  A review of the effects of prenatal cocaine exposure among school-aged children.  Pediatrics. 2010 Mar;125(3):554-65.

Salzwedel AP, Grewen KM, Vachet C, Gerig G, Lin W, Gao W.  Prenatal drug exposure affects neonatal brain functional connectivity.  J Neurosci. 2015 Apr 8;35(14):5860-9. doi:

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