Prenatal drug exposure and child outcome. Past, present, future.

Scientific study of prenatal drug exposure and child outcome began a period of substantial growth in the 1970s with a focus on exposure to opiates. By the mid-1980s, attention shifted to cocaine. Most of this research has involved cohort studies in which groups of children are followed up longitudinally from birth. Significant progress has been made regarding the assessment of child outcome (greater range of outcome areas and greater specificity of measures) and regarding attention to and analysis of confounding factors that travel with prenatal exposure. As progress has been made, investigators are tackling new and continuing challenges inherent in these complex studies. Considerable effort is being devoted to determining the level of severity of exposure. Interest is increasing regarding the use of neuroimaging assessments as well as the identification of possible biologic and environmental mechanisms underlying associations between prenatal exposure and subtle child outcomes.