University of Maryland School of Medicine, Department of Pediatrics, 737 W Lombard St, Room 161, Baltimore, MD 21201, USA.
Pediatrics. 2010 Mar;125(3):554-65. doi: 10.1542/peds.2009-0637. Epub 2010 Feb 8.
Studies through 6 years have shown no long-term direct effects of prenatal cocaine exposure (PCE) on children's physical growth, developmental test scores, or language outcomes. Little is known about the effects of PCE among school-aged children aged 6 years and older.
We reviewed articles from studies that examined the effects of PCE on growth, cognitive ability, academic functioning, and brain structure and function among school-aged children.
Articles were obtained by searching PubMed, Medline, TOXNET, and PsycInfo databases from January 1980 to December 2008 with the terms "prenatal cocaine exposure," "cocaine," "drug exposure," "substance exposure," "maternal drug use," "polysubstance," "children," "adolescent," "in utero," "pregnancy," "development," and "behavior." Criteria for inclusion were (1) empirical research on children aged 6 years and older prenatally exposed to cocaine, (2) peer-reviewed English-language journal, (3) comparison group, (4) longitudinal follow-up or historical prospective design, (5) masked assessment, (6) exclusion of subjects with serious medical disabilities, and (7) studies that reported nonredundant findings for samples used in multiple investigations. Thirty-two unique studies met the criteria. Each article was independently abstracted by 2 authors to obtain sample composition, methods of PCE assessment, study design, comparison groups, dependent variables, covariates, and results.
Associations between PCE and growth, cognitive ability, academic achievement, and language functioning were small and attenuated by environmental variables. PCE had significant negative associations with sustained attention and behavioral self-regulation, even with covariate control. Although emerging evidence suggests PCE-related alterations in brain structure and function, interpretation is limited by methodologic inconsistencies.
Consistent with findings among preschool-aged children, environmental variables play a key role in moderating and explaining the effects of PCE on school-aged children's functioning. After controlling for these effects, PCE-related impairments are reliably reported in sustained attention and behavioral self-regulation among school-aged children.
已有 6 年的研究表明，产前可卡因暴露（PCE）不会对儿童的身体生长、发育测试评分或语言结果产生长期的直接影响。而对于 6 岁及以上学龄儿童中 PCE 的影响则知之甚少。
我们回顾了研究 PCE 对生长、认知能力、学业功能以及大脑结构和功能影响的文章。
通过在 1980 年 1 月至 2008 年 12 月期间在 PubMed、Medline、TOXNET 和 PsycInfo 数据库中搜索“prenatal cocaine exposure”、“cocaine”、“drug exposure”、“substance exposure”、“maternal drug use”、“polysubstance”、“children”、“adolescent”、“in utero”、“pregnancy”、“development”和“behavior”等术语，获得相关文章。纳入标准为：（1）对产前暴露于可卡因的 6 岁及以上儿童进行的实证研究；（2）同行评议的英文期刊；（3）比较组；（4）纵向随访或历史前瞻性设计；（5）评估时设盲；（6）排除有严重医疗残疾的受试者；（7）报告用于多项研究的样本的非重复发现的研究。32 篇独特的研究符合标准。由两位作者分别独立对每篇文章进行摘要，以获取样本组成、PCE 评估方法、研究设计、对照组、因变量、协变量和结果。
PCE 与生长、认知能力、学业成绩和语言功能之间的关联较小，并且会受到环境变量的影响而减弱。即使在控制了协变量的情况下，PCE 与持续性注意和行为自我调节仍呈显著负相关。虽然有新的证据表明 PCE 与大脑结构和功能的改变有关，但由于方法学的不一致，解释受到限制。
与学龄前儿童的研究结果一致，环境变量在调节和解释 PCE 对学龄儿童功能的影响方面起着关键作用。在控制这些影响后，可靠地报告了 PCE 与学龄儿童持续性注意和行为自我调节方面的损害。
