Natal status of infants of cocaine users and control subjects: a prospective comparison.

Cocaine use by pregnant women has increased dramatically in recent years. To assess the effect of maternal cocaine use on infant outcome, we enrolled 224 women (105 cocaine users, 119 control subjects) and their infants (all of 34 weeks or more gestational age and nonasphyxiated) in a prospective, blinded study. Results showed that infants exposed to cocaine were more likely to be admitted to the newborn intensive care unit, be treated for congenital syphilis, have a greater length of stay, and be discharged to a person other than the mother (all p < 0.01). Birth weight and head circumference, adjusted for gestational age, were smaller in the infants exposed to cocaine than in control infants (p < 0.001). After statistically controlling for cigarette use and other confounders, however, the odds of infants exposed to cocaine and control infants having birth weight and head circumferences less than the 25th percentile for gestational age did not differ (both p > 0.80). Infants of cocaine-using mothers and control subjects had a similar incidence of abnormal cranial and renal ultrasonographic findings and abnormal pneumocardiograms (all p > or = 0.32). We conclude that in this cohort of nonasphyxiated infants of 34 weeks or more gestational age, infants exposed to cocaine had more medical and social problems than control infants but did not differ statistically in the incidence of severe growth retardation, abnormal cranial or renal ultrasonographic findings, or abnormal pneumocardiograms. We suggest that natal interventions for the nonasphyxiated term and near-term infant exposed to cocaine should include a careful history and physical examination, follow-up plans, and social service involvement.