With the increasing use of cocaine as a recreational drug, there has been a concomitant rise in the number of pregnant women using cocaine. The objective of this project is to initiate a longitudinal study of infants exposed to cocaine in-utero and compare them to methadone-maintained and control subjects, examining the infants' short- and long-term physical, behavioral and cognitive outcomes. All women will be enrolled in the Perinatal Services component of the Chemical Dependence Program of Northwestern Memorial Hospital and will receive comprehensive obstetric, medical, psychosocial and addictive care. Cocaine-using women will be divided into two groups according to concurrent use or nonuse of opiates. Two comparison groups matched for socioeconomic and medical factors will be established: the first a group of opiate-addicted women and the second a group of drug-free women selected from the prenatal clinic of Prentice Women's Hospital. All opiate-using women will be converted to low-dose methadone maintenance according to well-established criteria. Maternal urines will be screened throughout pregnancy for use of licit and illicit drugs, and neonatal urines will be evaluated over the first week of life to study excretion rates of cocaine and other drugs by the neonate. Neonates will be precisely evaluated for withdrawal, and at 3 days and at 1 month of age, neurobehavioral testing will be conducted with the Brazelton Neonatal Behavioral Assessment Scale. Infant growth will be monitored closely through 3 years of age, and development will be evaluated over this period of time with the Bayley Scales of Infant Development and the Stanford-Binet. Maternal education, therapy and support will be continued throughout the project, and community support organizations will be utilized to insure adequate supervision and follow-up. The information collected in this study will provide the first longitudinal data regarding the effects of cocaine on pregnancy and the developing fetus, neonate and child.
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