During the past few years there has been a tremendous increase in the abuse of crack in the pregnant population. In addition to the crack thee is a 30-35% abuse of other illicit drugs. There is a growing body of data on the perinatal effects of cocaine but very little information exists on the effects of crack. The overall purpose of the proposal is to investigate the effects of prenatal crack abuse on pregnancy and the early somatic and neurobehavioral development of the infant and young child. A total of 426 pregnant women will be enrolled in the study: 65% with a history of crack abuse; and 35% will be drug-free. Three time periods will be covered: gestation, neonatal, and infancy to 2 years. During pregnancy data will be collected on the use of crack including number, route, frequency. Use of other drugs of abuse will be noted. this will be done using drug intake questionnaires and urinary drug screens at frequent intervals. Data on past and present medical and obstetrical information as to infections, obstetrical complications, course of labor and delivery, nutrition and weight gain, fetal well being using fetal heart rate monitoring and ultrasonography will be collected. The neonate will have a physical and neurological exam. USG of the head to R/O congenital anomalies, and a cocaine intoxication symptom score. The Brazelton Neurobehavioral Assessment will be administered to evaluate early responsiveness. Charts will be reviewed for pertinent data. All infants will be enrolled in follow-up. The Infant Health Assessment Program (IHAP) was recently established in NYC with a mandate to track and ensure provision of comprehensive care to high risk infants. We will collaborate with the IHAP to ensure attendance at the follow-up clinic. The children will be seen at 6,12,18, and 24 months. To determine abnormalities growth para-meters, physical and neurological evaluations will be performed at each visit. Standard measures of cognitive and perceptual development will be administered to determine developmental and behavioral difficulties. To determine any deficits in communication and social skills standard measures and mother-infant interaction will be used. Maternal demographic and psychosocial data will be collected pre-and postnatally. The effects of crack use, maternal psychosocial functioning, prenatal and neonatal course, and mother infant interaction will be examined on the somatic and neurodevelopmental outcome of the infants. This information will provide a basis for recommendations for health care and intervention programs to minimize the risk for neurobehavioral and developmental problems.
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