Long-term effects following prenatal cocaine exposure: A systematic review.

Clinical Snapshot

Key Findings

• P Value: Not reported at the review level

• Effect Size: Not quantified; narrative synthesis only — no pooled effect sizes reported

• Primary Outcome: Prenatal cocaine exposure is consistently associated across maturational stages with early developmental effects (smaller head circumference, motor delays), deficits in visuospatial, language, and executive functions, focal neuroimaging alterations (white matter microstructure, task-related functional recruitment), growth deficits, and elevated externalising behaviours

• Nnt Or Sensitivity: Not applicable; no NNT, sensitivity, specificity, or hazard ratio calculable from this narrative synthesis. Individual study-level effect estimates are not aggregated.

• Confidence Interval: Not reported; no meta-analytic pooling performed

Clinical Application

The review's clinical recommendations — enhanced developmental surveillance, family-focused postnatal support, and integrated substance-use prevention — are feasible within existing paediatric and maternal-child health frameworks. Implementation requires multidisciplinary coordination across obstetrics, neonatology, developmental paediatrics, and social work. Neuroimaging surveillance is not recommended at a population level given the small and heterogeneous evidence base. In Australia, prenatal cocaine exposure is less prevalent than in North American cohorts but remains clinically relevant, particularly in urban centres. The RACGP and RANZCOG both emphasise universal screening for substance use in pregnancy using validated tools (e.g., AUDIT-C, DAST-10). The Maternal and Child Health framework in most Australian states provides structured developmental surveillance at key ages (0–5 years) that could incorporate PCE-specific vigilance for motor, language, and executive function delays. No PBS-listed pharmacological intervention exists specifically for PCE-related neurodevelopmental sequelae; management is supportive and behavioural. The TGA has not approved any agent for this indication. Child protection and family support services (e.g., Family by Family, Intensive Family Support Services) are relevant for the caregiving instability dimension highlighted in this review. Australian Indigenous communities, where substance use in pregnancy intersects with additional social determinants, warrant culturally safe, community-led approaches beyond those described in this predominantly North American literature. Children and adolescents with known or suspected prenatal cocaine exposure presenting to paediatric, developmental, child and adolescent mental health, or general practice services. Clinicians working with pregnant women who use cocaine and their families are the primary target audience.

Abstract

Cocaine use represents a global public-health concern, and children's exposure to this substance is receiving growing attention. Despite the importance of this phenomenon, efforts to isolate cocaine-specific long-term effects are affected by the limited availability of human cohorts followed into adulthood and by the influence of environmental factors and co-exposures. Addressing ongoing debates in the literature, this systematic review synthesizes human evidence on long-term outcomes following prenatal cocaine exposure (PCE), from infancy to early adulthood. A comprehensive search of PubMed and Scopus from inception to August 2025 identified 26 eligible studies. Results suggest that across maturational stages, PCE is consistently associated with early developmental effects (including smaller head circumference and motor delays), deficits in visuospatial, language and executive functions, focal neuroimaging alterations (white-matter microstructure and task-related functional recruitment), growth deficits, and elevated externalizing behaviours. However, evidence is characterised by heterogeneity in exposure assessment, frequent prenatal polysubstance exposure, socioeconomic confounding, caregiving instability and small neuroimaging samples. Overall, this review suggests that PCE is linked to a broad spectrum of detrimental effects and that some biological vulnerabilities associated with PCE may persist. Nonetheless, supportive postnatal environments may mitigate developmental disadvantages and promote better trajectories for affected children. These findings underscore the need for integrated public-health and clinical strategies that combine prevention of prenatal substance use with family-focused postnatal supports.

References

1. 1.Miazzi, R., Cestonaro, C., Attanasio, F., Travaini, G., Scarpazza, C., & Terranova, C. (2026). Long-term effects following prenatal cocaine exposure: A systematic review. PLoS ONE. https://doi.org/10.1371/journal.pone.0352587