23 year-old Jaimee Drakewood hurried in from the rain, ready to get to her last appointment at Children’s Hospital of Philadelphia. A team of researchers has been tracking her development since birth. Finally, after 23 years, the study was ending and researchers would have their questions answered.
Did cocaine harm the long-term development of children like Jaimee, who were exposed to the drug in their mother’s womb?
Researchers had expected the answer to be yes, however it wasn’t, they would find another far more critical factor.
The story, relayed by Susan FitzGerald of The Philly Inquirer, begins in 1989 as a crack epidemic was raging in Philadelphia. Hallam Hurt, then chair of neonatology at Albert Einstein Medical Center on North Broad Street, began a study to evaluate the effects of in-utero cocaine exposure on babies. Maternity wards in Philadelphia were being slammed with babies born to crack-addicted mothers. Studies show that nearly 1 in 6 babies had mothers who tested positive to cocaine.
Stories were being told about these crack babies. They were said to have small heads, and be easily agitated. Some were prone to tremors and had bad muscle tone. Even worse, the babies were aloof and avoided eye contact. Social workers believed there would be a lost generation; these children would grow up with learning and emotional difficulties. They would be unable to hold down a job or have meaningful relationships. An image of a “crack baby” became the symbol of bad mothering. Many cocaine using mothers lost their babies.
Because of this Hurt began a study of 224 near-term or full-term babies born between 1989 and 1992. Half of the mothers used cocaine during pregnancy, the other half did not. All came from low-income families and almost all were African-American. Hurt believed the study would help doctors and nurses who cared for cocaine-exposed babies. Her hope was that it would guide policies for drug prevention, treatment and interventions. She did not plan on it becoming one of the largest and longest running studies of in-utero cocaine exposure.
One of the mothers who signed up was Jaimee’s mom Karen Drakewood.
“Jaimee was beautiful when she was born. A head full of hair. She looked like a porcelain doll. She was perfect. My worst fear was that Jaimee would be slow, mentally retarded, or something like that because of me doing drugs,”
She agreed to enroll her baby in the cocaine study at Einstein. She promised herself that she would turn her life around for the sake of her children but soon went back to her old habit.
Hurt arrived at Children’s Hospital to discuss the findings of nearly 25 years of the effects of cocaine use in pregnancy. Presenting these results was not easy to summarize in a PowerPoint presentation. The study received almost 8 million dollars in federal money over the years and $130,000 from the Einstein Society.
Hurt began her lecture with quotations from the media around the time the study began.
A social worker on TV predicted that a crack baby would grow up to “have an IQ of perhaps 50.” A print article quoted a psychologist as saying “crack was interfering with the central core of what it is to be human,” and yet another article predicted that crack babies were “doomed to a life of uncertain suffering, of probable deviance, of permanent inferiority.”
Hurt quickly points out that cocaine can have devastating effects on pregnancy. The drug can cause a pregnant woman’s blood pressure to rise, cause premature labor, and can be linked to placental abruption. Babies born premature are at risk for a variety of medical and developmental problems. Parental drug use can also create a chaotic home life for a child.
The study only enrolled babies born at full term, so there was no chance of prematurity influencing the results. The babies were evaluated between 6 months and 1 year and every 6-12 months till they became young adults.
The research found no significant differences between the cocaine-exposed children and the non exposed children. For example a cocaine exposed child at age 4 had an IQ of 79, the non exposed child’s was 81.9
“We went looking for the effects of cocaine,” Hurt said. But after a time “we began to ask, ‘Was there something else going on?’ “
Both of the groups of children lagged in developmental and intellectual measures compared to the normal child. Hurt and her team began to think that poverty was an issue.
As the children grew, the researchers did many evaluations to tease out environmental factors that could be affecting their development. On the upside, they found that children being raised in a nurturing home – measured by such factors as caregiver warmth and affection and language stimulation – were doing better than kids in a less nurturing home. On the downside, they found that 81 percent of the children had seen someone arrested; 74 percent had heard gunshots; 35 percent had seen someone get shot; and 19 percent had seen a dead body outside – and the kids were only 7 years old at the time. Those children who reported a high exposure to violence were likelier to show signs of depression and anxiety and to have lower self-esteem.
Research has suggested that gestational cocaine exposure can affect brain development. However investigators could not find any clinically significant effect on behavioral tests of attention skills. As the participants became young adults, 42% used marijuana and three tested positive for cocaine. The drug use did not differ between those who were exposed to cocaine vs. those not exposed.
The team has kept tabs on 110 of 224 children originally in the study. The results are something Hurt did not expect.
“Poverty is a more powerful influence on the outcome of inner-city children than gestational exposure to cocaine,”
Other researchers like Claire Coles, a psychiatry professor at Emory University has found nothing to back up predictions that cocaine exposed babies were doomed for life. Her research has found that cocaine exposure does not seem to affect a child’s overall cognition and school performance:
“As a society we say, ‘Cocaine is bad and therefore it must cause damage to babies, when you have a myth, it tends to linger for a long time.”
Deborah A. Frank, a pediatrics professor at Boston University has also tracked a similar group of children. She found the “crack baby” label led to horrible stereotyping.
“You can’t walk into a classroom and tell this kid was exposed and this kid was not, unfortunately, there are so many factors that affect poor kids. They have to deal with so much stress and deprivation. We have also found that exposure to violence is a huge factor.
Frank said that while we know crack isn’t good for babies,” the stereo type that these kids would grow up and be addicts and criminals is not true. Some kids have stunned us with how well they’ve done.”
Jaimee Drakewood attended her 31st and last visit with her 16-month-old son KyMani in tow.
“We do appreciate everything you’ve done, because it’s not easy to get to all these appointments,” said team member Kathleen Dooley, as she handed Drakewood a framed certificate of appreciation. “We are proud of you and we feel you are family, because you are.”
The team has plans to stay in touch with study participants each year. They plan on using a new study with an MRI machine to explore the neural and cognitive effects of poverty on infant development.
“Given what we learned,” Hurt said, “we are invested in better understanding the effects of poverty. How can early effects be detected? Which developing systems are affected? And most important, how can findings inform interventions for our children?”
Jaimee and her mother Karen are among the teams best success stories. Jaimee plans on finishing college and becoming a food inspector. Karen is off of drugs and works at a residential adviser at Gaudenzia house.
Jamiee credits her big sister (a college graduate with a master’s degree) and her mother for keeping her on track.
“I’ve seen my mom at her lowest point and I’ve seen her at her highest. That hasn’t stopped me from seeing the superwoman in her regardless of where she was at,”
Despite the history of her family, Jaimee believes that she and her siblings are “destined to have accomplishments, to be greater than our parents.”