Maternal cocaine use during pregnancy can affect the infant directly through toxic effects or
indirectly through cocaine's influence on maternal psychological status. We followed 160
cocaine exposed and 56 nonexposed infants and their mothers identified at birth through
interview and/or urine screen. Although cocaine exposure defined the groups, infant
exposure to alcohol, marijuana, and tobacco was allowed to vary. Infants were 99% African
American and poor. All mothers completed the Brief Symptom Inventory (BSI) and infants were
given the Bayley Scales of Mental (MDI) and Motor (PDI) Development at a mean corrected age
of 17 ± 8 months. Both MDIs (94 ± 17 vs. 103 ± 16) and PDIs (101
± 16 vs. 108 ± 12) were lower for cocaine exposed infants. Psychological
distress was greater in cocaine using mothers. Hierarchical multiple regression was used to assess
the relative effects of gestational age, maternal psychological distress, and cocaine and polydrug
exposure on infant outcomes. Both psychological distress and cocaine and alcohol exposure
predicted lower MDIs after controlling for prematurity. Neither psychological distress nor
alcohol exposure predicted motor outcome, while cocaine had a significant effect. Tobacco and
marijuana exposure were unrelated to outcome. These findings provide further support for direct
effects of cocaine and alcohol on infant development, as well as highlight the need for studies to
document maternal psychological factors, which may increase child risk for poorer
outcomes.