NEW YORK, Mar 27 (Reuters Health) - Although the "crack baby" may be one of the most striking symbols of America's drug problems, studies since the 1980s show that prenatal cocaine exposure has not had the devastating effects on children's health that some feared it would.

In fact, researchers report in the March 28th issue of The Journal of the American Medical Association, cocaine use is no more damaging to a fetus than cigarette smoking. The difference, the authors explain, is that no American child has ever been labeled a "tobacco kid." And unlike crack-addicted mothers, no woman has been arrested for smoking tobacco or drinking during pregnancy.

In the 1980s, images of babies born to crack-addicted mothers painted a bleak picture: newborns who were listless, unresponsive and showing abnormal, frenetic movement. Some feared that as these babies grew up they would face serious developmental challenges that would affect their intelligence, physical functioning and emotional health.

But medical research has not borne out these fears, according to Dr. Deborah A. Frank and her colleagues at Boston University in Massachusetts. In a review of 36 studies conducted over 16 years, they found that when women's smoking and alcohol use were factored in, cocaine use did not appear to further boost the risk of developmental delays up to age 6.

These findings show that in terms of risks to the fetus, cocaine is on par with other substances of abuse, Frank told Reuters Health.

"It's irrational to demonize one substance and not others," she said, noting that pregnant women need to avoid all substances of abuse.

But, she and her colleagues note, cocaine and cocaine-addicted mothers have, in fact, been "demonized," with more than 200 women in 30 states having been arrested for using the drug during pregnancy. Although courts in 29 of these states have overturned convictions of many of these women, South Carolina's Supreme Court has upheld the practice of doctors screening pregnant women for cocaine use and turning over positive results to the police.

Last week, the US Supreme Court ruled that hospital workers cannot test pregnant women for drugs without their consent, if the purpose is to alert police.

While Frank referred to this practice as "doctors being vigilantes," she said that drug screening pregnant women for the purpose of counseling them is "perfectly appropriate." Yet many doctors may never speak to women about substance abuse during pregnancy.

"There's a big need for prenatal drug counseling that's not being met," Frank told Reuters Health.

This study confirms what experts have come to believe about prenatal cocaine exposure--that the effects are "somewhere in the middle of 'devastation' and 'no effect,'" Dr. Vince Smeriglio of the National Institute on Drug Abuse in Bethesda, Maryland, said in an interview.

The environment that these children grow up in, he noted, will largely determine whether any "small, subtle differences" in early development have lasting effects.

Although the image of the crack baby "has stirred partisan passions," scientific evidence indicates the image is "not based on fact," Dr. Wendy Chavkin of the Columbia School of Public Health in New York City writes in an accompanying editorial.

According to Chavkin, America's "war on drugs," and not medical evidence, has fueled the heightened concern over prenatal cocaine exposure. The country's abortion debate--particularly over whether a fetus is a person--has also had an impact, she notes.

"As citizens," Chavkin writes, "we may fall on different sides of these debates on abortion and drug addiction." But, she asserts, health professionals must "raise a calm steady voice for science and therapy."

Related MEDLINEplus Pages:

• Pregnancy and Substance Abuse