Prestigious pediatric journal publishes study that stemmed from undergrad's honors thesis
The babies looked sound to Beata Napiorkowski. But she knew better. Her role was to examine the one- and two-day-old newborns at Women and Infants Hospital. These were the babies of women who smoked crack during their pregnancies. Napiorkowski and a team of physicians and developmental psychologists were looking for patterns in the infants' behavior.
"We found that newborns who were exposed to crack looked like normal babies but didn't act like them," said Napiorkowski. "Cocaine-exposed infants were more jittery, had more muscle tension, and were harder to move because they were stiff."
The results of the study, which became Napiorkowski's honor thesis in the Department of Neuroscience, were published this summer in the prestigious research journal Pediatrics, with Napiorkowski listed as lead author. The study injected clear-cut evidence into a two-decade-old medical debate on what happens to newborns whose mothers smoked crack cocaine during pregnancy. Its testing procedure was developed by Brown researchers as part of a study of prenatal drug exposure, sponsored by the National Institutes of Health. Given that studies of "crack" babies in the 1980s produced conflicting findings and were biased at times by unscientific techniques, the study published in Pediatrics was designed to provide scientifically valid findings about the effects of substance exposure in the womb.
Nice work for an undergrad. Napiorkowski is one of several Brown students who conduct substance-abuse studies of infants. For this research, Napiorkowski recruited the mothers, examined their newborns, and wrote up the results by the end of her junior year.
Napiorkowski and co-researchers in the Department of Pediatrics in Women and Infants Hospital looked at the newborns of 57 women. Twenty infants had been exposed to cocaine, alcohol, marijuana and cigarettes. Seventeen newborns had been exposed to alcohol and/or marijuana and cigarettes. The other 20 infants were drug-free, but some of their mothers smoked cigarettes.
Mothers in the study were granted confidentiality, exempting the researchers from reporting their drug use. All of the mothers received prenatal care and all of the babies were normal birth weight.
The researchers found that crack-smoking pregnant women gave birth to babies who twitched, trembled and arched their backs more than unexposed newborns. Crack babies also displayed patterns of both excitability and lethargy, appeared to be more stressed and failed to follow certain stimuli, such as a rattle or bell, compared to unexposed infants.
The Brown researchers think the findings resulted from the combined action of cocaine with alcohol and marijuana. Alcohol can boost the effects of cocaine, and most of the crack-smoking women in the study abused alcohol and marijuana.
However, the study offered some encouraging news. In contrast to anecdotal reports, the babies were no more difficult to test than unexposed infants and didn't require special handling or consoling, said the researchers.
"From this study, we've also learned that cocaine exposure in the womb may not produce newborns with hemorrhages, lesions and brain damage, as reported elsewhere," said Barry Lester, principal developer of the study's testing procedure, professor of psychiatry and pediatrics, and one of the study's authors. "These are fragile, vulnerable babies. With the proper child rearing, they will do fine. If the resources are available, it's possible to intervene with drug-abusing moms early in their pregnancies to try and produce optimal newborns."
But Lester, who collaborates with Starbirth, a residential treatment program for pregnant and postpartum drug-using women, says that the newborns of most crack-using mothers are likely reared in environments of poverty, violence and poor parenting. Babies who twitch, cry or act fussy can further influence how parents treat the baby.
"A baby that isn't cuddly sweet can turn off a parent," Lester says. "For a drug-using mom, this is a real setup for failure, as problems with the baby and mother can trigger negative parenting. The trick is to get the mothers back on track, with parenting, psychiatric and addiction counseling."
Napiorkowski, now a second-year student in the School of Medicine, shares Lester's concerns that their efforts offer tangible applications. This summer, she studied 20 mothers-to-be, assessing the in-womb behavior of fetuses in women who smoke crack cocaine. Her focus is the differences in blood flow to the brains of fetuses of crack-smoking women compared to women who do not abuse the drug. Cocaine is implicated in hemorrhaging and other changes in the circulatory systems of both fetuses and newborns. This study is partially funded by a research assistantship from the Program in Liberal Medical Education.
"Our hope is that the results of this latest study will lead to intervention with cocaine-using pregnant women," said Napiorkowski, who is interested in the field of obstetrics after conducting this work. "If we find the drug affects a fetus, we might be able to show the women what cocaine does to the fetus as a way to get them to stop using drugs."
Napiorkowski says a highlight of her work is the chance to blend her training in neuroscience with the developmental psychology expertise offered by Lester and other faculty.