Background: Children born to HIV-infected women often have co-morbidities including other infections, illicit drug use, and medications. The multiple exposures these children may face make it extremely difficult to determine the etiology of problems such as growth deficits or developmental delays. Children exposed to cocaine or to opiates in utero have often been presumed to have long-term developmental problems, yet studies yield inconsistent and contradictory data. We assessed the possible effects of in utero cocaine and opiate exposure on growth, neuro-development, and behavior in children enrolled in the Women and Infants Transmission Study, a longitudinal multicenter prospective study of HIV-infected women and their children.

Methods: We included in the analysis1,914 infants born to HIV-infected women and who have data on growth or developmental outcome and HIV status. Of these, 174 are HIV-infected, 470 had in utero exposure to cocaine, and 280 to opiates. Follow-up included 89% of eligible infants at 1 yr, 76% at 2 yrs, and 47% at 5 yrs of age. Outcome measures for this analysis included height, weight and head circumference, and motor, cognitive, and behavioral test results from birth through 5 yrs of age. Data was analyzed using longitudinal data analysis models that controlled for gestational age, race, sex, maternal education, calendar year, and maternal exposure during pregnancy (e.g., cigarettes, alcohol, AZT, low CD4%, etc.).

Results: HIV-infected infants had depressed growth and neurodevelopment over the entire follow-up period as compared to HIV-uninfected infants. Cocaine-exposed infants had poorer weight, height, and head growth, as well as poorer motor and cognitive development for the first few months of life, but showed no significant long-term deficit in growth, development, or behavior. HIV-infected infants exposed to opiates had better neuro-developmental scores at 4–6 months than their HIV-infected opiate-unexposed counterparts, but this effect gradually disappeared over the first 3 yrs of life.

Conclusions: HIV-infected children show long-term delays in growth and development. In utero cocaine or opiate exposures exhibit independent effects on growth that are transient, but did not appear to cause long-term delays. By 5 years of age, long-term effects of in utero cocaine or opiate exposure on growth, development, or behavior were not noticed; longer follow-up and further research looking at school performance are necessary.