‘Crack baby’ study ends with unexpected result

Now, after nearly a quarter century, the federally funded study was ending, and the question the researchers had been asking was answered.

Did cocaine harm the long-term development of children like Jaimee, who were exposed to the drug in their mother’s womb? The researchers had expected the answer would be a resounding yes. But it wasn’t. Another factor would prove far more critical.

’80S EPIDEMIC

A crack epidemic was raging in Philadelphia in 1989 when 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.

In maternity wards in Philadelphia and elsewhere, caregivers were seeing more mothers hooked on cheap, smokable crack cocaine. A 1989 study in Philadelphia found that nearly one in six newborns at city hospitals had mothers who tested positive for cocaine.

Troubling stories were circulating about the so-called crack babies. They had small heads and were easily agitated and prone to tremors and bad muscle tone, according to reports, many of which were anecdotal. Worse, the babies seemed aloof and avoided eye contact.

Some social workers predicted a lost generation — kids with a host of learning and emotional deficits who would overwhelm school systems and not be able to hold a job or form meaningful relationships. The “crack baby” image became symbolic of bad mothering, and some cocaine-using mothers had their babies taken from them or, in a few cases, were arrested.

It was amid that climate that Hurt organized a study of 224 near-term or full-term babies born at Einstein between 1989 and 1992 — half with mothers who used cocaine during pregnancy and half who were not exposed to the drug in utero. All the babies came from low-income families, and nearly all were African-Americans.

Hurt hoped the study would inform doctors and nurses caring for cocaine-exposed babies and even guide policies for drug prevention, treatment, and follow-up interventions. But she never anticipated that the study, funded by the National Institute on Drug Abuse, would become one of the largest and longest-running studies of in-utero cocaine exposure.

One mother who signed up was Jaimee’s mom, Karen Drakewood. She was on an all-night crack binge in a drug house near her home in the city’s West Oak Lane section when she went into labor. Jaimee was born Jan. 13, 1990, weighing an even 7 pounds.

“Jaimee was beautiful when she was born. A head full of hair. She looked like a porcelain doll,” Karen Drakewood, now 51, said recently in her Overbrook kitchen. “She was perfect.”

But Drakewood knew looks could be deceiving. “My worst fear was that Jaimee would be slow, mentally retarded, or something like that because of me doing drugs,” she said. She agreed to enroll her baby in the cocaine study at Einstein.

Drakewood promised herself that she would turn her life around for the sake of Jaimee and her older daughter, but she soon went back to smoking crack.

SOMETHING ELSE

Hurt’s study enrolled only full-term babies so the possible effects of prematurity did not skew the results. The babies were then evaluated periodically, beginning at six months and then every six or 12 months on through young adulthood. Their mothers agreed to be tested for drug use throughout the study.

The researchers consistently found no significant differences between the cocaine-exposed children and the controls. At age 4, for instance, the average IQ of the cocaine-exposed children was 79.0 and the average IQ for the non-exposed children was 81.9. Both numbers are well below the average of 90 to 109 for U.S. children in the same age group.

When it came to school readiness at age 6, about 25 percent of children in each group scored in the abnormal range on tests for math and letter and word recognition.

“We went looking for the effects of cocaine,” Hurt said. But after a time “we began to ask, ‘Was there something else going on?’”

While the cocaine-exposed children and a group of non-exposed controls performed about the same on tests, both groups lagged on developmental and intellectual measures compared to the norm. Hurt and her team began to think the “something else” was poverty.

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.

The team has kept tabs on 110 of the 224 children originally in the study. Of the 110, two are dead — one shot in a bar and another in a drive-by shooting — three are in prison, six graduated from college, and six more are on track to graduate. There have been 60 children born to the 110 participants. The years of tracking kids have led Hurt to a conclusion she didn’t see coming.

“Poverty is a more powerful influence on the outcome of inner-city children than gestational exposure to cocaine,” Hurt said at her May lecture. Other researchers also couldn’t find any devastating effects from cocaine exposure in the womb.

LAST VISIT

Jaimee Drakewood came to her last visit at Children’s with her 16-month-old son KyMani in tow. It was the 31st time she had met with the researchers. “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 plans to stay in touch with study participants each year. They have started a new study that uses MRI and other tools 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?”

The team considers Jaimee and her mother, Karen, among their best success stories. Jaimee is heading into her senior year at Tuskegee University in Alabama and hopes to become a food inspector. She is home for the summer with her son and working as a lifeguard at a city pool.

After a few starts and stops, including a year in jail, Karen Drakewood is off drugs and works as a residential adviser at Gaudenzia House. Her older daughter just received a master’s degree at Drexel University; her son is a student at Florida Atlantic University.

Even in the worst moments, Karen Drakewood said she tried to show her kids “what their future could hold.” “If a child sees the light, they will follow it.” Jaimee Drakewood credits her big sister and 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,” Jaimee said.

Despite her family’s history, Jaimee believes she and her siblings are “destined to have accomplishments, to be greater than our parents.”