MATERNAL COCAINE ABUSE: LONG TERM EFFECTS ON INFANTS Nearly eight million Americans regularly use cocaine.  Although knowledge of cocaine's dangers grows daily, there is less information about the potential harmful effects of this "recreational drug" on the fetus exposed in-utero.  Preliminary work in animals and several reports in humans suggest that adverse effects on pregnancy and the fetus do occur.  The nurseries in our hospital admit approximately 100 newborns per year born to mothers who routinely use cocaine during their pregnancy.  We can therefore initiate a systematic large-scale investigation that will determine the effect of maternal cocaine use on pregnancy, the fetus, the newborn, and the growing child.  During an 18-month period 120 cocaine using mothers and their infants and 120 control mothers and their infants will be enrolled.  A detailed history of cocaine use, per trimester - route, type, and frequency will be obtained.  We will evaluate and compare the two groups to determine (1) incidence of adverse affects in pregnancy (stillborn, premature labor, premature separation of the placenta); (2) incidence of congenital malformations (each infant will be examined by a geneticist, and be evaluated by renal and cranial ultrasound); (3) incidence of abnormal respiratory patterns; (4) incidence of Sudden Infant Death Syndrome; and (5) incidence of abnormal growth and development.  Infants will be examined, and tested at least five times in a three-year follow-up period.  Data collection on maternal drug abuse, lifestyle and compliance with infants health care assessments will continue during this same time period.  Because numerous microbial agents can cause congenital malformations and abnormal growth and development, all infants from both groups will be screened for the presence of congenital infections, including exposure to the human immunodeficiency virus.  If the children of cocaine-using mothers are adversely affected by use of this drug, a major effort must be directed to transmit this information to cocaine users, especially those of childbearing age.