Overall, these volumetric T1-weighted MR studies suggest that prenatal cocaine exposure is associated with long-term morphological CNS changes, and that these may correlate with functional outcomes. For example, both caudate and putamen receive dense dopaminergic innervation, and changes in their morphology may underlie difficulties in attention that some children with prenatal cocaine exposure experience. Likewise, alterations in the thalamus have been hypothesized to underlie subtle learning difficulties that children with prenatal cocaine exposure may encounter36. Finally, as the Rivkin paper describes, demonstrated changes in cortical gray matter may be due to the presence of poly-substance confounds and not consequent to prenatal cocaine exposure alone.
