increased prematurity rates. Increased contractility of the uterus may also be behind the increased likelihood of placental abruption (the placenta tearing away from the uterine wall), which some findings have linked with PCE. Diagnosis Cocaine use during pregnancy can be discovered by asking the mother, but sometimes women will not admit to having used drugs. Mothers may lie for fear of prosecution or having their children taken away, but even when they are willing to tell the truth, their memories may not be very accurate. Determining the purity of the drug they have taken also may not be possible. More reliable methods for detecting cocaine exposure involve testing the newborn's hair or meconium (the infant's earliest stool). Hair analysis, however, can give false positives for cocaine exposure, and a newborn may not have enough hair to test. The newborn's urine can be tested for cocaine and metabolites, but it must be collected as soon as possible after birth. It is not known how long after exposure the markers will still show up in a newborn's urine. The mother's urine can also be tested for drugs, but it cannot detect drugs used too far in the past or determine how much or how often the drugs were used. Tests cannot generally detect cocaine use over a week prior to sample collection. Mothers are more honest about cocaine use when their urine is also tested, but many users still deny it. Both maternal and neonatal urine tests can give false negatives. Effects and prognosis Studies have returned widely varying reports of the effects of PCE; some claim the physical disabilities are severe and generalized, others find specific effects, others none all. The timing of the dose of the drug is an important determinant of outcome, in addition to how much is used, for how long, and what kind of care is rendered after birth. Drug use in the first trimester is the most harmful to the fetus in terms of neurological and developmental outcome. The effects of PCE later in a child's life are poorly understood; little information is available about the effects of in utero cocaine exposure on children over the age of five. Some studies have found PCE-related differences in height and weight, while others have not; these differences are generally either small or are gone by the time children are of school age. Much is still not known about