To the Editor.—

Hoyme et al1 have described seven children from four states with congenital limb reduction defects associated with prenatal exposure to cocaine. I am concerned that digit and limb reduction following cocaine or methamphetamine exposure in utero may be much more common than the nine existing case reports1,2 indicate and that a Ross Laboratories patient education brochure is correct in stating, "cocaine can make a baby have missing fingers."3

We began recognizing cocaine-exposed infants in 1986.

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