The current study examines the effect of prenatal cocaine use on physical, cognitive, and behavioral development at birth, 1, 3, and 7 years, controlling for other factors that affect child development. Women who used cocaine during pregnancy were more likely to be single and to use alcohol, marijuana, and tobacco than were women who did not use cocaine. Prenatal cocaine use was associated with reduced gestational age, but not with birth weight, length, or head circumference. Neonatal neurobehavioral assessments were affected by prenatal cocaine exposure. Growth at 1 year was not affected by prenatal cocaine use. At 3 years, prenatal cocaine use was a significant predictor of head circumference and of the composite score on the Stanford-Binet Intelligence Scale (4th edition). Prenatal cocaine use was also associated with temperamental differences at 1 and 3 years and with behavior problems at 3 years. These findings represent a pattern of central nervous system effects, related to prenatal cocaine exposure, which is predicted by the teratologic model.