Maternal cocaine use during pregnancy can affect the infant directly through toxic effects orindirectly through cocaine's influence on maternal psychological status. We followed 160cocaine exposed and 56 nonexposed infants and their mothers identified at birth throughinterview and/or urine screen. Although cocaine exposure defined the groups, infantexposure to alcohol, marijuana, and tobacco was allowed to vary. Infants were 99% AfricanAmerican and poor. All mothers completed the Brief Symptom Inventory (BSI) and infants weregiven the Bayley Scales of Mental (MDI) and Motor (PDI) Development at a mean corrected ageof 17 ± 8 months. Both MDIs (94 ± 17 vs. 103 ± 16) and PDIs (101± 16 vs. 108 ± 12) were lower for cocaine exposed infants. Psychologicaldistress was greater in cocaine using mothers. Hierarchical multiple regression was used to assessthe relative effects of gestational age, maternal psychological distress, and cocaine and polydrugexposure on infant outcomes. Both psychological distress and cocaine and alcohol exposurepredicted lower MDIs after controlling for prematurity. Neither psychological distress noralcohol exposure predicted motor outcome, while cocaine had a significant effect. Tobacco andmarijuana exposure were unrelated to outcome. These findings provide further support for directeffects of cocaine and alcohol on infant development, as well as highlight the need for studies todocument maternal psychological factors, which may increase child risk for pooreroutcomes.