A patient of yours has a history of multiple substance abuses. She is now pregnant again and tells you that she has a little boy that is 2 years old who is slow in school and has difficulty concentrating. Which of the following substances has been associated with behavioral and developmental abnormalities in children?

Moderate consumption of coffee has not been associated with any fetal risks. Consumption of more than five cups of coffee a day has been shown to be associated with a slightly increased risk of spontaneous aboion in some studies. Cocaine use has been associated with an increased incidence of placental abruption and a constellation of congenital anomalies (skull defects, disruptions in urinary tract development, limb defects, and cardiac anomalies). Marijuana has not been associated with any adverse fetal effects. Tobacco use has been associated with a number of adverse pregnancy outcomes including spontaneous aboion, preterm labor, growth restriction, placental abruption, placenta pre, and attention deficit disorder and behavior and learning problems.