Cocaine use represents a global public-health concern, and children's exposure to this substance is receiving growing attention. Despite the importance of this phenomenon, efforts to isolate cocaine-specific long-term effects are affected by the limited availability of human cohorts followed into adulthood and by the influence of environmental factors and co-exposures. Addressing ongoing debates in the literature, this systematic review synthesizes human evidence on long-term outcomes following prenatal cocaine exposure (PCE), from infancy to early adulthood. A comprehensive search of PubMed and Scopus from inception to August 2025 identified 26 eligible studies. Results suggest that across maturational stages, PCE is consistently associated with early developmental effects (including smaller head circumference and motor delays), deficits in visuospatial, language and executive functions, focal neuroimaging alterations (white-matter microstructure and task-related functional recruitment), growth deficits, and elevated externalizing behaviours. However, evidence is characterised by heterogeneity in exposure assessment, frequent prenatal polysubstance exposure, socioeconomic confounding, caregiving instability and small neuroimaging samples. Overall, this review suggests that PCE is linked to a broad spectrum of detrimental effects and that some biological vulnerabilities associated with PCE may persist. Nonetheless, supportive postnatal environments may mitigate developmental disadvantages and promote better trajectories for affected children. These findings underscore the need for integrated public-health and clinical strategies that combine prevention of prenatal substance use with family-focused postnatal supports.