Infants of Mothers with Cocaine Use: Review of Clinical and Medico-Legal Aspects (original) (raw)
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Cocaine use during pregnancy: prevalence and correlates
Pediatrics, 1989
Cocaine use during pregnancy was assessed by interviews and urine assays obtained prenatally and immediately postpartum from 679 urban women enrolled in prenatal care. Of these, 17% were found to have used cocaine at least once during pregnancy. Eight percent had urine assays positive for cocaine metabolites using the enzyme-mediated immunoassay technique with a cutoff of 300 ng/mL of benzoylecgonine. Of the cocaine users, 24% denied use at the time of the interview and were identified solely by urine assay. Cocaine users were significantly (P < .01) less likely than nonusers to be married, Hispanic, or black born outside of the United States and were less well nourished. Users reported significantly (P < .01) more sexually transmitted diseases, prior low birth weight infants, spontaneous and elective abortions, and greater use of alcohol, cigarettes, marijuana, opiates, and other illicit drugs during pregnancy. Because cocaine use is correlated with many potential risk factors, large sample sizes and multivariate statistical techniques are needed to determine whether cocaine use during pregnancy poses an independent risk for adverse neonatal outcomes. [cocaine, pregnancy, marijuana, prenatal care.] TEXT: Cocaine use has increased dramatically during the past decade among many segments of the population of the United States, including women of childbearing age. [n1] Concerns have arisen regarding potentially adverse effects of its use during pregnancy on the fetus and neonate. [n2,n3] Published scientific reports of infants exposed to cocaine in utero describe a variety of adverse effects including disordered neurobehavioral function, depressed birth weight, shorter length, smaller head circumference, and higher rates of congenital malformations. [n3-n6] Rare, but catastrophic reproductive outcomes, such as perinatal cerebral infarction associated with maternal cocaine use, have also been described. [n6,n7] In addition, several investigators have linked women's cocaine use to an increased risk of spontaneous abortion and of stillbirth associated with abruptio placenta. [n3,n5,n6,n8] These observations are consistent with animal data that demonstrate that cocaine increases maternal blood pressure and decreases uterine blood flow. [n9] These studies have been important in suggesting that maternal cocaine use during pregnancy may pose a risk to the fetus. This conclusion warrants cautious evaluation before serving as a basis for public health and clinical efforts, however. There are two major methodologic issues: sample selection and identification of potentially confounding variables. Prevalence and patterns of cocaine use during pregnancy have never been ascertained for a sample of women seeking routine prenatal care. In previous studies, highly select samples have been used. One investigator identified cocaine users on the basis of prenatal referral to a drug treatment program, [n3] whereas others selected cases following
Review of Clinical Pharmacology and Pharmacokinetics, International Edition
S u m m a r y: Subject of this literature review is the impact of cocaine abuse during pregnancy and its long-term consequences on the fetus. Prenatal exposure to cocaine is associated with withdrawal symptoms in the neonate. Numerous studies have reported an increased risk of cardiac anomalies such as ventricular septal defect, auricular septal defect, heart block, cardiomegaly, hypoplastic right or left side of the heart, absent of ventricle, coarctation of aorta, peripheral pulmonic stenosis, patent ductus arteriosus, aortic dissection and aortic valve prolapse and in addition, maternal cocaine abuse is associated with thickening of the interlobular arterial wall of the fetal kidney and narrowing of the lumen and genitourinary anomalies, neurobehavioral and developmental deficits in infants exposed to cocaine in utero. In humans the most common consequences of cocaine abuse during pregnancy include premature birth, lower birth weight, respiratory distress, bowel infarctions, cerebral infarctions, reduced head circumference, intrauterine developmental retardation, delayed development of fetal nervous system, increased risk for congenital cardiac defects, defects of urogenital tract, . Send reprint requests to: Anna Deltsidou, Kifisias 51, 115 23, Athens, Greece decreased fetal urine output and bladder cycle, and increased risk of seizures.
Cocaine and the use of alcohol and other drugs during pregnancy
American Journal of Obstetrics and Gynecology, 1991
Recent reports of adverse pregnancy outcomes associated with prenatal cocaine exposure have raised questions about the actual numbers of infants who are exposed to cocaine in utero. Whereas toxicologic urine screens obtained at delivery can detect cocaine use in the preceding few days, they fail to yield a comprehensive picture of use during and immediately before pregnancy. According to postpartum self-report, 15% of a teaching hospital sample and 3% of a private hospital sample of mothers had used cocaine during pregnancy or in the previous month (total = 876). Rates at the teaching hospital reflect a fifteenfold increase over the past 12-year period, when compared with previously obtained data. Cocaine users were significantly more likely to report that they drank alcohol, smoked cigarettes, and took other illicit drugs during pregnancy than women who denied using cocaine. Mothers at highest risk for cocaine use were those who were black (20%), were single-separated-divorced (24% to 33%), and had less than a high school education (21%).
Newborn outcomes exposure to crack cocaine during pregnancy: a critical review
Brazilian Journal of Development, 2020
Crack cocaine is a psychotropic and neurotoxic drug with high prevalence of consumption, considerate a public health problem and identified as risk factors to human health. Crack cocaine use among women in reproductive age increased in few year and the literature of the neonatal exposure to this substance during pregnancy are limited. Thus, this critical review discusses the major newborn outcomes reported in original studies, highlighting neurologic abnormalities and malformations outcomes. Sixteen studies were included in this review. The main physiological outcome found in newborn exposure to crack cocaine during gestation were lower birth weight; preterm birth; growth restricted infants; lower 5-minute Apgar scores; small for gestational age; and, small head circumference and congenital malformations. There were several negative neurologic and outcomes were reported on the literature. Moreover, there were still no consensus and the main criticism in this area is the limited studies available.
Cocaine effects on fetal development: A comparison of clinical and animal research findings
Neurotoxicology and Teratology, 1991
DOW-EDWARDS, D. L. Cocaine effects on fetal development: A comparison of clinical and animal research findings. NEURO-TOXICOL TERATOL 13(3) 347-352, 1991.-The clinical and animal literature describing the effects of cocaine use during pregnancy is reviewed. The difficulties associated with studying populations using illicit drugs during pregnancy and the multiple risk factors present in cocaine-using pregnant women limit the strength of the drug-associated effects. Nevertheless, cocaine use during pregnancy is associated with a significant number of obstetrical complications, small for gestational age infants and neurobehavioral abnormalities. In animal studies, only the neurobehavioral abnormalities could be demonstrated following the administration of nontoxic doses of cocaine. Furthermore, animal studies indicate that neurochemical changes, including those identified in the neuroendocrine axis, persist into adulthood. Pregnancy Drug abuse Cocaine Congenital malformations Fetal growth Fetal development Neurobehavioral effects
Early Human Development, 1992
As cocaine use during pregnancy has become increasingly recognized, there also has been increased concern about the toxic and teratogenic properties of cocaine on the fetus. A significant literature exists describing the adverse fetal and neonatal outcomes associated with in utero cocaine exposure. However, specific causality by cocaine on outcome in the human is difficult to ascertain because of multiple confounding variables associated with substance abuse including social factors and polydrug use as well as diff%zulty in confirming timing, dose and frequency of cocaine exposure. Most literature suggests that prenatal cocaine exposure is associated with developmental risk to the fetus. What is currently unknown is the extent of risk, the additive and/or synergistic factors contributing to cocaine's toxicity and the reversibility of the injury. In this paper we review the pharmacologic properties of cocaine as related to a model of mechanisms for developmental injury secondary to cocaine exposure and the published literature on the adverse fetal and neonatal outcomes associated with cocaine use during pregnancy. Specific attention has been focused on the structural, neurobehavioral and respiratory control teratogenesis.