Temporal patterns of cocaine use in pregnancy. Perinatal outcome (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
Correlates Of Cocaine Use In Pregnancy
2015
Background: Cocaine is the third most commonly used illicit substance in pregnancy. Few studies exist to specifically look for correlates of cocaine use in pregnancy. Objective: To identify correlates of frequency of cocaine use in pregnancy Methods: We analyzed retrospective data from 50 postpartum women with a history of cocaine use or dependence who participated in a treatment trial for postpartum cocaine use. Study variables included severity of baseline cocaine use, age of onset of use, comorbid mental illness, poly-substance use, trauma and social support history. Data were analyzed using GLMM Negative Binomial Regression. Results: The strongest correlate of cocaine use in pregnancy was baseline cocaine use six months prior to pregnancy. Daily or greater cocaine use at baseline was associated with a 2.88 increase in the degree of cocaine use in pregnancy (SD=0.57, p <0.0001) on a scale of 0 to 8 measuring frequency of cocaine use. Weekly or greater cocaine use prior to pregnancy was associated with a 2.58 increase in degree of cocaine use (SD= 0.57, p<0.0001). Positive marijuana use in pregnancy was associated with a 1.24 increase in frequency of cocaine use (SD=0.24, p<0.0001). Older age at onset of cocaine use and higher social support scores were both significant, but weakly associated with increased cocaine use in pregnancy. Comorbid mental illness, alcohol use and trauma history were not statistically significant. Conclusions: This study identified several correlates of heavier cocaine use in pregnancy, and may help guide clinicians in improving screening and directing resources for education of pregnant, cocaine using women.
Infants of Mothers with Cocaine Use: Review of Clinical and Medico-Legal Aspects
Children
Illicit drug use is a global problem that also affects pregnant women. Substance use and alcohol abuse during pregnancy may have various harmful consequences for both mothers and foetuses. Intrauterine exposure to illicit substances can be investigated through maternal reports and toxicological tests on mothers’ and/or newborns’ samples. While the negative effects of alcohol and opioid use on pregnancy, the foetus, and/or newborn are well established, the effects of cocaine use remain controversial. We performed a review of the literature to evaluate the current state of knowledge of the effects of intrauterine cocaine exposure on newborns’ and children’s long-term development and to highlight possible implications for health professionals dealing with women who use cocaine during pregnancy. Although intrauterine cocaine exposure has been associated with reduced infant measurements, no specific amount of cocaine use exerting such effects has been determined, and no long-term effects...
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%).
American Journal of Obstetrics and Gynecology, 1990
Universal urine testing for cocaine, amphetamines, and opiates was performed on 1643 women admitted to an obstetric service for a 1-year period with 20.5% having positive results. There were 299 patients with positive toxicology results matched for race and discharge date with patients having negative toxicology and drug history. Significant differences in age, prior obstetric history, prenatal care, alcohol history, and smoking were noted between groups. There was a significant decrease in birth weight, head circumference, length, and gestational age for the drug-positive group, which was most marked in cocaine and multiple drug users. These differences persisted after we controlled for smoking, prenatal care, and prior preterm births. Differences in birth weight and head circumference remained after we controlled for gestational age. Rates of congenital anomalies and abruptio placental were similar between groups. Perinatal substance abuse is independently associated with growth retardation and prematurity. Multiple risk factors are frequently present, necessitating a comprehensive approach to prenatal care. (AM J OSSTET GVNECOL 1990;163:1535-42.)