Cardiovascular Effects of Cocaine in Neonates Exposed Prenatally

Tuboku‐Metzger, A.; O'shea, J. P.; Campbell, Robert E.; Hulse, J A; Bugg, George; Jones, David E.

doi:10.1055/s-2007-994192

Cited by 10 publications

(4 citation statements)

References 16 publications

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“…2,12 However, within the reported literature no consistent pattern of congenital anomalies has been observed and no increased incidence of malformations substantiated. [17][18][19][22][23][24][25][26][27][28][57][58][59][60] The reasons for these divergent findings in the human literature could be related to a variety of methodologic issues. For example, there is the problem of separating cocaine effect from the confounding effects of such things as other drug exposures, infectious diseases, and nutritional differences, all of which have known fetal effects.…”

Section: Discussionmentioning

confidence: 99%

The Search for Congenital Malformations in Newborns With Fetal Cocaine Exposure

et al. 2001

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ABSTRACT. Context. The association between prenatal cocaine exposure and congenital anomalies is not definitive.Objective. To determine whether prenatal cocaine exposure results in an increased number or identifiable pattern of abnormalities.Design. A prospective, longitudinal cohort enrolled between 1991 and 1993.Setting. Rural public health population delivering at a regional tertiary medical center.Patients. Two hundred seventy-two offspring of 154 prenatally identified crack/cocaine users and 154 nonusing controls were matched on race, parity, location of prenatal care (that related to level of pregnancy risk), and socioeconomic status. Drug use was determined through repeated in-depth histories and urine screens. Infants not examined within 7 days of birth were excluded.Outcome Measures. Assessments were made by experienced examiners masked to maternal drug history. Included were 16 anthropometric measurements and a checklist of 180 physical features defined and agreed upon in advance.Results. There were no differences on major risk variables between the included and excluded infants. There were significantly more premature infants in the cocaineexposed group. Cocaine-exposed infants were significantly smaller in birth weight, length, and head circumference but did not differ on remaining anthropometric measurements. There was no difference in type or number of abnormalities identified between the exposed and nonexposed groups. There was no relationship between amount or timing of exposure and any of the outcomes.Conclusions. This prospective, large-scale, blinded, systematic evaluation for congenital anomalies in prenatally cocaine-exposed children did not identify an increased number or consistent pattern of abnormalities. A search for congenital malformations related to prenatal cocaine exposure has been underway since physicians became aware of the epidemic of prenatal use in the mid-1980s. Concern has been aroused because of a variety of case reports, small patient series, and retrospective studies reporting abnormalities of the skull, heart, skeleton, gastrointestinal tract, and genitourinary tract in infants born to women who used cocaine during pregnancy. [1][2][3][4][5][6][7][8][9][10][11][12][13] Over the years, the results of prospective studies have yielded somewhat conflicting outcomes. 14 -28 Methodologic concerns in many of these studies have precluded widespread acceptance of their findings, either positive or negative, leaving unanswered the question regarding the association between prenatal cocaine exposure and congenital anomalies.The most commonly identified mechanism of the effects of prenatal exposure involves the vasoconstrictive properties of cocaine. The proper growth and development of the fetus depend on a wellfunctioning vascular system. Vasoconstriction resulting in disruption of blood flow to the fetus could result in the development of structural abnormalities throughout gestation. 29,30 The purpose of this study was to determine whether prenatal cocaine exposure was associat...

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Section: Discussionmentioning

confidence: 99%

The Search for Congenital Malformations in Newborns With Fetal Cocaine Exposure

et al. 2001

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“…However, in a blinded cross-sectional study to determine whether chronic cocaine exposure in utero produces abnormalities in left ventricular function showed no significant differences in left ventricular shortening fraction, heart rate, rhythm, and conduction in term neonates with or without prenatal cocaine exposure [Tuboku-Metzger et al 1996]. Additionally, Mehta et al [2002c] have reported that prenatal cocaine exposure results in changes in diastolic filling in neonates (under 48 hours old) with the degree of change observed being correlated to degree of fetal cocaine exposure.…”

Section: Human Studiesmentioning

confidence: 99%

“…Prenatal cocaine exposure has been found to have significant clinical effects including increasing the rate of arrhythmias in the neonate [Frassica et al 1994;Lipshultz et al 1991], decreasing cardiac output [Van de Bor et al 1990], increasing the risk of heterotaxy heart disease [Kueh and Loffredo, 2002], and an increased risk of transient ST segment elevation, which was consistent with transient myocardial ischemia [Mehta et al 1993]. However, in a blinded cross-sectional study to determine whether chronic cocaine exposure in utero produces abnormalities in left ventricular function showed no significant differences in left ventricular shortening fraction, heart rate, rhythm, and conduction in term neonates with or without prenatal cocaine exposure [Tuboku-Metzger et al 1996]. Additionally, Mehta et al [2002c] have reported that prenatal cocaine exposure results in changes in diastolic filling in neonates (under 48 hours old) with the degree of change observed being correlated to degree of fetal cocaine exposure.…”

Section: Introductionmentioning

confidence: 99%

Short- and long-term adverse effects of cocaine abuse during pregnancy on the heart development

Meyer

Zhang

2009

Therapeutic Advances in Cardiovascular Disease

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The effect of cocaine on the developing fetus is a topic of considerable interest and debate. One of the potential effects of fetal cocaine exposure is damage to the developing heart. This review provides an overview of the current understanding of the short- and long-term effects of fetal cocaine exposure on the heart in both humans and animal models. Human studies are still preliminary but have suggested that fetal cocaine exposure impacts on the developing heart. Studies in animal models provide strong evidence for a programming effect resulting in detrimental long-term changes to the heart induced by fetal cocaine exposure. In the rat model, fetal cocaine results in apoptosis in the term heart, left ventricular remodeling and myocyte hypertrophy, as well as increased sensitivity to ischemia/reperfusion injury in the adult male offspring. The rat model has also shown evidence of epigenetic modifications in response to intrauterine cocaine. Increased DNA methylation of promoter regions leads to a long-term decrease in the expression of the cardioprotective gene, PKCε. The current data shows fetal cocaine exposure has significant immediate and long-term cardiac consequences in animal models and while human studies are still incomplete they suggest this phenomenon may also be significant in humans exposed to cocaine during development.

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“…Echocardiography of infants born to women following cocaine exposure and comparison infants (total of 87 infants evaluated) has not demonstrated any difference in the shortening fraction of the left ventricle or abnormalities in cardiac rhythm. 30 Prenatal exposure to cigarettes has been associated with elevated BP at birth and at 12 months of age. 31 We did not find any association with either cocaine, opiate, marijuana, tobacco, or alcohol use during pregnancy and hypertension at 6 years of age.…”

Section: Commentmentioning

confidence: 99%