Cocaine in pregnancy: The effect of maternal administration of cocaine on the maternal and fetal pituitary-adrenal axes

Lack of Effect of Fetal Administration of Cocaine on Maternal and Fetal Plasma Adrenocorticotropin, Cortisol and Lactate Concentrations at 127–138 Days Gestational Age

“…Hypercapnia and the reduction in fetal pH following cocaine administra tion to the fetus has not been reported previously. Fetal administration of cocaine does not reduce uterine blood flow [7], so the reduction in fetal oxygenation is most likely a result of decreased umbilical blood flow. The fetal acidemia may have resulted from the cocaineinduced hypercapnia coupled with increased lactic-acid production.…”

“…We speculate that these effects of cocaine during pregnancy may reflect changes in umbilical blood flow and/or increased fetal skeletal muscle activity. Of particular importance is the demon stration that cocaine administration to the pregnant ewe has a greater effect on the fetal hypothalamo-pituitaryadrenal axis [7] than when it is administered directly to the fetus in much higher doses. Further studies of the effects of fetal administration of cocaine on umbilical blood flow and the effects of chronic administration of cocaine on the maternal and fetal endocrine systems in pregnancy are needed to identify and dissect direct effects of cocaine on the fetus from those mediated through maternal and placental mechanisms.…”

“…Since cocaine administration increases plasma catecholamines [3], aadrenergic mechanisms could stimulate vasopressin re lease centrally [4] which then acts to release adrenocorti cotropin (ACTH) from the pituitary. Cocaine can also stimulate ACTH release either directly [5] or via cortico tropin-releasing factor (CRH) [6], Maternal administra tion of cocaine stimulates the fetal pituitary-adrenal axis [7], Administration of cocaine to pregnant ewes de creases uterine blood flow resulting in fetal hypoxemia [8,9]; therefore, cocaine may stimulate the fetal pitu itary-adrenal axis secondarily to the induced fetal hypox emia [7], Since the ovine fetal hypothalamo-pituitaryadrenal axis is vital to the maturation of several fetal organ systems, such as the lung [10] and the hypothalamo-hypophysial-thyroid axis [ 11 ], we designed studies to identify the effects of direct fetal administration of co caine on this axis.…”

Lack of Effect of Fetal Administration of Cocaine on Maternal and Fetal Plasma Adrenocorticotropin, Cortisol and Lactate Concentrations at 127–138 Days Gestational Age

“…Cocaine blocks reuptake of catecholamines at nerve terminals ultimately raising the plasma catecholamine concentration [3], Since co caine administration increases plasma catecholamines [3], a-adrenergic mechanisms could stimulate vasopres sin release centrally [4] which then acts to release adre nocorticotropin (ACTH) from the pituitary. Cocaine can also stimulate ACTH release either directly [5] or via corticotropin-releasing factor (CRH) [6], We have dem onstrated that maternal administration of cocaine stim ulates the fetal pituitary-adrenal axis [7], Administration of cocaine to pregnant ewes decreases uterine blood flow resulting in fetal hypoxemia [8,9].…”

“…Therefore, the stimulation of the fetal pituitary-adre nal axis may be secondary to the induced fetal hypox emia [7] rather than a direct effect of the passage of cocaine across the placenta [3], Since the ovine fetal hypothalamo-pituitary-adrenal axis plays a vital role in the maturation of several fetal organ systems, such as the lung [10] and the hypothalamo-hypophysial-thyroid axis [11], we designed studies to identify the effects of direct fetal administration of cocaine on this axis.…”