Cocaine Use in Pregnancy

Abstract

With the increasing use of cocaine in the United States, there has been growing concern regarding its effects on the fetuses and neonates of pregnant cocaine abusers. Twenty-three cocaine-using women enrolled in a comprehensive perinatal-addiction program were divided into two groups: those using cocaine only and those using cocaine plus narcotics. These two groups were compared with a group of women who had used narcotics in the past and were maintained on methadone during pregnancy, and with a group of drug-free women. All four groups were similar in maternal age, socioeconomic status, number of pregnancies, and cigarette, marijuana, and alcohol use. Their medical histories indicated that the cocaine-using women had a significantly higher rate of spontaneous abortion than the women in the other two groups. In the pregnancies under study, four cocaine-using women had onset of labor with abruptio placentae immediately after intravenous self-injection of cocaine. Neonatal gestational age, birth weight, length, and head circumference were not affected by cocaine use. However, the Brazelton Neonatal Behavioral Assessment Scale revealed that infants exposed to cocaine had significant depression of interactive behavior and a poor organizational response to environmental stimuli (state organization). These preliminary observations suggest that cocaine influences the outcome of pregnancy as well as the neurologic behavior of the newborn, but a full assessment will require a larger number of pregnancies and longer follow-up.

Substance misuse in early pregnancy and relationship to fetal outcome

“…Cocaine use has been linked to an increased incidence of spontaneous abortion, renal and limb abnormalities, prematurity and low birth weight [15,17,23]. Behavioural abnormalities in infants exposed to cocaine in-utero have also been described [4]. Intra-uterine growth retardation, craniofacial abnormalities and developmental delay are features of the fetal alcohol syndrome [13,14,22].…”

Issues in prenatal cocaine use research: Problems in identifying users and choosing an appropriate comparison group

“…Although few, if any, of the available studies have thoroughly matched or controlled for confounding variables, several have chosen women from the same obstetrical population as the drug users to reflect a background with similar prenatal risk factors (e.g., socioeconomic status, maternal age, and parity; Bingo1 et al, 1987;Chasnoff, Burns, Schnoll, & Burns, 1985;Chasnoff, Griffith, MacGregor, Dirkes, & Burns, 1989;MacGregor et al, 1987;Matera, Warren, Moomjy, Fink, & Fox, 1990). These studies all reflect a poorer pregnancy outcome for the cocaine-using pregnant woman.…”

“…Commonly used secondary drugs include nicotine, alcohol, marijuana, and opiates (Frank et al, 1988;. Several problems exist in the studies reported to date: (1) studies have not taken into account other drug use (Chouteau et al, 1988); (2) secondary drug use was identified but not taken into account in data analysis (Dombrowski et al, 1991;Handler, Kistin, Davis, & F e d , 1991;MacGregor et al, 1987;Spence et al, 1991); and (3) comparison groups were chosen with similar secondary drug use patterns but sample size prohibited using appropriate statistical analyses to determine the impact of multiple drugs on outcome (Bingol et al, 1987;Chasnoff et al, 1985). Only a few studies have taken secondary drug use patterns into account in their analyses of outcome (Frank et al, 1990;McCalla et al, 1991;Zuckerman et al, 1989).…”

Punishing Drug Addicts Who Have Babies: Women of Color, Equality, and the Right of Privacy

“…L. REv. 1011, ro67 n. 196 (1989). Coiker recognizes that the "physician's actions reflect the dominant sociai message -that a healthy (white) woman should wan t to bear a child ' ' I d .…”