Perinatal cerebral infarction and maternal cocaine use

Chasnoff, Ira J.; Bussey, Mary E.; Savich, Renate; Stack, Cynthia V.

doi:10.1016/s0022-3476(86)80896-4

Cited by 351 publications

(61 citation statements)

References 12 publications

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“…40 -42 Other studies in both species, however, have indicated that prenatal cocaine exposure may be teratogenic in a dose-dependent manner, resulting in abnormalities of the limbs, [43][44][45] cardiovascular, 43,46 genitourinary, 43,44,47,48 and central nervous systems. 43,44,46,47,49 Some human reports have likewise noted anomalies of the genitourinary 3,10,11,13,20,21 and cardiovascular systems, 1,8,14 -16 skull defects, 14 limb defects and intestinal atresias, 6,13,20,21,50 and a variety of central nervous system lesions 4,5,7,9,13,[51][52][53][54][55][56] in infants exposed to cocaine in utero. Two additional studies report mild facial abnormalities in exposed infants.…”

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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“…Cocaine may also indirectly affect cognitive and motor functions through several other mechanisms, including vascular disruption leading to uterine hypoxia (Wood, Plessinger, & Clark, 1989), nutritional deficits associated with fetal growth retardation (Frank et al, 1990;Hadeed & Siegal, 1989;Lester et al, 1991;Singer, Arendt, Song, Warshawsky, & Kliegman, 1994;Zuckerman et al, 1989), and an increased incidence of subtle brain lesions (Chasnoff, Bussey, Savic, & Stack, 1986;Frank, McCarten, Cabral, Levinson, & Zuckerman, 1994;.…”

Section: Discussionmentioning

confidence: 99%

Relationship of prenatal cocaine exposure and maternal postpartum psychological distress to child developmental outcome

et al. 1997

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Maternal cocaine use during pregnancy can affect the infant directly through toxic effects or indirectly through cocaine's influence on maternal psychological status. We followed 160 cocaine exposed and 56 nonexposed infants and their mothers identified at birth through interview and/or urine screen. Although cocaine exposure defined the groups, infant exposure to alcohol, marijuana, and tobacco was allowed to vary. Infants were 99% African American and poor. All mothers completed the Brief Symptom Inventory (BSI) and infants were given the Bayley Scales of Mental (MDI) and Motor (PDI) Development at a mean corrected age of 17 ± 8 months. Both MDIs (94 ± 17 vs. 103 ± 16) and PDIs (101 ± 16 vs. 108 ± 12) were lower for cocaine exposed infants. Psychological distress was greater in cocaine using mothers. Hierarchical multiple regression was used to assess the relative effects of gestational age, maternal psychological distress, and cocaine and polydrug exposure on infant outcomes. Both psychological distress and cocaine and alcohol exposure predicted lower MDIs after controlling for prematurity. Neither psychological distress nor alcohol exposure predicted motor outcome, while cocaine had a significant effect. Tobacco and marijuana exposure were unrelated to outcome. These findings provide further support for direct effects of cocaine and alcohol on infant development, as well as highlight the need for studies to document maternal psychological factors, which may increase child risk for poorer outcomes.

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“…Because cocaine or its metabolites may be detected in neonatal urine DET, diethyltryptamine; DMT, dimethyltryptamine; LSD, lysergic acid diethylamide; MDA, methylenedioxyamphetamine; MDEA, 3,4-methylenedioxyethamphetamine; MDMA, 3,4-methylenedioxymethamphetamine (ecstasy); and MMDA, 3-methoxy-4,5-methylenedioxyamphetamine. a Adapted from Milhorn. for as long as 7 days after delivery, 18 observed abnormalities in exposed infants may reflect drug effect rather than withdrawal. In an unmasked study, 6%, 14%, and 35% of infants exposed to cocaine only, heroin only, or cocaine plus heroin, respectively, qualified for treatment on the basis of scoring.…”

Section: Cocaine and Other Stimulantsmentioning

confidence: 95%

“…Neurobehavioral abnormalities 16,17 frequently occur in neonates with intrauterine cocaine exposure, most frequently on the second or third postnatal days. 18 These abnormalities may include irritability, hyperactivity, tremors, highpitched cry, and excessive sucking. Because cocaine or its metabolites may be detected in neonatal urine DET, diethyltryptamine; DMT, dimethyltryptamine; LSD, lysergic acid diethylamide; MDA, methylenedioxyamphetamine; MDEA, 3,4-methylenedioxyethamphetamine; MDMA, 3,4-methylenedioxymethamphetamine (ecstasy); and MMDA, 3-methoxy-4,5-methylenedioxyamphetamine.…”

Section: Cocaine and Other Stimulantsmentioning

confidence: 99%

Neonatal Drug Withdrawal

Hudak¹,

Tan²,

Frattarelli³

et al. 2012

Pediatrics

758

608

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Maternal use of certain drugs during pregnancy can result in transient neonatal signs consistent with withdrawal or acute toxicity or cause sustained signs consistent with a lasting drug effect. In addition, hospitalized infants who are treated with opioids or benzodiazepines to provide analgesia or sedation may be at risk for manifesting signs of withdrawal. This statement updates information about the clinical presentation of infants exposed to intrauterine drugs and the therapeutic options for treatment of withdrawal and is expanded to include evidence-based approaches to the management of the hospitalized infant who requires weaning from analgesics or sedatives.

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Perinatal cerebral infarction and maternal cocaine use

Cited by 351 publications

References 12 publications

The Search for Congenital Malformations in Newborns With Fetal Cocaine Exposure

The Search for Congenital Malformations in Newborns With Fetal Cocaine Exposure

Relationship of prenatal cocaine exposure and maternal postpartum psychological distress to child developmental outcome

Neonatal Drug Withdrawal

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