Temporal Patterns of Cocaine Use in Pregnancy Perinatal Outcome

Chasnoff, Ira J.; Grifith, D. R.; MacGregor, Scott N.; Dirkes, Kathryn; Burns, Kayreen A.

doi:10.1097/00132582-198910000-00017

Cited by 27 publications

(40 citation statements)

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“…23,24 Rates of preterm labor, intrauterine growth retardation and neonatal morbidity are significantly reduced for cocaine-using women, who are identified early in pregnancy and cease use by third trimester. 25 A study of 6774 pregnant women receiving prenatal care through Kaiser Permanente Managed Care Plan demonstrated that pregnant women, who screened positive for alcohol and other drug use and received even a single brief intervention had a reduced rate of low birth weight infants, preterm infants and infants who required ventilation. 26 Identification of the lighter drinker takes on added importance in that research into the effects of alcohol as a teratogen have revealed that even low doses of alcohol may have serious long-term consequences for children.…”

Section: Discussionmentioning

confidence: 99%

Validation of the 4P's Plus© screen for substance use in pregnancy validation of the 4P's Plus

et al. 2007

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Objective: The purpose of this study is to validate the 4P's Plus screen for substance use in pregnancy.Study Design: A total of 228 pregnant women enrolled in prenatal care underwent screening with the 4P's Plus and received a follow-up clinical assessment for substance use. Statistical analyses regarding reliability, sensitivity, specificity, and positive and negative predictive validity of the 4Ps Plus were conducted.Result: The overall reliability for the five-item measure was 0.62. Seventy-four (32.5%) of the women had a positive screen. Sensitivity and specificity were very good, at 87 and 76%, respectively. Positive predictive validity was low (36%), but negative predictive validity was quite high (97%). Of the 31 women who had a positive clinical assessment, 45% were using less than 1 day per week. Conclusion:The 4P's Plus reliably and effectively screens pregnant women for risk of substance use, including those women typically missed by other perinatal screening methodologies.

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Section: Discussionmentioning

confidence: 99%

Validation of the 4P's Plus© screen for substance use in pregnancy validation of the 4P's Plus

et al. 2007

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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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“…These characteristics include absent, late, or inadequate prenatal care; a previously documented or admitted history of drug abuse; a previous unexplained late fetal demise; precipitous labor; abruptio placentae; hypertensive episodes; severe mood swings; cerebrovascular accidents; myocardial infarction; and repeated spontaneous abortions. 80,[83][84][85][86][87][88] The legal implications of testing and the need for consent from the mother may vary among the states. 89 Each hospital should consider adopting a policy for maternal and newborn screening to avoid discriminatory practices and to comply with local laws.…”

Section: Differential Diagnosismentioning

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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Temporal Patterns of Cocaine Use in Pregnancy Perinatal Outcome

Abstract: Seventy-five cocaine-using women enrolled in a comprehensive perinatal care program were divided into two groups: those who used cocaine in only the first trimester of pregnancy (group

Cited by 27 publications

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Validation of the 4P's Plus© screen for substance use in pregnancy validation of the 4P's Plus

Validation of the 4P's Plus© screen for substance use in pregnancy validation of the 4P's Plus

The Search for Congenital Malformations in Newborns With Fetal Cocaine Exposure

Neonatal Drug Withdrawal

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