Fetal cocaine exposure

The prevalence rate of cocaine use during pregnancy is 10-45% in some centers in North America. As cocaine use is increasing and widespread, information on the possible adverse effects secondary to fetal cocaine exposure continues to amass in case reports and studies. 

Behnke M, Eyler FD, Garvan CW, Wobie K. The search for congenital malformations in newborns with fetal cocaine exposure. Pediatrics 2001 107(5) E74. 

Parton, L., Baumgartner, W. A., and Hill, V., Quantitation of fetal cocaine exposure by radioimmunoassay of hair, Pediatr. Res., 21,1987, A372. 

Since 1987, and the first report of fetal cocaine exposure by Parton etal., ° 10 papers have presented data on gestational exposure revealed by hair analysis. The most important results " ° are presented in Table 2. All the reports have clearly demonstrated that the hair analysis technique is better able to detect previous drug use than is the standard urinalysis. However, hair analysis cannot completely replace urine testing, since drug use occurring only in the recent few days would not be detectable by hair analysis, yet would be detectable through urinalysis. 

Ostrea, E. M., Brady, M., Cause, S., Ra)unundo, A. L., and Stevens, M., Drug screening in newborns by mecoiuum analysis a large-scale, prospective, epidemiologic study,. Pediatrics, 89,107, 1992. Parton, L., Warburton, D., HiU, V., and Baumgartner, W., Quantification of fetal cocaine exposure by radioimmunoassay of hair, Pediatr. Res., 372A, 1987. 

Simone, C., Derewlany, L.O., Oskamp, M., Johnson, D., Knie, B., Keren, G. (1994). Acetylcholinesterase and hutyr-ylcholinesterase activity in the human term placenta implications for fetal cocaine exposure. J. Lab. Clin. Med. 123 400-6. 

Cocaine exposure in utero can affect various fetal organs. Gastrointestinal disorders, including ten cases of necrotizing enterocolitis (291), one of intestinal atresia, and one of spontaneous colonic perforation, have been reported (292). 

Jones KL. Developmental pathogenesis of defects associated with prenatal cocaine exposure fetal vascular disruption. Clin Perinatol 1991 18(l) 139-46. 

Slotkin TA. Fetal nicotine or cocaine exposure Which one is worse J Pharmacol Exp 77 erl998 285(3) 931—45. 

Peters, A.J., Abrams, R.M., Burchfield, D.J., and Gilmore, R.L. 1992. Seizures in a fetal lamb after cocaine exposure a case report. Epilepsia 33 1001-1004. 

The impact of prenatal exposure to cocaine on fetal growth and fetal head circumference has been studied in 476 African-American neonates, including 253 full-term infants prenatally exposed to cocaine (with or without alcohol, tobacco, or marijuana) and 223 non-cocaine exposed infants (147 drug-free, 76 exposed to alcohol, tobacco, or marijuana) (300). The cocaine-associated deficit in fetal growth was 0.63 standard deviations and for gestational age 0.33 standard deviations. There were also cocaine-associated deficits in birth weight and length, but no evidence of a disproportionate effect on head circumference. 

Fetal microcephaly has been attributed to cocaine abuse during pregnancy (323). Urine toxicology confirmed the presence of morphine, benzoylecgonine, barbiturates, paracetamol, and propoxyphene. Analyses of amniotic fluid, placenta, and fetal serum and urine were also positive for these substances. The authors suggested that vascular disruption was the likely major mechanism of anomalies, both behavioral and malformative, due to prolonged exposure to cocaine in utero. 

Nair P, Rothblum BA, Hebei R. Neonatal outcome in infants with evidence of fetal exposure to opiates, cocaine and cannabinoids. Clin Pediatr 1994 33 280-5. 

Since speech and language acquisition develop relatively late in children, separating prenatal and postnatal effects on their development is often impossible. Known factors include the general social effects of poverty combined with fetal alcohol spectrum disorder, producing deficits in children in language performance.28 Other factors common in a poverty environment and known to affect language performance are prenatal exposure to cocaine and tobacco.29... 

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