Estimates suggest that about 5 percent of pregnant women use one or more addictive substances, 25 and there are around , cocaine-exposed pregnancies every year. Cocaine use during pregnancy is associated with maternal migraines and seizures, premature membrane rupture, and separation of the placental lining from the uterus prior to delivery.
It is difficult to estimate the full extent of the consequences of maternal drug use and to determine the specific hazard of a particular drug to the unborn child. This is because multiple factors—such as the amount and number of all drugs used, including nicotine or alcohol; extent of prenatal care; exposure to violence in the environment; socioeconomic conditions; maternal nutrition; other health conditions; and exposure to sexually transmitted diseases—can all interact to influence maternal and child outcomes.
Babies born to mothers who use cocaine during pregnancy are often prematurely delivered, have low birth weights and smaller head circumferences, and are shorter in length than babies born to mothers who do not use cocaine. This paper reviews the literature on maternal cocaine use and subsequent child medical and psychological health, focusing on the following general areas: a pharmacologic and medical effects of cocaine; b epidemiologic studies; c behavioral and developmental outcome of cocaine-exposed infants; d research methodology; and e clinical interventions.
In terms of fetal effects, animal studies indicate that cocaine readily crosses the placenta and enters the fetal circulation. This reduction in the supply of oxygen to the fetus has implications for later neurological and cognitive-behavioral development. These cocaine-initiated events may cause premature birth and birth asphyxia. Down-regulation of neurotransmitter receptors may result in defective synaptic development. Cerebral hypoxia, as noted above, can relate to deficits in development.
Vascular disruption prenatally has been related in some cocaine studies to malformations in offspring. Fetal malnutrition, mediated by prematurity or maternal malnutrition, may result in growth retardation or microcephaly.
Specific areas of the fetal brain may be affected by cocaine exposure, instigating alterations in cerebral activity or structure that negatively affect development. Brain growth appears to be similarly affected as determined by small head circumferences. In fact, the most compelling finding to date of the adverse effect of fetal cocaine exposure on infant development is that of intrauterine growth retardation.
Most available studies of the development of cocaine-exposed infants have focused on full-term infants. As prematurity and low birth weight appear to be obstetric effects of maternal cocaine use, the follow-up of only full-term cohorts may be misleading and overly optimistic by eliminating the most affected infants.
The developmental risks of prematurity may be exacerbated in cocaine-exposed preterms, or alternatively, may be reduced because of lowered fetal exposure. These neurological abnormalities may be factors affecting the early developmental problems seen in follow-up studies and have implications for long-term academic and learning disabilities. Thus, in utero cocaine exposure has been related to a variety of significant medical and neurologic risks for the infant. The most commonly used method of detection of cocaine use in pregnant women in studies to date has been urine screening at delivery.
Thus, studies relying on urine screening alone are likely to underidentify maternal cocaine use; as are studies dependent on only self-report and clinical interview Zuckerman, Frank, et al. Although not yet well validated, meconium assays, which can potentially identify maternal cocaine use throughout the entire gestation period, are likely to replace urine assays in research programs due to their advantages. However, hair analysis remains a controversial method, requiring further study and validation.
Racial and social class differences have been noted as to preferred drugs assessed through anonymous urine toxicology screens. The few available studies suggest that cocaine use is more prevalent among poor minority women and that marijuana use predominates among white, middle-class patients Chasnoff et al. The social and legal consequences of detecting drug use during pregnancy may be racially biased. Multiple associated social and health risks detrimental to fetal and infant development have been uniformly documented in all studies examining the characteristics of cocaine-using pregnant women.
Cocaine-use during pregnancy is associated with heavy and chronic use of additional legal and illegal drugs. Marijuana, alcohol, and cigarette use are increased at almost three times the rate found in non-cocaine-using samples from similar racial and social class groups Frank et al. These confounding drugs may also adversely effect the outcome of the pregnancy or the neurobehavioral development of the infant. Cocaine-using women weigh less at the birth of their infant, and may gain less weight during their pregnancies, suggesting that anorexia and poor maternal nutrition, known side effects of chronic cocaine usage, may exacerbate any direct effect of cocaine on fetal growth Frank et al.
Rates of infection are also high in cocaine-using women, particularly of sexually transmitted diseases, and in some areas of the country, of HIV and syphilis, both of which adversely affect perinatal outcome. Paternal use of drugs is an important, as yet unquantified, issue in assessing the sequelae of cocaine exposure in infants, since animal studies have implicated paternal use as a significant factor in evaluating the effects of other teratogens on offspring development.
Variations in prenatal timing, dosage, frequency, and patterns of cocaine and other drug use among pregnant women which may affect perinatal and infant outcome may be significant and need to be studied. The general public has been familiarized with child developmental problems associated with the cocaine epidemic through the popular media. Currently, there are no available studies of the development or behavior of cocaine-exposed infants beyond 3 years of age.
Thus, no firm conclusions can be drawn regarding the possible severity of, or types of, abnormal developmental outcomes associated with fetal cocaine exposure. These dramatic clinical examples may be the exception rather than the rule. Such severe patients may be highlighted by the media but may not be representative of the characteristics of the entire population of cocaine-exposed infants. The clinical literature does have serious concerns about the social behaviors and educational needs of cocaine-exposed children.
In areas of the country where the crack-cocaine epidemic has become entrenched, child welfare departments have documented significant increases in the need for infant and child foster care. Although it is generally accepted that parental abandonment, abuse, and neglect of children are associated with increases in maternal drug use Dixon, ; U.
GAO, a , there is variation among states on current legislative practices in child abuse and neglect Marshall, The recent explosive increase in maternal drug use has prompted innovative alternatives for protective custody including in-home intensive programming, home visiting, and residential drug treatment for mothers and children U. Many of these programs have begun only recently so information about outcomes is not complete. In addition, an emerging infant developmental literature has begun to document specific neurobehavioral effects of fetal cocaine exposure on maternal and infant behavior.
These studies have focused on infant behavior, infant cognitive development, and maternal—child interaction. In their pioneering studies, Chasnoff and colleagues described cocaine-exposed neonates as different from non-drug-exposed infants Chasnoff et al. Lethargy, poor responsivity, irritability, tremulousness, hypertonicity, and disorganization of feeding and sleeping patterns were characteristics described by workers caring for these infants in neonatal nurseries.
Subsequently, several standardized scales have been used to describe objectively and to quantify these behavioral characteristics in the fetal and neonatal periods.
To determine whether or not cocaine-exposed infants experienced a withdrawal syndrome-after birth similar to that seen in heroin- or methadone-addicted infants, some investigators have used the Neonatal Abstinence Scale Finnegan, with varying results. This scale measures 21 signs of drug withdrawal, including tone, sleeping and feeding irregularities, tremulousness, and tachypnea.
An infant showing signs of withdrawal, for example, may cry incessantly, as well as sleep or eat poorly. Since withdrawal scales designed for narcotic drugs may not be relevant to cocaine, other measures may be more appropriate for describing the spectrum of behaviors seen in cocaine-exposed neonates. The NBAS was developed to assess the behavioral repertoire of the full-term infant from birth through the first month of life.
Items assess visual and auditory orientation, habituation, reflex behavior, physiological stability, and interactive behavior with the examiner, including ability to alert and attend. These items are typically expressed through cluster scores. Abnormalities in comparison to non-cocaine-exposed infants have been found across several studies which examined cocaine-exposed infants with the NBAS in the neonatal and early infant periods Chasnoff, Griffith, et al.
Several of these studies have had adequate sample sizes so that some control could be made for potentially confounding variables. Eisen et al. Control infants were matched based on a random stratification procedure on sex, ethnicity, gestational age, and birth weight.
Groups were equivalent on maternal age, gravidity, abortion history, and presence of hepatitis. While mothers who used opiates were excluded, cocaine-using women were found to have higher use of cigarettes and alcohol. Depressed habituation scores on the NBAS were noted in cocaine-exposed newborns, indicating that cocaine-exposed neonates were less adept at screening out aversive stimulation than comparison infants.
Results from a stepwise regression analysis indicated maternal cocaine use to be the only significant variable entering the equation, predicting a significant amount of variance in infant habituation score. A longitudinal investigation at 2, 14, and 28 days postnatal age was undertaken by Coles et al. This study controlled experimentally for gestational age, other drug use, associated maternal illness, and duration of drug use.
Maternal drug use was assessed via self-report and urine screening. Infants of women who used cocaine or alcohol, and no other drugs except cigarettes and marijuana, were recruited.
Comparison infants were mothers of similar age, race, and social class. Full-term healthy infants were examined at 2, 14, and 28 days, and grouped as follows: no cocaine or other drugs, cocaine-positive postpartum, cocaine-negative postpartum, and alcohol only. While no group differences were found at 2 days, cocaine-exposed infants who were positive postpartum showed poorer autonomic regulation at 14 and 30 days, and had more abnormal reflexes at 30 days than the no-cocaine group.
The effects were most pronounced by 28 days, when cocaine independently predicted abnormalities in motor and reflex behavior and state regulation. The importance of assessment of polydrug use was also demonstrated in this study, as marijuana, alcohol, and cigarette use, either alone or in interaction with cocaine, also predicted NBAS differences.
Less optimal infant behavior on NBAS assessment was noted in another study which followed term, cocaine-exposed and non-exposed infants at birth and at 1 month of age Neuspiel et al. No differences were found on NBAS clusters at birth; however, cocaine-exposed infants demonstrated reliably poorer motor responses at follow-up.
Cocaine exposure accounted for a significant portion of the motor cluster score variance, but not when potentially confounding variables, including other drugs, perinatal variables, and demographic and examination factors, were controlled. Using a matched design to control for confounding variables of race, parity, tobacco use, intrauterine growth, and delivery type, Woods et al.
They found no differences between groups; at either time. However, as infants were assessed at less than 3 days of age, the effects of other medications used in delivery for both groups may have: obscured differences.
At 1 month follow-up, sample size was reduced such that power to detect differences may have been inadequate. Thus, of the few currently available studies, there have been no consistent findings related to specific newborn behavioral abnormalities in term, healthy cocaine-exposed infants, perhaps due to methodologic differences in sample selection, variation in control for various confounds, timing and nature of assessment instruments, and attrition rates.
Only one study Coles et al. This study suggests both independent and interactive effects of cocaine on infant behavior that warrant further study. Only children of mothers who had entered a prenatal drug treatment program and who may not be representative of general sample of cocaine-exposed infants were studied, however. The level of play behavior, also a correlate of cognitive development, may also be affected.
Although this study was inconclusive due to methodologic problems, the use of a standardized free play assessment during which levels of manipulative, functional, and symbolic play were rated may be useful in providing information about cognitive processing deficits not apparent in typical IQ testing.
Although current findings are preliminary, they are consistent with clinical and research reports of early behavioral abnormalities in the neonatal period, and with human and animal studies that document fetal problems of hypoxia and growth retardation known to be related to neurological development and functioning. Thus, cocaine-exposed infants appear to be at risk for later learning and behavioral disabilities from a biological perspective.
As environmental and caretaking factors also exert considerable effects on the long-term outcome of children, these factors must be considered in evaluating risk in cocaine-exposed infants.
In a hospital national study, the U. General Accounting Office a found that approximately 1, of the 4, drug-exposed infants born in surveyed were placed in foster care, suggesting a serious level of neglect and abuse requiring out-of-home placement. While foster placement may be considered a better alternative than the often chaotic and dangerous environment associated with maternal drug use, the poor quality of many foster homes and the lack of supportive health and social services to foster care families also may be detrimental.
For those infants who return home from the hospital with their mothers, the effects of maternal drug life-style must be considered. For example, the impact of an impoverished home environment in which available resources are funneled into drug procurement can only be negative. Domestic violence, child neglect and abuse, and poor health care directly and negatively affect child development. Regan, Ehrlich, and Finnegan wrote that the overlap of drug use and social problems for this target population warrant comprehensive monitoring of maternal depression and confusion, as well as interventions aimed at the restoration of self-esteem, promotion of better parenting skills, and addressing episodes of spouse abuse as an alternative to a sole referral to child welfare services.
Little is known about the interactional and caretaking behaviors of cocaine-using women. This can lead to severe bleeding, early birth, and possibly fetal death.
According to the American Congress of Obstetricians and Gynecology ACOG , babies of mothers who used crack cocaine during pregnancy for prolonged periods also have a higher risk of birth defects including: A smaller than normal head Reduced growth potential Genital, kidney, and brain defects Withdrawal symptoms appear such as sleeplessness, feeding difficulties, muscle spasms and tremors. For the person using crack, it can cause: Respiratory failure Strokes Heart attacks Seizures These health issues are life-threatening and can be passed to the unborn baby.
Another issue for the newborn is brain structure changes that affect their performance in school and social behavior in life and may persist in their early teenage years. For the user, the effects of cocaine may be immediate, the effects on the unborn baby may last their whole life. Questions About Treatment?
Call now to be connected with a compassionate treatment specialist. Call Now Treatment for Pregnant Women Inpatient treatment is the best way for a pregnant woman to get treatment for crack cocaine addiction. Pregnant women and their other children should avoid the environment that supports a drug addiction.
These treatments address a withdrawal period where the woman may experience depression, lethargy and anxiety for about a week. In a rare few cases, paranoid psychosis during withdrawal occurs if the woman took frequent, high doses of crack cocaine. Medication is not usually used during withdrawal from crack cocaine in pregnant women because there is little or no data on the effect these drugs may have on the fetus. In some cases, antidepressants are prescribed for the first five days to reduce the depression that often causes a high dropout rate during this period.
If a woman needs prolonged use of antidepressants or sedatives, there may be other psychological issues that are not related to crack cocaine addiction. Inpatient treatment can also provide regular cognitive behavior therapy CBT that can help address the reasons the patient originally became addicted to drugs.
It uses several goal-oriented systematic procedures to address dysfunctional emotions, cognitive processes, and maladaptive behaviors. The therapist will try to help the patient find strategies to address these problems.
Resource: ncbi. Praise the Lord for the drug rehab programs and their workers. Perhaps this would be a could turning point for both the mother and child. A great reason to recover! I believe they should stress the teachings of the negative effects of drugs while pregnant.
Great article. Everyone knows that drugs can cause fatal damages in our babies like brain defects and other birth defects. Or even have the audacity to ask what will happen if they do a certain drug during their pregnancy.
Im glad there are places like Choices Recovery to aid in helping these people make better decisions and become better mentally and physically.
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