Cocaine Use During Pregnancy

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Cocaine Use During Pregnancy

Approximately 45,000 women in this country used cocaine during pregnancy in 1992, according to the National Institute on Drug Abuse. Cocaine is a dangerous drug for unborn babies. While earlier predictions that many cocaine-exposed babies would be severely brain damaged have not come true, these babies still face many health problems, ranging from subtle to life-threatening.

How does cocaine hurt an unborn baby?

Cocaine use during pregnancy can affect a pregnant woman and her unborn baby in many ways. During the early months of pregnancy, it may increase the risk of miscarriage. When the drug is used late in pregnancy, it may trigger premature labor. It also may cause an unborn baby to die or to have a stroke, which can result in irreversible brain damage.

Women who use cocaine during pregnancy are:  A.  twice as likely to have a premature baby;  B.  More likely to have a low birth-weight baby;  C. More likely to have babies born with smaller heads and smaller brains proportionate to body size.

Studies show that women who use cocaine during pregnancy are at least twice as likely as other women to have a premature baby. And because cocaine cuts the flow of nutrients and oxygen to the fetus, the baby may be much smaller at birth than it would be otherwise. Cocaine-exposed babies also tend to have smaller heads, which may indicate a smaller brain. These problems appear more commonly in babies of women who use cocaine throughout pregnancy than in babies whose mothers stop using the drug in the first trimester.

Cocaine use also may cause the placenta to pull away from the wall of the uterus before labor begins. This condition, placental abruption, can lead to extensive bleeding and can be fatal for both the mother and her baby. (Women who smoke cigarettes during pregnancy also are at increased risk of placental abruption. Many women who use cocaine also smoke cigarettes, which may contribute to their increased risk of abruption.) The drug also may increase other complications of labor and delivery.

How does cocaine use during pregnancy affect newborns?

Babies exposed to cocaine before they are born may start life with serious health problems. Babies of women who use cocaine regularly during pregnancy are between three and six times more likely to be born at a low birthweight (less than 5.5 pounds) than babies of women who do not use the drug. Low birthweight can result from poor growth before birth, premature birth, or a combination of both. Low-birthweight babies are 20 times more likely to die in their first month than normal-weight babies. Those who survive are at increased risk of lifelong disabilities including mental retardation, cerebral palsy, visual and hearing impairment.

Some studies suggest that cocaine-exposed babies are at increased risk of birth defects. The Centers for Disease Control and Prevention (CDC) reported that mothers who used cocaine early in pregnancy were five times as likely to have a baby with a malformation of the urinary tract as mothers who do not use the drug.

A number of studies have found that cocaine-exposed babies tend to score poorly on tests given at birth to assess the newborn's physical condition and overall responsiveness. They do not do as well as unexposed babies on measures of motor ability and reflexes, attention and mood control, and they appear less likely to respond to a human face or voice.

Babies exposed to cocaine before birth sometimes have feeding difficulties and sleep disturbances. Beginning at birth, some exposed babies go through something similar to "withdrawal" from the drug. Many are very jittery and irritable, and startle and cry at the gentlest touch or sound. Consequently, these babies are very difficult to comfort and often are described as withdrawn or unresponsive. Other cocaine-exposed babies "turn off" surrounding stimuli by going into a deep sleep for most of the day.

In either case, the baby's reaction to cocaine, frequently coupled with the mother's continued dependence on the drug, makes bonding between mother and baby difficult. Bonding is believed to be important to a baby's emotional development.

What other problems are faced by babies whose mothers used cocaine during pregnancy?

We do not know all of the special problems that these children will face. Some, but not all, studies suggest that they may have a greater-than-normal chance of dying of sudden infant death syndrome (SIDS). The cocaine, in conjunction with other poor health practices that often accompany cocaine use, may contribute to these deaths.

Recent studies suggest that these children may lag behind unexposed peers in motor skills, at least through two years of age. Most affected appear to be fine motor skills, such as those used in learning to write, draw or play sports.

Most children who were exposed to cocaine before birth have normal intelligence. This is encouraging, in light of earlier predictions that many of these children would be severely brain-damaged. However, studies of cocaine-exposed school-aged children do suggest subtle effects on intelligence and behavior. Exposed children tend to score about 3 points lower on tests of IQ than nonexposed children. While effects on overall intelligence appear small, the effects on specific language abilities are larger. Teachers also report more problem behaviors in cocaine-exposed children compared to unexposed children. As a result of these subtle effects on learning and behavior, some exposed children will need special education to help reach their full potential.

How can a woman protect her baby from the dangers of cocaine?

The birth defects and other problems caused by cocaine are completely preventable. The March of Dimes advises women who use cocaine to stop before they become pregnant or to delay pregnancy until they believe they can avoid the drug completely throughout the pregnancy. The March of Dimes also encourages pregnant women who use cocaine to stop using the drug immediately, because of the harm continued cocaine use can cause. Women who stop using cocaine early in pregnancy appear to reduce their risk of having premature or low-birthweight babies.

What is the March of Dimes doing to address the problems of cocaine use during pregnancy?

The March of Dimes supports research aimed at learning more about the effects of prenatal cocaine exposure in the newborn period and in later childhood, with the goal of helping children overcome potential problems. For example, one study looks at how cocaine exposure affects speech and language skills. Another looks at the impact of cocaine exposure on the development of self control, which is necessary for learning and functioning at school and at home. These studies could lead to educational programs that can help these children learn more effectively.

The March of Dimes has sponsored conferences on cocaine use during pregnancy for health professionals and the media to increase awareness of this problem, and conducts educational programs to inform the public of the dangers of cocaine and other drugs to unborn babies.

References

Arendt, R., et al. Motor development of cocaine-exposed children at age two years. Pediatrics, volume 103, number 1, January 1999, pages 86-92.

Delaney-Black, V., et al. Prenatal cocaine exposure and child behavior. Pediatrics, volume 102, number 4, October 1998, pages 945-950.

Eyler, F.D., et al. Birth outcome from a prospective, matched study of crack/cocaine use: II. Interactive and dose effects on neurobehavioral assessment. Pediatrics, volume 101, number 2, February 1998, pages 237-241.

Lester, B.M., et al. Cocaine exposure and children: the meaning of subtle effects. Science, volume 282, October 1998, pages 633-634.

Slutsker, L. Risks associated with cocaine use during pregnancy. Obstetrics and Gynecology, volume 79, number 5, May 1992, pages 778-789.

Chavez, G., Mulinare, J., Cordero, J.F. Maternal cocaine use during early pregnancy as a risk factor for congenital urogenital anomalies. Journal of the American Medical Association, volume 262, number 6, 1989, pages 795-798.

Volpe, J.J. Effect of cocaine on the fetus. The New England Journal of Medicine, volume 327, number 6, August 6, 1992, pages 399-407.

All materials provided by the March of Dimes are for information purposes only and do not constitute medical advice.

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