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Cocaine Addiction among Pregnant Women

It is found from the National Institute on Drug Abuse that approximately 45,000 pregnant women were using cocaine in 1992.  Cocaine exerts several threats to unborn babies. Different kinds of health problems are observed among babies that were exposed to cocaine. These health problems range from minor to major life-threatening problems although the earlier predictions have not come true that were about the damage of the brain of cocaine-exposed babies.

Unborn Baby and Threat to Its Health Due To Cocaine
There are different ways in which the health of a pregnant woman and an unborn baby can be affected due to the use of cocaine during pregnancy.  Miscarriage is the biggest expected threat during the early months of pregnancy.  Premature labor can occur if cocaine is used in the later months of pregnancy.  An unborn may also suffer from a stroke or it may die. A stroke then may result in irreversible damage of brain.
Premature birth occurs most likely as a result of cocaine use during pregnancy.  Cocaine-exposed babies usually have a low birth-weight. Most of the time, the head of such babies are smaller and their brains are small to in ratio with their body size.

It is found from studies (Kuczkowski, 2003; Plessinger & Woods, 1998; Vidaeff & Mastrobattista, 2003) that women who use cocaine during pregnancy usually have a premature baby at least twice as compared to other women who do not take cocaine or any other drug during pregnancy. The size of the baby can be very small at the time of birth because oxygen and nutrients cannot be flown to the fetus due to cocaine. The heads of the cocaine-exposed babies are usually very small and thus their brain is very small too. These problems are most commonly found among women who do not quit the use of cocaine throughout their pregnancy whereas such problems are less commonly found among women who stop using cocaine as soon as they conceive the baby or in the first trimester.

It is also found that the placenta becomes pulled away and does not remain on the wall of the uterus before the beginning of labor when cocaine is used during pregnancy. This condition is called placental abruption and it is very harmful for both mother and baby because this can lead to fatal condition. Moreover, other complications become enhanced during labor and delivery of the baby.

Cocaine Use during Pregnancy and Physiological Effects and Complications
Several obstetric complications may arise to the health of fetus and mother when cocaine is used during pregnancy. Women who use cocaine in their pregnancies are found to have less weight gain and they also suffer from different cardiac complications such as hypertension, cardiac ischemia, arrhythmia and hemorrhagic stroke (Kuczkowski, 2003; Plessinger & Woods, 1998; Vidaeff & Mastrobattista, 2003). If a pregnant woman is already suffering from cardiovascular problems then cocaine acts as an additive to increase the complications. (Wagner, Katikaneni, Cox, & Ryan, 1998). Certain cardiovascular events such as seizures and stroke are significantly found among pregnant who use cocaine during pregnancy. This is due to the increase in the toxic nature of cocaine during pregnancy. (Plessinger & Woods, 1998).

Pregnant women using cocaine are also found to suffer greatly from uterine rupture, placental abruption, hepatic rupture and maternal death (Kuczkowski, 2003; Plessinger & Woods, 1998).

There are several physiological effects of cocaine such as hypertension, tachycardia and vasoconstriction. These effects may also be found in cocaine-exposed fetus. When women take cocaine, vasoconstriction of the maternal uterine blood vessels takes place so supply of nutrients and oxygen do not reach to the fetus properly because these blood vessels are primarily responsible to supply nutrients and oxygen to the fetus. As a result, fetal hypoxemia and uteroplacental insufficiency occur (Woods, Plessinger, & Clark, 1987).

Several complications such as premature labor and delivery, fetal intracranial hemorrhage, spontaneous abortion and abruptio placentae may take place due to vasoconstriction. (Cohen, Green, & Crombleholme, 1991; Fajemirokun-Odudeyi & Lindow, 2004; Plessinger & Woods, 1998; Wootton & Miller, 1994).

Physiologic Effects of Cocaine Exposure during Pregnancy in Neonates
There are certain physiologic effects of cocaine exposure in neonates. The molecular weight of cocaine is low and the nature of cocaine is both lipophilic and hydrophilic. Due to these properties, cocaine can easily cross the placenta and makes its way to the blood brain barrier. Cocaine is metabolized in fetus very slowly as compared to its metabolism in adult. So cocaine gets maximum time to remain in fetus. (Schenker et al., 1993; Wagner et al., 1998). Mahone and colleagues (1994) performed a study on a similar topic and found that cocaine and its compounds not only fetus by the process of diffusion to the placental vessels and umbilical cord but they are also diffused in the amniotic fluid from where the fetus swallow them.

Several studies have found the effect of prenatal expose to cocaine in infants in the form of variations in intrauterine growth such as varied length, birth weight and head circumference and other effects such as prematurity. Several studies have observed the association between prematurity and IUGR of the newborn and the use of cocaine by mother.  Studies have shown that as fetus is exposed to cocaine, the newborn suffers from low birth weight, less birth length and small head circumference and this rate is increasing rapidly. The rate of premature birth is also increasing among cocaine exposed newborns despite the use of different (Bada et al., 2002; Chiriboga, Brust, Bateman, & Hauser, 1999; Richardson, Hamel, Goldschmidt, & Day, 1999; Singer et al., 2002). several other studies have not found any signification relationship among lower birth weight, less birth length, small head circumference and premature birth (Bandstra et al., 2001; Bateman & Chiriboga, 2000; Eyler, Behnke, Conlon, Woods, & Wobie, 1998).

Singer and colleagues (2002) performed a study to find out the neonatal exposure to cocaine on its length, birth weight, head circumference and premature birth. In their study, 218 infants were observed who had been exposed to cocaine in their neonatal life and 197 infants were observed who were not exposed to cocaine, then the researchers found out that when cocaine was used during pregnancy, an increase in premature labor and delivery occurred with low birth weight, less birth length, small head circumference and shorter gestational age.  Similarly, Bandstra et al. (2001) also performed a similar study and found that low birth weight and less birth length are found to be associated with material cocaine use but no effect on head circumference was found. Bandstra et al. (2001) performed a similar study and found that material cocaine use does not have effect on premature delivery because all the infants in their study were full-term.

Sudden Infant Death Syndrome (SIDS)

A small number of studies have shown the relationship among the neonatal exposure to cocaine and sudden infant death syndrome (SIDS). A significant increased risk of SIDS was found to have strong relationship with maternal substance abuse in a study of 1760 cases where other confounding variables were kept controlled. Those variable included teenage mother, maternal cigarette smoking, black race and birth weight (Kandall, Gaines, Habel, Davidson, & Jessop, 1993). Fares, McCulloch, and Raju (1997) performed a research on 10 previously published studies and found out that there is no association of SIDS with cocaine but SIDS is observed by prenatal exposure to illicit drugs in general. Klonoff-Cohen and Lam-Kruglick’s (2001) also performed a study to find out any such relation and they found that there is no relationship between the maternal use of cocaine or any other illicit drug and SIDS.

It can be concluded from this literature research that there is a relationship between the prenatal exposure to cocaine and small head circumference, low birth weight, less birth length and shorter gestational age.

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