Cocaine and Pregnancy
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.
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 birth weight (less than 5.5 pounds) than babies of women who do not use the drug. Low birth weight can result from poor growth before birth, premature birth, or a combination of both. Low-birth weight 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.
Cocaine use has reached epidemic proportions in the United States. By 1986 it was estimated that nearly 40% of people between the ages of 25 and 30 years had tried cocaine (Gawin and Ellinwood). At various hospitals across the country, pregnant women have been interviewed about their use of drugs. Between 10% and 20% of pregnant women admit to using cocaine sometime during pregnancy.
Several studies also indicate that even when a mother reports she is not using drugs, an urine screen may indicate such use. In one of these studies, 26% of pregnant women who tested positive for cocaine denied using it.
In New York City, the great majority of infants coming into foster care are born to women who abused cocaine or "crack" during pregnancy. Cocaine abuse is thought to be escalating as street prices are dropping. In addition, teenagers are thought to be younger when they first use the drug.
The following are characteristics of cocaine exposed infants:
- Lower birth weight, shorter in length
- Smaller head circumference
- A piercing cry, which is apparently indicative of neurological dysfunction
- Lower Apgar score
- Irritability and hypersensitivity. The newborn shoots from sleep to screaming and is inconsolable.
- Poor feeding
- High respiratory and heart rates
- Startling responses
- Poor sleep patterns
- Significantly lower scores on two of the dimensions measured by the Brazelton Neonatal Behavioral Assessment Scales (BNBAS): 1) scales related to interactive abilities, and 2) scales related to organizational responses to environmental stimuli. Infants who perform poorly on the BNBAS are considered high risk, especially if performance is poor in more than one of the behavioral dimensions.
- Inability to respond to caregiver. These cocaine exposed infants are largely unable to respond to the human voice and face and are unable to interact with others.
- An increased risk of malformations of the genito-urinary tract. Dr. Chasnoff recommends that these infants should have routine ultra-sound evaluations of their kidneys in order to rule out such defects.
- There is evidence that the use of cocaine shortly before birth can be associated with cerebral infarction (stroke) which damages the brain of the newborn. A CT scan of the brain may be indicated when both the infant and mother test highly positive for cocaine at the time of birth and when there are additional indications to suggest a stroke might have occurred.
- A greater incidence of Sudden Infant Death Syndrome (SIDS). In Dr. Chasnoff's sample, 15% of the infants died of SIDS, more than triple that of heroin or methadone exposed infants.
- Sleep pattern abnormalities associated with apnea and deep sleep, which may be associated with the greater incidence of SIDS
- Visual abnormalities which may be associated with retinopathy or damage to the iris. This is thought to be related either to actual damage caused by the cocaine and/or the premature birth associated with such use.