Perinatal implications of cocaine exposure

Abstract

Obstetric outcome was reviewed for 139 women who volunteered information on cocaine abuse during pregnancy past 20 weeks. Information on the duration of use during pregnancy was not accurate enough for documentation. In previous pregnancies, only 44.6% of the infants were live born, with spontaneous or therapeutic abortions in 41.1% and stillbirths accounting for 3.6%. In the current pregnancies, 91 patients (66.1%) were nonwhite, and multiple-drug usage was found in 92%, with intravenous cocaine use in 44.6% and freebasing in 31.7% as the main routes of administration. Syphilis or another infection, no prenatal care and poor weight gain (less than or equal to 19 lb) in pregnancy was present in one-third of the patients, while 38% did not know their gestational age. Precipitate labor was found in 63.9% and meconium-stained amniotic fluid in 20.5%. The mean birth weight of the infants was significantly lower than that of the general hospital population; low birth weight (less than 2,500 g) occurred in 36.2%, small size for gestational age in 32.4%, neurologic problems in 30.9% and syphilis in 15.4% of the infants. Congenital abnormalities, in 17.4%, seemed to be multifactorial. The consistent pattern of poor outcome in both the previous and present pregnancies reflects the life-style peculiar to cocaine abusers. Prospective studies are in progress to identify the true incidence of cocaine usage and to outline the counseling of childbearing women against cocaine use during pregnancy, emphasizing prevention since cures are not available.