Prevalence of use of cocaine and other substances in an obstetric population

Article Abstract:

Use of cocaine by pregnant women has devastating effects on fetal development, and a study of its prevalence was undertaken at the Sloane Hospital for Women in New York City. During a period of approximately five weeks, urine samples from 509 women with pregnancies of more than 20 weeks' gestation were evaluated for cocaine, opiate drugs, methadone, amphetamines, barbiturates, benzodiazepines, ethanol (alcohol), and phencyclidine ('PCP', or 'angel dust'). Historical data were also collected for these patients. The women were admitted to the hospital because they were in labor, had premature rupture of membranes (the membranes surrounding the fetus), or were having delivery with oxytocin (a drug that causes uterine contractions) or by cesarean section. Results showed that 24 percent of the urine specimens (123 samples) tested positive for drugs or their metabolites. Cocaine or its metabolites were present in 51 samples (10 percent of the total population), and amphetamines or their metabolites in 65 samples (13 percent). Almost all (49) of the cocaine-positive samples were from clinic patients, and 49 clinic patients also tested positive for amphetamines (along with 16 private patients). Cocaine-positive women were less likely to have had prenatal care, and were more likely to give a history of cigarette, alcohol, or other drug use. This group had a higher rate of complications, including labor onset or rupture of membranes at gestational ages less than 37 weeks. These associations were not found for the amphetamine-positive cases, and the urine amphetamine test was such that over-the-counter cold remedies could have led to a positive result. Slightly more than one-third of the positive results for cocaine, and none of the results for amphetamines, were predicted by the patients' medical histories. The results indicate a high level of cocaine and amphetamine use in these pregnant women, and suggest that urine screening of all pregnant women is highly advisable for effective treatment of possible complications. (Consumer Summary produced by Reliance Medical Information, Inc.)

Testing, Complications and side effects, Amphetamines

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Cocaine-related maternal death

Article Abstract:

Evidence supporting the adverse effects of cocaine use during pregnancy is mounting. Cocaine can cause life-threatening heart rhythms and heart attack in the mother and neurodevelopmental deficits, fever and sudden infant death syndrome in the infant. Cocaine exerts its effects by narrowing blood vessels. The compromised blood supply to the heart can cause both a heart attack and a decreased blood supply to the intestines, leading to bowel injury. A 26-year-old black woman was brought into the hospital unconscious, with no blood pressure, pulse or respiration. She was seven to eight months pregnant and a fetal heart beat was detectable at 40 beats per minute. Although resuscitation failed, a cesarean section was performed to try a save the 32-week-old fetus. Despite exhaustive efforts, the infant also died. The woman's boyfriend said the patient had developed chest pain and collapsed during sex, but he denied she had used cocaine. However, cocaine was detected in the patient's blood and nose at autopsy, and the coroner declared cocaine intoxication as the cause of death. In this case, sexual activity increased oxygen demands on the heart, which, compounded by the hyperdynamic state normally found during pregnancy, exaggerated the ''sex-cocaine'' syndrome. Cocaine is the most lethal street drug, and causes a death rate among experimental animals that is twice that of heroin. This patient had no prenatal care, was poorly nourished and unemployed. She died leaving three other children. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Patient outcomes, Mortality, Fetus, Pregnancy, Complications of, Pregnancy complications

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Case-control study of antenatal cocaine use and platelet levels

Article Abstract:

Cocaine use during pregnancy does not cause thrombocytopenia, according to a study of 326 pregnant women. Thrombocytopenia is an abnormally low blood platelet count, which can cause excessive bleeding.

Thrombocytopenia

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