Since the mid-1980s, about 1 million babies in this country have been born to mothers who used cocaine during pregnancy, according to the National Institute on Drug Abuse. Cocaine is a dangerous drug for unborn babies and for pregnant women. Babies exposed to cocaine before birth may face health problems, ranging from subtle to life threatening. However, because most pregnant women who use cocaine also use other drugs, alcohol and tobacco, it is difficult to determine which health problems are caused solely by cocaine use.
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. It also may cause other problems for the unborn baby, including stroke, which can result in irreversible brain damage, heart attack, serious birth defects or death.
When cocaine is used late in pregnancy, it may trigger premature labor (labor that occurs before 37 weeks of pregnancy). Studies show that women who use cocaine during pregnancy are at least twice as likely as other women to have a premature baby. The baby may be much smaller at birth than it would be otherwise, because cocaine causes blood vessels to constrict, which decreases the flow of nutrients and oxygen to the baby. 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, or who use the drug a few times during pregnancy.
Cocaine use also may cause the placenta to pull away from the wall of the uterus before labor begins. This condition, called placental abruption, can lead to extensive bleeding and can be fatal for both the mother and the baby. (Prompt cesarean delivery, however, can prevent most deaths.) 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 more likely to be born at low birthweight 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 of life than normal-weight babies. They also face an increased risk of lifelong disabilities including mental retardation, cerebral palsy and problems with vision, hearing, coordination and motor skills.
Some studies suggest that cocaine-exposed babies are at increased risk of birth defects. In 1989, the Centers for Disease Control and Prevention reported that mothers who use cocaine early in pregnancy are five times as likely to have a baby with a malformation of the urinary tract as mothers who do not use the drug.
Some studies have found that babies who are regularly exposed to cocaine tend to score lower than unexposed babies on tests given at birth to assess the newborn’s physical condition and overall responsiveness. They may not do as well as unexposed babies on measures of motor ability, reflexes, attention and mood control, and they appear less likely to respond to a human face or voice.
Babies who are regularly exposed to cocaine in utero sometimes have feeding difficulties and sleep disturbances. As newborns, some are jittery and irritable, and they may startle and cry at the gentlest touch or sound. Therefore, these babies may be difficult to comfort and may be described as withdrawn or unresponsive. Other cocaine-exposed babies “turn off” surrounding stimuli by going into a deep sleep for most of the day. Generally, these behavioral disturbances are temporary and resolve over the first few months of life.
Some studies report that cocaine-exposed babies have a greater chance of dying of sudden infant death syndrome (SIDS). However, other studies suggest that poor health practices that often accompany maternal cocaine use (such as use of other drugs) may also play a major role in these deaths.
What is the long-term outlook for children who are exposed to cocaine before birth?
It is not known for sure if exposure to cocaine affects intelligence, because this requires good long-term studies, and it is not always possible to follow exposed babies through childhood. Some studies suggest that most children who are 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, other studies suggest that cocaine may have subtle effects on mental development of children exposed before birth, including lower IQ levels.
A recent study at Case Western Reserve University found that cocaine-exposed 2-year-olds scored six points lower than unexposed peers on tests of mental development, a small but probably significant effect. These toddlers were also twice as likely as unexposed peers to score in the mentally retarded range. While it is not yet known whether these children will continue to have learning difficulties when they reach school age, a study at Brown University found that cocaine-exposed school-aged children scored about three points lower on IQ tests than non-exposed children. While cocaine’s effects on overall intelligence appear small, a few IQ points can sometimes make the difference between a child who can function well in a regular classroom and one who requires special assistance.
Studies are inconclusive regarding cocaine-exposed children and their risk of having learning and behavioral problems. In one study teachers reported more problem behaviors, such as difficulties paying attention, in cocaine-exposed children compared to unexposed children. Other studies found that cocaine exposure may adversely affect language abilities. As a result of these subtle effects on learning and behavior, some exposed children will need special education to help reach their full potential.
However, other studies have not found consistent differences in learning or behavior between cocaine-exposed children and their unexposed peers. Researchers continue to follow cocaine-exposed children as they reach their teen years to clarify their long-term outlook. Because many cocaine-exposed children are also exposed before birth to other drugs, tobacco and alcohol, it remains difficult to determine which problems may result from cocaine exposure and which may result from other substances or from environmental conditions (such as poor parenting, lead exposure and iron deficiency) after birth.
Some studies suggest that cocaine-exposed babies may lag behind unexposed peers in motor skills, at least through the first seven months of life. These differences tend to disappear after this time. One study found that cocaine exposed children were significantly shorter and lighter than unexposed peers at age 7.
How can a woman protect her baby from the dangers of cocaine?
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 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.
Does the March of Dimes support research on cocaine use during pregnancy?
The March of Dimes supports research aimed at learning more about the effects of cocaine exposure on pregnancy and in newborns and older children. One researcher is exploring physical and behavioral factors during pregnancy that may help to discourage women from using cocaine and other drugs. Others have looked at how cocaine exposure affects speech and language skills, to develop educational programs that help these children learn more effectively. The March of Dimes also produces a variety of educational materials that inform pregnant women and others of the dangers of cocaine and other drugs during pregnancy.
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