Ira J. Chasnoff

Cocaine use in pregnancy.

With the increasing use of cocaine in the United States, there has been growing concern regarding its effects on the fetuses and neonates of pregnant cocaine abusers. Twenty-three cocaine-using women enrolled in a comprehensive perinatal-addiction program were divided into two groups: those using cocaine only and those using cocaine plus narcotics. These two groups were compared with a group of women who had used narcotics in the past and were maintained on methadone during pregnancy, and with a group of drug-free women. All four groups were similar in maternal age, socioeconomic status, number of pregnancies, and cigarette, marijuana, and alcohol use. Their medical histories indicated that the cocaine-using women had a significantly higher rate of spontaneous abortion than the women in the other two groups. In the pregnancies under study, four cocaine-using women had onset of labor with abruptio placentae immediately after intravenous self-injection of cocaine. Neonatal gestational age, birth weight, length, and head circumference were not affected by cocaine use. However, the Brazelton Neonatal Behavioral Assessment Scale revealed that infants exposed to cocaine had significant depression of interactive behavior and a poor organizational response to environmental stimuli (state organization). These preliminary observations suggest that cocaine influences the outcome of pregnancy as well as the neurologic behavior of the newborn, but a full assessment will require a larger number of pregnancies and longer follow-up.

Cocaine use during pregnancy: Adverse perinatal outcome

Cocaine use has increased dramatically in the United States during the past decade. The life-threatening cardiovascular and central nervous system complications of cocaine have been well documented; however, few studies have examined the risks of cocaine use during pregnancy. In this report the perinatal outcome data of 70 women receiving care at the Perinatal Center for Chemical Dependence of Northwestern University, whose pregnancies were complicated by cocaine abuse, were compared with those of matched control subjects. The use of cocaine during pregnancy was associated with lower gestational age at delivery, an increase in preterm labor and delivery, lower birth weights, and delivery of small for gestational age infants.

Cocaine use in pregnancy: perinatal morbidity and mortality.

With the increasing use of cocaine in the United States, there has been growing concern regarding its effects on the fetuses and neonates of pregnant cocaine abusers. Fifty-two cocaine-using women enrolled in a comprehensive perinatal addiction program were evaluated and compared with 73 women who had used narcotics in the past and were maintained on methadone during pregnancy. The groups were similar in maternal age, socioeconomic status, number of pregnancies and cigarette, marijuana and alcohol use. The cocaine-using women had a significantly higher rate of premature labor, precipitous labor, abruptio placentae, fetal monitor abnormality and fetal meconium staining than the women in the methadone group. Neonatal gestational age, birth weight, length and head circumference were not affected by cocaine use compared to methadone use. However, the Brazelton Neonatal Behavioral Assessment Scale revealed that infants exposed to cocaine had significant depression of organizational response to environmental stimuli (state organization) when compared to methadone-exposed infants. In another aspect of the study, an increased rate of SIDS (15%) was found for 66 cocaine-exposed infants as compared to a 4% rate of SIDS in 50 methadone-exposed infants.

Three-Year Outcome of Children Exposed Prenatally to Drugs

OBJECTIVE To evaluate the 3-year behavioral and developmental outcome of children prenatally exposed to maternal substances of abuse. METHOD Ninety-three children exposed prenatally to cocaine and other drugs taken by the mother during pregnancy (Group 1), 24 polydrug/noncocaine exposed children (Group 2), and 25 nonexposed children (Group 3) were evaluated at 3 years of age as part of a longitudinal prospective study of the impact of intrauterine substance exposure on long-term outcome. The Stanford-Binet Intelligence Scale: Fourth Edition(SBIS) was administered by examiners blinded to the exposure background of the children, and a pediatrician performed a complete medical evaluation on all the children. The childrens primary caregiver completed the Achenbach Child Behavior Checklist. Stepwise multiple regression procedures were used to determine the factors that best predicted 3-year growth, intelligence, and behavior. RESULTS Groups 1 and 2 differed from Group 3 on head circumference. Group 1 scored lower than Group 3 on SBIS Verbal Reasoning. Group 2 scored Slower than Group 3 on SBIS Abstract/Visual Reasoning. Cocaine exposure predicted poor verbal reasoning. Marijuana exposure predicted poor abstract/visual reasoning. Examiner rating predicted intellectual outcome and caregiver ratings. Caregivers rated exposed children as more aggressive than nonexposed. CONCLUSION Contrary to information in the popular media, not all substance-exposed children suffer the same poor prognosis. In fact, generalizations about the fate of drug-exposed children must await additional research into the outcome of the broader population of drug-exposed children, examining the roles of maternal and environmental factors across a variety of geographic locations and socioeconomic levels.

Prenatal Exposure to Cocaine and Other Drugs: Outcome at Four to Six Yearsa

ABSTRACT: In a longitudinal, prospective study, 95 children born to mothers who used cocaine and other drugs during pregnancy and 75 matched, nonexposed children born to mothers who had no evidence of alcohol or illicit substance use during pregnancy were evaluated for cognitive and behavioral outcome at 6 years of age. Prenatal exposure to cocaine and other drugs had no direct effect on the childs cognitive outcome (measured as IQ), but it had an indirect effect as mediated through the home environment. However, prenatal exposure to cocaine and other drugs did have a direct effect on the childs behavioral characteristics at 4–6 years of age, with the home environment having little impact. This study helps us to understand the fragile interaction of biological and environmental factors affecting the cognitive and behavioral development of children prenatally exposed to cocaine and other drugs.

Drug Use in Pregnancy: Parameters of Risk

With the increasing incidence of substance abuse in the United States, there has been a concomitant increase in the number of women becoming pregnant while using substances of abuse. The infant delivered to a drug-addicted woman is at risk for problems of growth and development as well as neonatal abstinence, and is also at increased risk of infections and exposure to HIV. The long-term outcome of these infants is influenced not only by the mothers use of illicit substances but by the frequent additional use of licit substances, such as cigarettes and alcohol. The drug-seeking environment in which many of these children are raised also may impair maximal development for these infants. In addition, many women from substance-abusing backgrounds lack a proper model for parenting and require intervention by the health care community to guide them in their roles as parents. Thus, multiple factors in the lives of these children, compounded by the early neurobehavioral deficits of drug-exposed newborns, earmark these infants to be at high risk for continuing developmental and later school problems.

Misdiagnosis and Missed Diagnoses in Foster and Adopted Children With Prenatal Alcohol Exposure

OBJECTIVE: The purpose of this article is to assess the rate of misdiagnosis and missed diagnoses of fetal alcohol spectrum disorders (FASD) among a population of foster and adopted youth referred to a children’s mental health center. METHODS: Data were collected from a sample of 547 children who underwent a comprehensive multidisciplinary diagnostic evaluation. Utilizing current diagnostic criteria, children were diagnosed, as appropriate, with fetal alcohol syndrome, partial fetal alcohol syndrome, alcohol-related neurodevelopmental disorder, or alcohol-related birth defects. Changes in rates of alcohol exposure-related diagnoses and cooccurring mental health disorders pre- and postassessment were analyzed by using McNemar’s test for dependent proportions. RESULTS: Among 156 children and adolescents who met criteria for a diagnosis within the fetal alcohol spectrum, 125 had never been diagnosed as affected by prenatal alcohol exposure, a missed diagnosis rate of 80.1%. Of the 31 who had been recognized before referral as affected by prenatal alcohol exposure, 10 children’s FASD diagnoses were changed within the spectrum, representing a misdiagnosis rate of 6.4%. The remaining 21 (13.5%) children’s diagnoses stayed the same. There also were significant changes in the rate of mental health diagnosis, and learning disorders, communication disorders, and intellectual disability, objective signs of neurocognitive damage, were not recognized in a significant number of children with FASD. CONCLUSIONS: Within this clinical sample, 86.5% of youth with FASD had never been previously diagnosed or had been misdiagnosed. These high rates of missed diagnoses and misdiagnosis have significant implications for intervention and therapeutic services.

Motor assessment of cocaine/polydrug exposed infants at age 4 months.

Fifty nondrug-exposed infants and 74 cocaine/polydrug-exposed infants were evaluated on the Movement Assessment of Infants (MAI). The test provides an assessment of risk for motor dysfunction at age 4 months. There was a significant difference in total risk scores between the two groups of infants with cocaine-exposed infants having higher total risk scores (p less than .0001). Categorical risk scores revealed significant differences between the infants in muscle tone, primitive reflexes, and volitional movement with cocaine-exposed infants scoring more poorly in each category (p less than .0001). The groups scored differently on 11 of the 49 MAI items in those categories. Placement of infants within previously established ranges of risk scores (0-7 = no risk; 8-13 questionable risk; greater than 13 = high risk) revealed a significant difference in distribution between the two groups (p less than .0001). Earlier studies of the effects of intrauterine drug exposure have not revealed significant differences in motor development. The MAI demonstrated differential assessments of risk for motor dysfunction between cocaine-exposed and nondrug-exposed infants.

Cocaine, Pregnancy, and the Growing Child

Substance abuse is not a new phenomenon. In the 1930s in the United States, there were epidemics of cocaine and alcohol abuse. In the 1960s and 197Os, marijuana, alcohol, and heroin were the most commonly abused drugs. However, the thalidomide tragedy of the 1960s gave rise to serious concerns that any substances a pregnant woman ingested could have a potential impact on her developing fetus. In the early 197Os, the modern description of the fetal alcohol syndrome’ turned clinicians’ attention to recreational drugs a woman might use during gestation, and this was soon followed by the description of the neonatal abstinence syndrome in newborns undergoing withdrawal from their mothers’ use of opiates, especially heroin, during pregnancy.2 The emergence of cocaine in the early 1980s as a drug of choice among large portions of the US population marked a new era in perinatal medicine, for here was a drug that was viewed as safe and nonaddictive and did not need to be injected, all of which made it very attractive to

Chemical dependence and clinical Depression in pregnancy

The Short Form of the Beck Depression Inventory (BDI) was administered to 54 chemically dependent pregnant women to assess the extent and depth of depression in the population. The women were divided into three groups by age: Teenagers, young adults, and older adults. Results suggested that this population, as a whole, scored very high on this depression scale. Further, results indicated that the older chemically dependent women scored significantly higher on the depression index than did either of the two younger groups, while the teenagers obtained a mean score comparable to that of the general adolescent population.