Kayreen A. Burns

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.

Parenting Dysfunction in Chemically Dependent Women

The destructive impact of chemical abuse by a parent on other members of the family has been well documented in the literature1,2. Because the number of infants born to chemically abusing mothers is on the increase, there is a genuine concern about the quality of parenting by these mothers. It is reasonable to assume that the ignorance, naivety or irresponsibility that was involved in their use of drugs during pregnancy would carry over into their parenting. We know how important the mother’s role is in the socioemotional development of her infant. In the early dyadic interaction of mother and infant, when the early bases of development are laid, the mother’s initiation of and response to her baby affect the likelihood of the occurance of specific infant behaviors. Newborn infants need to be carefully trained in how to interact socially. It is by first coacting with their mothers and fathers that they learn to initiate social interaction by themselves.

Phencyclidine: effects on the fetus and neonate

As phencyclidine hydrochloride (PCP) has become one of the more frequently abused drugs in the United States, there has been increasing interest in its effect on the fetus and neonate of the pregnant abuser. Two groups of women enrolled in a comprehensive perinatal addiction program were studied: 7 women abused PCP prior to and during pregnancy, and these women were compared to a group of 27 drug-free women. No differences between the two groups were seen in maternal age, gravidity, gestational age or Apgar scores. At birth, there was no difference in birth weight, length, or head circumference between the two groups of neonates. The most characteristic features of the PCP-exposed infants were the sudden outbursts of agitation and rapid changes in level of consciousness, similar to responses described in adults intoxicated with PCP. Scores on the Brazelton Neonatal Behavioral Assessment Scale revealed a significant increase in lability of states and poor consolability in PCP-exposed infants. 3-month scores on the Bayley Scales of Infant Development revealed no significant difference between the two groups of infants.

The Slingerland Screening Tests: Local Norms

In order to increase the utility of the Slingerland Screening Tests, percentile rank norms were calculated for 2272 elementary school students in grades K through 6. Tables of norms are presented for key percentile ranks. Separate tables of norms were calculated for males and females since significant mean sex differences were found. The split-half reliability coefficients obtained lend firm support to the notion that the tests are reliable.

The effects of maternal narcotic vs nonnarcotic addiction on neonatal neurobehavior and infant development

There is no question that the number of women using and abusing nonnarcotic drugs far exceeds the number who are addicted to narcotics (Chambers and Hart 1977). Current data show that 63% to 93.5% of women use analgesics during pregnancy and that sedative drug use ranges from 22% to 28% (Doering and Stewart 1978; Forfar and Nelson 1973; Hill 1973). However, until recently, little attention has been given to pregnancies complicated by the maternal use of drugs other than heroin and methadone.

350 COCAINE USE IN PREGNANCY

With the increasing use of cocaine in the United States, there has been growing interest in its effects on the fetus and neonate of the pregnant abuser. Two groups of cocaine-using women (Group I, N=10, cocaine use only; Group II, N=10, cocaine plus methadone maintenance for narcotic addiction) enrolled in a comprehensive perinatal addiction program were studied and compared to a group of women with a history of narcotic use only, maintained during pregnancy on methadone (Group III, N=15) and a group of drug-free women (Group IV, N=15). All 4 groups were similar for maternal age, socioeconomic status and cigarette use, and the 3 drug-using groups were similar for alcohol and marijuana use. Gravidity was similar for all 4 groups, but women in each of Groups I and II had a significantly higher rate of spontaneous abortions, abruptio placentae and premature delivery than women in either Group III or Group IV. In the series of pregnancies under study, 4 pregnancies in Groups I and II had onset of labor with abruptio placentae immediately following IV self-injection of cocaine. Mean neonatal gestational age, birth weight, length and head circumference were not affected by cocaine use. Utilizing the Brazelton Neonatal Behavioral Assessment Scale, cocaine-exposed infants showed more irritability and state lability than either methadone-exposed or drug-free infants and significant depression of interactive behaviors, especially visual orientation.

249 DEVELOPMENTAL CONSEQUENCES OF INTRA UTERINE EXPOSURE TO NARCOTIC VS. NONNARCOTIC SUBSTANCES

Although there is a great deal of information regarding the long-term growth and development of infants born to mothers who used and abused narcotic substances during pregnancy, there is little information regarding outcome of nonnarcotic-exposed infants. Two groups of infants born to drug-addicted mothers were evaluated over a period of 2 years and compared to a control group of drug-free infants. Group I infants (N=40) were delivered to mothers on well-controlled low-dose methadone maintenance and Group II infants (N=24) were delivered to poly-drug-addicted women who used Valium, marijuana, PCP, phenobarbital, cocaine and alcohol in various combinations. Group III infants (N=35) were delivered to drug-free mothers. All 3 groups were similar in maternal age, education, cigarette use and socioeconomic class and neonatal gestational age and Apgar scores. Weight and length of Group I infants were significantly smaller through 6 months of age but by 12 months had caught up to control infants1 weight and length. Mean head circumference for Group I infants was significantly decreased at birth and continued to be so through 2 years. Group II infants showed no deviation from control infants in all growth parameters except that a subgroup of PCP-exposed infants exhibited a small head circumference. On the Bayley Scales of Infant Development, no differences were found between the 3 groups although all 3 groups exhibited a downward trend by 2 years of age.

THE EFFECTS OF MATERNAL NARCOTIC VS NONNARCOTIC ADDICTION ON NEONATAL NEURO-BEHAVIOR AND INFANT DEVELOPMENT

In order to evaluate the effects of maternal abuse of non-narcotic drugs during pregnancy, four groups of infants born to drug-addicted mothers were evaluated and compared to a control group of normals. Group I infants (N=51) were delivered to mothers on methadone maintenance, Group II infants (N=22) to sedative/stimulant (nonnarcotic)-abusing mothers, Group III (N=13) to Ts and blues-abusing mothers, Group IV (N=9) to PCP-abusing mothers and Group V (N=27) to mothers who had no evidence of drug abuse. All five groups were similar in maternal age, gravidity, socioeconomic class and neonatal gestational age. Significant decreases in weight, length and head circumference at birth were found (ANOVA) for the narcotic-exposed (Groups I and III) infants while nonnarcotic-exposed infants demonstrated normal growth parameters at birth. Using the BNBAS, Group I infants demonstrated deficits in visual and auditory orientation and motor maturity. All four groups of drug-exposed neonates demonstrated deficits in state control. Group IV infants, in addition, showed increased lability of state and poor consolability when compared to all other drug groups (Fischers LSD). On the Bayley Scales, scores for all groups, including the control, began to fall away from the normal range at 18 months of age, a phenomenon not uncommon in infants from lower socioeconomic homes.