Richard K. Stone

Teratogenicity of cocaine in humans

To study teratogenicity of cocaine in humans, we studied three groups of pregnant women and their offspring: group 1, 50 women who abused cocaine only; group 2, 110 women who were polydrug abusers; and group 3, 340 who were drug free. All three groups were similar for socioeconomic status, cigarette smoking, and ethnicity. Maternal age of group 1 was similar to that of group 3, but group 2 mothers were significantly older. Gravidity was significantly higher in groups 1 and 2 compared with group 3. No statistical difference was found in spontaneous abortion rate among the three groups, but the stillbirth rate was significantly higher in group 1 (chi 2 = 6.89, P less than or equal to 0.01). All stillbirths were related to abruptio placentae. Birth weight, length, and head circumference were significantly decreased in infants in groups 1 and 2 compared with group 3 (P less than or equal to 0.0001), but no statistical difference was found between groups 1 and 2. The congenital malformation rate was significantly higher in group 1 compared with group 3 (chi 2 = 7.07, P less than or equal to 0.01). We conclude that cocaine abuse in humans significantly reduces weight of the fetus, increases the stillbirth rate related to abruptio placentae, and is associated with a higher malformation rate.

Early Presentation with a Desmoid Tumor Discovery of Multiple Colonic Polyps

A 14-year-old patient who was eventually found to have Gardner syndrome initially presented at the age of 3 years with a desmoid tumor involving the scalp. A careful review of the family history revealed a high incidence of colonic cancer, which prompted endoscopic evaluation of the patient. The discovery of adenomatous polyps in the colon confirmed the diagnosis of Gardner syndrome. In patients with hard or soft tissue tumors, the possibility of Gardner syndrome should be kept in mind, and a thorough family history taken. Early diagnosis may prevent malignant transformation of colonic polyps.A 14-year-old patient who was eventually found to have Gardner syndrome initially presented at the age of 3 years with a desmoid tumor involving the scalp. A careful review of the family history revealed a high incidence of colonic cancer, which prompted endoscopic evaluation of the patient. The discovery of adenomatous polyps in the colon confirmed the diagnosis of Gardner syndrome. In patients with hard or soft tissue tumors, the possibility of Gardner syndrome should be kept in mind, and a thorough family history taken. Early diagnosis may prevent malignant transformation of colonic polyps.

Incidence of major congenital malformations in offspring of alcoholics and polydrug abusers

The incidence of major congenital malformations was compared in the offspring of mothers who abused alcohol only (group I), versus mothers who abused alcohol and opiates (group II) during pregnancy. In group I the percent of patients with malformations was 33, where as in group II it was 14. The prevalence of fetal alcohol syndrome was higher in blacks than Hispanics. Independent of race the alcohol-opiate combination seems less teratogenic to the fetus than alcohol alone.

MATERNAL DRINKING AND FETAL CLUBFOOT

We studied the prevalence of clubfoot in 129 patients with Fetal Alcohol Syndrome (FAS) or Alcohol Related Birth Defects (ARBD) aged 1-24 years. The mothers were all chronic alcoholics who abused ≥ 3 oz of absolute alcohol/day before and during pregnancy. They were divided in 2 groups: group I: alcohol abusers and group II: polydrug abusers (alcohol + narcotics ± cocaine). Group I comprised 55 mothers (40 blacks, 15 Puerto Ricans) and group II 30 (19 blacks, 11 Puerto Ricans). The socio-economic background, duration of alcoholism, average age at delivery and type of delivery were comparable in both groups.Four patients (all males, 2 blacks and 2 Puerto Ricans) were found to have talipes equinovarus, as well as other anomalies. Three had bilateral and one unilateral clubfoot. All four were seen in the nursery, where the deformities were corrected, and two were followed in clinic. Two mothers belonged to group I and two to group II.The occurrence of clubfoot in our study is significantly higher (P<0.01) than the accepted rate of 1.2/1,000.In the embryo marked equinovarus is a normal stage of development. In the newborn it means permanent growth arrest, which might have been caused by various agents: viruses, radiation, thalidomide, etc. Since narcotic addiction during pregnancy does not result in congenital malformations in the offspring we submit that alcohol, a known teratogen, should be added to the above list

549 FAMILIAL FETAL ALCOHOL SYNDBOME INCIDENCE IN BLACKS AND HISPANICS

In a previous study we noted a higher incidence of fetal alcohol syndrome (F7AS) in blacks, vs. Hispanics. We new compared the incidence of familial FAS and alcohol-related effects (ARE) in black, (group I) and Hispanic (group II) patients, ranging in age from 1 day to 20 years. The average age of mothers at first visit was slightly higher in group II (31 vs. 28.6 in group I). The amount of alcohol abused during pregnancy (≥ 3 oz of absolute alcohol/day), average duration of alcohol abuse and socio-economic background (on public assistance, unwed mothers) were similar in both groups. Group I comprised 16 families with 39 children, 16 females and 23 males. Eleven families had 2 afflicted children, 4 families had 3 and one family had 5 afflicted children. FAS was diagnosed in 25 patients and ARE in 14. Group II comprised 7 families with 17 children, 10 females and 7 males. Five families had 2 afflicted children, one family had 3 and 1 family 4 afflicted children. FAS was found in 13 patients and ARE in 4. Though our clinic population is 65% Hispanic, familial FAS was significantly more frequent in blacks (P < .01). We conclude that for yet unexplained reasons single and multiple cases of FAS are more frequent in black than in Hispanic families.