Cocaine use in pregnancy.

BACKGROUND Cocaine use during pregnancy has many deleterious effects on both the mother and the fetus, including the following: preterm labor (< 37 weeks' gestation), congenital anomalies, intrauterine growth retardation (IUGR), abruptio placenta, low-birth-weight infants (< 2500 g), neonatal death, and sudden infant death syndrome (SIDS). Potentially catastrophic maternal outcomes include a pre-eclampsia-like syndrome, acute pulmonary edema, seizures, cardiac arrhythmia, and sudden death. Family physicians who practice obstetrics might encounter cocaine-abusing women as part of their primary care practice. This article reviews the current knowledge regarding the pharmacology, pathophysiology, prevalence, demographics, and methods of detecting cocaine use in pregnancy. METHODS Material for this paper came from a MEDLINE review of the literature from 1988 to the present. RESULTS AND CONCLUSIONS Family physicians who practice obstetrics, especially those who practice in urban minority settings, are likely to encounter pregnant women who are abusing cocaine. Signs of maternal cocaine use are dilated pupils and increased heart rate, blood pressure, respirations, and reflexes. Other signs include agitated sensorium, arrhythmias, and seizures. Preterm labor, pre-eclampsia, and acute pulmonary edema can all be caused by maternal cocaine use. Methods of testing for cocaine are urine or meconium drug screening. Hair analysis is presently being researched but is not yet at a level of clinical reliability. Getting the patient into prenatal care as early as possible has been shown to improve birth outcomes.