REPRODUCTIVE RISKS OF COCAINE

Cocaine use during pregnancy in the USA has increased dramatically in the past decade, and has resulted in an associated increase in a varie ty of maternal and perinatal complications. However, a number of confo unding factors make it difficult to determine the direct impact of per inatal cocaine use on maternal and fetal outcome, Many substance-abusi ng women use multiple drugs while pregnant, receive inadequate prenata l care and are predisposed to other health problems that impact on per inatal outcome. As a result of the rapid clearance of cocaine and limi tations of available screening methods, the identification of individu al users can be difficult, Furthermore, the determination of accurate prevalence rates of cocaine use during pregnancy has been frustrated b y sampling bias, Cocaine has profound systemic and cardiovascular effe cts in both the mother and the fetus, and as a result a number of comp lications (i.e. fetal malformations, preterm labour, placental abrupti on) have been attributed to perinatal cocaine exposure, In addition, m aternal cocaine use has been associated with a number of neonatal abno rmalities, including cardiopulmonary effects, somatic changes and neur obehavioural sequelae. It is estimated that US $500 million dollars in additional health expenditure resulted from increased neonatal hospit al costs and longer lengths of stay for cocaine-exposed neonates. This article reviews the reproductive risks associated with prenatal cocai ne hse. The pharmacology and physiology of cocaine in relation to preg nancy is discussed, and the impact of this substance on the growth and development of the fetus and infant is reviewed.