ULTRASOUND DIAGNOSIS OF FETAL ANOMALIES ASSOCIATED WITH IN-UTERO COCAINE EXPOSURE - FURTHER SUPPORT FOR COCAINE-INDUCED VASCULAR DISRUPTIONTERATOGENESIS

The dramatic increase in cocaine use over the past decade has led to a concern about its possible teratogenicity. We have identified 6 struc tural fetal anomalies which we postulate may have cocaine-induced vasc ular accidents as the teratogenic mechanism: 2 complex choriod plexus cysts, gastroschisis, meconium peritonitis, urethral stenosis, and rad ial hypoplasia. Two additional anomalous neonates were born to perinat al cocaine users. Eight of 51 (15.7%) cocaine-exposed perinates exhibi ted anomalies versus 120 of 2,194 (5.4%) perinates without known cocai ne exposure during this time period. This represents a 3-fold relative risk (RR = 2.87, OR = 3.22, chi square = 9.68, p < 0.005) for the coc aine-exposed fetus. Subjects were all identified as cocaine users prio r to ultrasound-detected anomaly and ultrasonologists were blinded to maternal drug history. The vascular disruption model as the plausible mechanism for cocaine-associated teratogenesis is supported by the typ e of anomalies reported. In addition, cocaine use was prospectively de termined to have occurred at the critical developmental period in each case.