PATTERNS OF COCAINE BINGING - EFFECT ON PREGNANCY

OBJECTIVE: The purpose of this study was to determine how cocaine and crack binging affected perinatal complications. STUDY DESIGN: Between Jan. 1 and Dec. 31, 1989, patterns of cocaine-crack binging and perina tal consequences in 905 pregnant women from multiethnic, multiracial, inner-city populations were studied. Binging cycles reflect the chaoti c lifestyle of drug abuse and multiple obstetric at-risk cofactors as integral parts of binging and are more accurately defined than amount of drugs consumed.RESULTS: Binging patterns in 905 pregnant women who use cocaine-crack as their primary drug were as follows: group 1, 78 w omen with ''erratic'' binging that is variable in intervals, duration, and amounts but who are very aggressive drug seekers; group 2, 67 wom en who binged daily; group 3, 760 women who binged in cycles at 3-, 5- , 7-, or > 7-day intervals. Binges ranged from 26.4 to 34.4 hours. Com plications were proportional to the frequency of binging, (linear asso ciation p < 0.0007). The prematurity rate in group 1 was unexpectedly as high as that in group 2 (35.9% vs 34.3%). Acute problems (vaginal b leeding 21.8%, abruptio placentae 14.3%, stillbirths 20.5%) were most significant in group 1, while chronic problems (small-for-gestational- age infants 32.8%, systemic infections 31.3%, anemia 35.6%, and low ma ternal weight [<100 pounds] 32.8%) were more significant in groups 2 a nd 3. Odds ratios show that prematurity, abruptio placentae, and vagin al bleeding were two to three times more likely to occur if test resul ts for cocaine were positive at delivery. However, in group 1 the like lihood of abruptio placentae was unchanged whether toxicologic test re sults were positive (14.3%) or negative (14.0%), reflecting the role o f cofactors in binging. CONCLUSION: Erratic use of cocaine-crack resul ts in perinatal complications that are as severe as those occurring wi th daily binging but the patterns differ. Cofactors play a significant role in outcomes.