Maternal-fetal and neonatal effects of in utero cocaine exposure.

Abstract

I nfants passively exposed to cocaine are the most poignant examples of the exacting toll taken by the drug abuse epidemic that has swept our nation. Khalsa and Gfroerer have reported in this issue that the most recent National Household Survey on Drug Abuse showed an encouraging decline from 1985 to 1990 in the prevalence of cocaine use during the last month and during the last year among women of childbearing age. Whether this positive trend will be reflected by a concomitant decrease in the prevalence of cocaine use by pregnant and postpartum women has yet to be determined. Although perinatal substance abuse transcends race, ethnicity, and socioeconomic status,“’ it is no exaggeration that inner city hospitals are overwhelmed with the current wave of cocaine-exposed pregnancies. The University of Miami/Jackson Memorial Medical Center (UM/JMMC) has one of the largest perinatal services in the country (approximately 15,000 annual deliveries) zlid serves a predominantly indigent population. Detailed maternal histories and urine toxicology assays were performed on 215 consecutive deliveries by Abbott TDx fluorescent polarization immunoassay (Chicago, IL), with confirmation by gas chromatography mass spectrometry.3 Exposure to cocaine and marijuana was found in 12% and 17%, respectively, of the mother-infant dyads. These cases documented by maternal history