Pregnancy and cocaine abuse

• some evidence that suggests there is a link between stillbirths, miscarriages through placental detachment (placenta abruptio), premature labour and delivery and low birth weight and small-for-dates babies, though this may reflect lifestyle and smoking rather than a direct effect
  • placental abruptio and pre-term rupture of membranes are the only confirmed problems associated with cocaine use
    • placenta abruptio, if it occurs after 24 weeks would result in pre-term labour not miscarriage
    • abruption does not inevitably result in delivery at the time; this depends on the extent of the abruption and may or may not result in the death of the fetus
  • approximately one quarter to one third of the cocaine will pass across the placental barrier to the foetus, which may lead to agitation and apnoea initially at birth
    • most of these symptoms will settle by comforting the baby and avoiding loud noises or bright lights (the 'crack' baby image is a myth)
  • heavy cocaine use is likely to be incompatible with successful breast-feeding so, if breast-feeding is successful, cocaine use will not be too high to allow it. Consequently there is no reason why cocaine using women should not be encouraged to try breast-feeding since their more vulnerable babies have most to gain from it
    • all women should be encouraged to breast-feed except, currently, those who are HIV positive
• women using cocaine during their pregnancy should be advised to stop altogether, as there is no safe drug for substitute prescribing (2)
  • psychological therapies, including family interventions, should be offered to this group of women.

Reference:

• (1) RCGP (2004). Guidance for working with cocaine and crack users in primary care
• (2) RCGP (2007). Drug misuse and dependence: UK guidelines on clinical management.