Running head: EFFECTS OF PRENATAL COCAINE USE ON NEWBORNS

Prenatal Cocaine Use and the Effects

On Newborns

Thomas Duffy, Anthony Scandy, Vince Sferra, Ian Hileman

Youngstown State University

Abstract
EFFECTS OF PRENATAL COCAINE USE ON NEWBORNS

While addiction is a growing concern in our nation, it’s not only adults that are of

concern when the topic comes up anymore. More often than not, we are now more concerned

with the life of the children who are affected by addiction, and even more specifically, the lives

of those unborn: in other words fetuses who are burdened by maternal addiction. The number of

prenatal cocaine use in the United States continues to be a major problem and is estimated to be

the cause of many complications during pregnancy not only for the mother, but also for

newborns. Researchers have done studies to determine whether cocaine use by the mother during

pregnancy has an effect on the newborn’s birth weight, head circumference, cognition deficits,

longer hospital stays, respiratory distress syndrome, withdrawal syndrome and even prematurity.

Children born to cocaine addicted mothers also were found in adoption center or foster care

homes. Cocaine use during pregnancy is a common theme, especially for those of the lower class

and while there are treatments that can be done after the baby is born to attempt to correct any

abnormalities; the focus of treatment needs to be done far before the child is born because lack of

prenatal care tends to be a common theme. Gaining knowledge about the harmful effects of illicit

drug use is just one simple adjustment that can be made. The objective of research is determine

whether or not cocaine plays a factor in child abnormalities or if there are other factors being

overlooked, as well as treating any abnormalities that may appear when they are born.

Prenatal Cocaine Use and the Effects on Newborns

Drug use has become a much more common phenomena throughout the years, with

police making drug busts more now than ever, children using drugs at younger ages and

drugs being easily accessible by various means. Of the many different kinds of drugs you are

able to find, cocaine is a popular drug that can be smoked or inhaled and can predispose the body

to harmful effects. Drug use in general is not the only problem on the rise; drug use during
EFFECTS OF PRENATAL COCAINE USE ON NEWBORNS

pregnancy is also a growing concern by not only harming the mother’s body, but also the fetus’

body through the umbilical cord and other means. Based on the knowledge that there are

mother’s who abuse cocaine, the following research question has been formed: Are children who

are born to cocaine addicted mothers more likely to have a lower birth weight than children who

are born to drug free mothers?

Literature Review

Introduction

In order to gather more information to distinguish the relationship between prenatal

cocaine exposure in children born to mothers’ who abused cocaine and whether or not prenatal

cocaine exposure influenced their birth weight; information was gathered via OhioLINK

databases, more specifically CINHAL Plus and Proquest. In order to find consistent yet different

variations of data collection, eight articles were reviewed to view the relationship the mother’s

cocaine abuse had on the child’s birth weight.

Cocaine

Cocaine is an illegal addicting drug that can be harmful to the body and cause

changes to the brain. It also starts an addictive lifestyle that affects many aspects of the

abusers’ lives. It is a schedule II drug that can be used as an anesthetic and it is also a

central nervous system stimulant. Cocaine is available in two different forms; cocaine

hydrochloride which is a powder that is inhaled and also crack cocaine which can be

smoked. Cocaine causes constriction of the blood vessels which leads to high blood pressure and

tachycardia. According to a report by the National Pregnancy and Health Survey (NIDA, 1996) it

was estimated that 45,000 infants were born that were exposed to prenatal cocaine use. In 2002,

a report done by the National Survey on Drug Use and Health found that three percent of women
EFFECTS OF PRENATAL COCAINE USE ON NEWBORNS

who were pregnant between the ages of eighteen to forty-five reported illicit drug use in the past

month. While cocaine use is seen among all races and socioeconomic classes, African American

women of low socioeconomic classes are found to have abused cocaine the most; especially if

there was evidence of a lack of prenatal care.

How Babies in Utero are Affected

In 2011, a study was conducted by De Castro to explore the correlations with maternal

methadone dose and neonatal outcomes, and to test the ability to detect in utero exposure to

illicit drugs. The study contained nineteen opioid dependent subjects from two different trials

and determined the window of detection of drugs in the umbilical cord. This study was looking

at methadone specifically but also women who were addicted to a variety of substances

throughout their pregnancy. According to the study, during the pregnancy, “cocaine and opiate

positive umbilical cords concentrations were compared to those in placenta and meconium.” The

study found that the methadone was significantly present in the umbilical cord. While the

umbilical cord is a great indicator of drug exposure for infants, testing meconium has been

proven to be great for testing for drug exposure including cocaine.

In 1994, Mahone and his colleagues researched a similar relationship between the

babies in the uterus and the cocaine the mother’s were ingesting. Similar findings were

present, as the fetus can receive the cocaine from the mother through the umbilical cord,

placental vessels, and the amniotic fluid; which the fetus can ingest the cocaine. Mahone

also found that the fetus has a slower metabolism, which makes the infant exposed to

cocaine for a much longer time compared to the mother using cocaine. Ogunyemi and

Hernandez-Loera found similar results by researching the effects that cocaine has on

pregnant women. They backed up results from Mahone in that cocaine is present in the
EFFECTS OF PRENATAL COCAINE USE ON NEWBORNS

amniotic fluid, but also found that urine tests twelve to twenty four hours after birth are a

great indicator of maternal cocaine use. While also identifying meconium as well to back

up De Castro’s findings, a hair analysis can be a test done months after the baby is born to

test for maternal cocaine use.

In 1998, Eyler conducted a study looking at the relationship that cocaine has on babies in

utero between a group that abused cocaine and a control group with no exposure. Upon

completion of the study, Eyler found that the first trimester was the most common time for

women to abuse cocaine, mostly due to women being unaware of their pregnancy. The first

trimester is the most critical for a child’s development, so using substances during this stage can

be life threatening for a fetus or have a major impact on the development of the child.

Results Upon Childbirth

In 2002, Singer and his colleagues analyzed 218 infants exposed to cocaine in the uterus

with 197 infants who had no prior exposure used as the control group and not only found that the

infants prenatally exposed to cocaine had a lower birth weight, but also were delivered earlier

with a smaller head circumference. Bandstra came to similar conclusions in 2001, finding that

the birth weight alone was less for the infants prenatally exposed to cocaine. Bandstra and

Singer looked at similar populations; both focusing on African American women who

revealed a history of cocaine use with a low socioeconomic status background while using a

control group and a polydrug group to find results.

Richardson constructed a similar study in 1998, looking at 295 infants who were exposed

to cocaine while in utero and received no prenatal care, comparing the results to 98 infants who

received prenatal care by a physician by at least the fifth month of pregnancy while also being

prenatally exposed to cocaine. Richardson noted that both groups saw a reduction in birth
EFFECTS OF PRENATAL COCAINE USE ON NEWBORNS

weight, length, gestational age, and head circumference regardless of receiving prenatal care. At

the end of each trimester, Richardson conducted work to make sure each person was compliant

and looking for other confounding factors such as use of other substances during pregnancy.

In 1998, Eyler constructed similar research design and contrastly found that cocaine use

during pregnancy had no effect on the babies’ birth weight upon birth which consequently

presented with no abnormalities upon birth. Eyler identified 154 pregnant women who were

African American and of low socioeconomic status who used cocaine during pregnancy

excluding participants if they claim to have taken substances other than cocaine and marijuana

against a control group of the same number. Although Eyler noted no difference in birth weight

between the babies being born; a low head circumference, a low chest circumference, and a

increased incidence of prematurity was found in the group that was exposed to cocaine.

In the year 2000, Bateman and Chiriboga had done a slightly different study by

researching if the amount of exposure to cocaine had any different effects on a newborn by

grouping two hundred and forty full term infants into different groups while making

changes if there were other complications present. The three groups were defined as no

exposure, low exposure, and high exposure. There were one hundred and thirty six infants

making up the no exposure, fifty two making up the low exposure, and fifty two making up

the high exposure group. Upon completion of the study, changes were only found in the

high exposure group with no changes for those with low exposure to cocaine, noting that a

decrease in head circumference and a decrease in birth lengths were present compared to

the group not exposed to cocaine.

Ogunyemi and Hernandez-Loera took four hundred women; two hundred who had a

history of cocaine exposure and two hundred women who had no exposure while pregnant. Of
EFFECTS OF PRENATAL COCAINE USE ON NEWBORNS

the two hundred women who were exposed to cocaine, eighty four percent tested positive for

cocaine use during pregnancy via blood work and the group also had a higher average age than

the group not exposed to cocaine; the vast majority were unemployed. The pregnant women who

had a history of cocaine use were found to give birth earlier than those who had no cocaine use,

giving birth to children who had significantly less birth weight, and also having longer hospital

stays due to congenital abnormalities and respiratory problems. Of the study group, the highest

level of education was higher than the control group, ninety eight percent of the group was

unemployed, five percent were married compared to thirty five percent of the control

group, sixty seven percent admitted to smoking more than five cigarettes per day, thirty

seven percent consumed alcohol, eleven percent tested positive for opiates, and twenty

percent previously reported marijuana use. Contrastly, in the study group, three percent

stated tobacco use, two percent reported alcohol use, and one percent stated previous

marijuana and opiate use.

In 1985, Chasnoff conducted a study to study the effects of cocaine on neonates and

fetuses. The study included twenty three women who used cocaine or other substances by

breaking them into two groups based on whether or not they solely use cocaine or if they use

cocaine in addition to other drugs. It then contained two control groups, one of which used no

drugs and the final group used methadone for maintenance during pregnancy. The study began in

January of 1983 and concluded in September of 1984 and overall, twenty three infants were

studied. Chastoff found the participants in this study were similar in the fact that they were the

same number of gestational weeks, came from the same socioeconomic status, similar in the

number of previous pregnancies, and had the same amount of drug use. The study focused on

young women with a history of illicit drug use and attempted to determine the overall effects that
EFFECTS OF PRENATAL COCAINE USE ON NEWBORNS

cocaine itself would have on these children. Throughout the study, urine testing was done.

Findings included a higher rate of spontaneous abortion in subjects who regularly used cocaine.

This substantial piece of evidence proves that cocaine poses an immediate risk to the fetus,

however; birth weight, birth length, head circumference, and premature births were not directly

affected by cocaine use although behavior and response to stimuli were affected by cocaine.

Treatment

H. Westley Clark constructed a study researching treatments for cocaine exposed infants

and found that in the years of 1993 and 1995, the federal government allowed twenty seven

grants to be used to support thirty five different treatment projects for substance abusing women,

both during pregnancy and after delivery. The grants also supported the mother’s children and

their recovery process after birth. The grants came to a grand total of one hundred and thirteen

million dollars. The projects were designed to allow the newborns to live with their mothers..

Most substance abusing women are dealing with other issues also, such as having low income,

poor education, and limited job skills. Maternal substance abuse also produces many different

effects on the pregnancy and fetus. During utero, drug use could result in fetal anomalies, such as

low birth weight, smaller head circumference, and increase in premature births. Often these

situations result in child protection services to intervene, and the possibility of terminating the

mother’s custody of the child. It is necessary that the treatment given to the mothers is child

focused. The goals of the treatment provided from this project are to help pregnant women have

safer pregnancies, deliver healthier newborns, and promote better parenting.

At the start of these programs, forty-two percent of the women participating were

pregnant, forty percent were postpartum with at least one child currently living with them, and

eighteen percent were postpartum with no child in their current residence. The median age of
EFFECTS OF PRENATAL COCAINE USE ON NEWBORNS

mothers participating was twenty nine years old. These women were all chronic substance

abusers prior to being chosen. Eighty eight percent of the women had already been treated for

alcohol or drug abuse prior to this project. Seventy three percent of women had reported abusing

more than one substance, and greater than fifty percent of the women reported that the primary

drug being abused was cocaine. Fifty two percent of mothers had not received a diploma, ninety

two percent did not have a job and forty eight percent of mother’s stated that government

assistance was their main source of income. Treatment resulted in a preterm delivery rate of

seven percent, and five percent had low birth weight deliveries. These statistics are seventy to

eighty percent better than women who are receiving no treatment at all, which proves the project

to be successful. In conclusion, this project indicated that treatment for drug and alcohol abusing

mothers, along with allowing the children to live with their mothers during treatment, is a

successful approach to improve these unfortunate situations.

When a drug addicted mother is willingly able to admit her problem and is eager to start

treatment, the rate of success will be the highest possible. Majority of people can not stop using

cocaine without treatment, or some type of intervention. In one study only twelve percent of

pregnant women were able to stop use of alcohol and drugs without any intervention. It is an

important responsibility of the nurse to ask skillful questions to seek honest information out of

these women. Proper screening includes a proper interview and toxicology of the patient’s urine.

Infants who are exposed to cocaine during utero show hypertonia without the classic signs of

withdrawal being present. Drug and alcohol abusing mothers also pass these drugs and toxins

through their breast milk. In this study there was two reports of infants experiencing signs of

withdrawal. The first infant had seizures after breastfeeding and the mother stated she had used a

topical cocaine powder to ease the pain her nipples were experiencing. The second infant was
EFFECTS OF PRENATAL COCAINE USE ON NEWBORNS

having tremors, vomiting, extreme irritability, and had diarrhea after the infant ingested breast

milk from the mother. In conclusion, this study proved that it is mandatory to be treated to stop

the use of drugs and alcohol in mothers who are abusing them, especially during pregnancy.

Conclusion

While evidence support that prenatal exposure to cocaine can have an effect on the birth

weight of the newborn who was affected, consistency shows that it is not always the case. The

majority of studies show that cocaine can lower the birth weight but there are some studies that

prove that birth weight is unaffected whether or not the newborn was exposed to cocaine.

However, studies do show that while birth weight is not always affected, a factor is always

different from the group that is exposed to cocaine compared to the group that is not, whether

that is a smaller head circumference, higher incidence of premature birth, or even a change in

motor or cognitive functioning. In other words, cocaine use during pregnancy results in harmful

effects for the newborn and sometimes the mother as well. The best treatment for the newborns

affected by cocaine is good prenatal care focusing on safe deliveries and healthy pregnancies

without use of drugs and taking care of the mother's’ body and fetus. Overall, prevention of

drugs is the best intervention.

EFFECTS OF PRENATAL COCAINE USE ON NEWBORNS

De Castro, A., Jones, H. E., Johnson, R. E., Gray, T. R., Shakleya, D. M., & Huestis, M. A.

(2011). Methadone, Cocaine, Opiates and Metabolite Disposition in Umbilical Cord and

Correlations to Maternal Methadone Dose and Neonatal Outcomes. Therapeutic drug

monitoring, 33(4), 443.

Chasnoff, I. J., Burns, W. J., Schnoll, S. H., & Burns, K. A. (1985). Cocaine use in

pregnancy. New England Journal of Medicine. 313(11), 666-669.

D. Ogunyemi, G.E. Hernandez-Loera. (2004). The Impact of Antenatal Cocaine Use on

Maternal Characterisitcs and Neonatal Outcomes. Journal of Maternal - Fetal and Neonatal

Medicine. Retrieved from media.proquest.com

EFFECTS OF PRENATAL COCAINE USE ON NEWBORNS

This study investigates televised portions of the news and they use the networks of ABC, NBC,

and CBS news. During the time frame they studied, 1983 to 1994, there were 84 reported airings

that talked about women and cocaine use. The researchers involved in this study compared the

stereotype of a crack mother to that of a “mugger” stereotype. They used the “mugger” reference
EFFECTS OF PRENATAL COCAINE USE ON NEWBORNS

from another article in their study. The article stated, “ … to effectuate moral panic in England

depended on converging images of race,poverty, the city, violence, and social menace. A similar

convergence had been noted for the stereotype of crack mother: race, addiction, and poverty

linked to sexuality and motherhood justify efforts to regulate pregnancy(Humphries, D, 1998).”

The study investigates all the evidence, such as pictures and the dialogue involved with these

stereotypes throughout the article. Evidence found in this study found the news coverage relating

to drugs follows a pattern in which it grabs everyone's attention, then it reaches the height of its

popularity, and then finally everyone forgets about the subject and pays more attention to other

topics on the news. They found this pattern throughout their study of the years 1983 to 1994. in

the beginning, they interviewed middle class white women, who all mentioned that they did not

go out and find the drug, their significant others gave it to them. They would then find out they

are pregnant and addicted to cocaine. Then, in 1985, the discovery of crack was the popular topic

on the news. There still was a high use of crack use in white women which was 72%. They then

stated in 1987, they began broadcasting it as a minority drug and used Hispanics and African

Americans as the model. Then in 1988 the news aired the first crack mother on television. She

was then the model fitting the image of a crack mother. They covered many court cases of crack

mothers as well. The difference this article found in the models portrayed on news, the white

middle class woman was unknowing of the effects of cocaine of the baby and how easily they

became addicted. They stated that the minority model did not have a choice since there was no

federal funding for abortion. They had to give birth even though they knew what they were doing
EFFECTS OF PRENATAL COCAINE USE ON NEWBORNS

The article studies how environmental factors affect the babies growth and development. The

study wants to find results of development by comparing the babies of cocaine addicted mothers

that were given up for adoption against the babies staying with the original cocaine addicted

mother (no adoption). There was 52 children used. The 52 were divided in half. The first half of

the adopted babies and the other half were, as stated by Nulman, “were controls matched for

maternal IQ, socioeconomic status, and gestational age(Nulman, I., Rovet, J., Greenbaum, R.,

Loebstein, M., & et al, 2001).” The result categories used were head circumference, McCarthy

General Cognitive Index, language performance and temperament test. Every adopted mother

was grouped to the first woman in The Motherisk Program database. The groupings were based

on similar socioeconomic status, the maternal IQ, and infants gestational age. Pre-term babies

were grouped based on gestational age and the babies age at screening. The statistics associated

with babies were found through interviews of mothers and reading medical records. These stats

included things like birth weight, complications, etc. The maternal IQ used the WAIS-R to

obtain the results. The babies were then assessed by a doctor for a physical and neuro

assessment. Each baby that was tested were around the same age of 31-94 months. The cocaine

addicted mothers were younger than the mothers were adopting. The study finds that the babies

will be deficient in their language, be a high risk for developing ADHD, and IQ in both groups.

The results may have some variability relating to the addicted mother. Most addicted mothers

tend to smoke cigarettes, drink alcohol,and consume other drugs. These can also affect these

babies and it hard for them tell how those substances affect each baby
EFFECTS OF PRENATAL COCAINE USE ON NEWBORNS

Bays, J., MD. (1992). The Care of Alcohol and Drug Affected Infants. Pediatric Analls.

Clark, H. W. (2001). Residential Substance Abuse Treatment for Pregnant and Postpartum
Women and Their Children: Treatment and Policy Implications. Nursing & Allied Health
Database.