pregnancy and cocaine abuse
Last reviewed 11/2020
- 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
- placental abruptio and pre-term rupture of membranes are the only confirmed
problems associated with cocaine use
- 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.