Correspondence

Use of Cocaine during Pregnancy

N Engl J Med 1993; 329:667August 26, 1993

Article

To the Editor:

Exposure of the fetus to cocaine may lead to serious destructive lesions in the brain1-3. Results of brain imaging studies in newborns have revealed that ischemic cerebral lesions may occur, leading to clinical manifestations when large. Fetal death in women using cocaine during pregnancy has been most frequently related to abruptio placentae. We report a case of fetal death with generalized cerebral ischemia and necrosis that was probably related to maternal abuse of cocaine in late pregnancy.

A 28-year-old woman with a history of cocaine abuse became pregnant in February 1992 and was followed at our antenatal clinic from the 13th week of gestation. At that time, she stated that she had stopped using cocaine two months earlier. Urine toxicologic screening for cocaine was negative at 13 and 30 weeks of gestation. The course of the pregnancy was initially uneventful, with normal laboratory tests and fetal ultrasonography at 13, 20, and 32 weeks. At 39 weeks of gestation, fetal death was diagnosed by auscultation during a routine visit and confirmed by ultrasonography. The next day, a dead male infant weighing 2700 g was delivered. The patient stated that she had been taking cocaine by nasal insufflation during the previous three weeks. Blood and urine tests for cocaine were positive. On fetal autopsy, signs of generalized cerebral ischemia and edema were found, with extensive infarction in the distribution of major cerebral vessels.

In rare instances, cerebral infarction may lead to death in fetuses exposed to cocaine. Ischemia caused by transient vasoconstriction has been proposed to explain common findings associated with cocaine use during pregnancy. As in adults, vasospasm may be crucial in the genesis of ischemic cerebrovascular phenomena in the fetus.

Eduard Gratacos, M.D.
Pere Joan Torres, Ph.D.
Eugenia Antolin, M.D.
Universitat de Barcelona, 08036 Barcelona, Spain

3 References

1. 1

   Volpe JJ. Effect of cocaine use on the fetus. N Engl J Med 1992;327:399-407
   Full Text | Web of Science | Medline

2. 2

   Dixon SD, Bejar R. Echoencephalographic findings in neonates associated with maternal cocaine and methamphetamine use: incidence and clinical correlates. J Pediatr 1989;115:770-778
   CrossRef | Web of Science | Medline

3. 3

   Handler A, Kistin N, Davis F, Ferre C. Cocaine use during pregnancy: perinatal outcomes. Am J Epidemiol 1991;133:818-825
   Web of Science | Medline