Effects of PCP, Cocaine on Unborn: A Tragic Picture

Scientists have long known that babies whose mothers use heroin and methadone are born with drug addictions of their own as well as some serious long-term physical and mental problems. But only recently have medical researchers begun to study the effects of cocaine and PCP (phencyclidine) on unborn children--and the picture they are seeing is not pretty.

The offspring of these drug users typically suffer numerous small strokes before they are born, some are irritable and often inconsolable at birth, others are nearly catatonic and many are unable to master basic physical skills as infants. What’s more, scientists now suspect, the abnormalities may be permanent.

What makes the problem even more troubling are indications that the incidence of drug abuse by pregnant women is rising rapidly. Testifying at a special hearing called Wednesday by Los Angeles County Supervisor Ed Edelman, Jean McIntosh of the Department of Children’s Services said that, since 1981, her department had recorded a 453% increase in infant and child drug problems. Only a portion of the increase can be attributed to more accurate medical tests and better reporting, she said.

In the first six months of 1985 alone, more than 300 babies were born in Los Angeles County showing symptoms of drug withdrawal, according to the Department of Health Services. And those figures include only the number of cases reported to government authorities. Many cases, medical experts contend, go unreported.

Initially, medical researchers had assumed that once drug-abused babies were forced to go “cold turkey” from the chemicals that entered their systems in utero, the newborns would fairly quickly overcome vomiting, diarrhea and the other initial symptoms of withdrawal.

“Much to our dismay, we are finding that is not the case,” said Dr. Judy Howard, medical director of UCLA’s Suspected Child Abuse and Neglect Team, which is conducting one of several new studies of the long-term effects of mothers’ drug abuse on newborns.

Howard said “many serious” mental and physical problems are evident in the child’s first few months of life and “numerous indications . . . (of) serious abnormalities in the brain structure that will not be revealed until later years.”

Said Dr. Xylina Bean, a neonatalogist at King-Drew Medical Center in South-Central Los Angeles, “There is almost no literature on this subject. . . . But what we are seeing is very troubling.

“Typically they (the babies exposed to PCP) are very alert, very active babies,” Bean said. “Their mothers often think they are smarter. They hold their heads up faster. . . . But, in fact, it is abnormal behavior. Although we aren’t sure why, the tone of the muscles in the head is of the kind that we see in (children with) cerebral palsy,” a disorder of the central nervous system characterized by spastic paralysis or other forms of defective motor ability.

By six months of age, Howard said, these children continue to display the jitteriness, tremors and irritability they showed at birth.

By nine months, she said, the children “still can’t figure out how to make their hands work.”

By 12 months, according to a study conducted by Dr. Willis Wingert, director of Pediatric Ambulatory Services at Los Angeles County-USC Medical Center, the IQs of these youngsters begin to drop.

By 20 to 24 months, Howard said, they “can’t get their tongues to coordinate to be able to form words.”

“We are working in a new frontier and we often don’t even know what to look for,” Howard explained in an interview. “We have to learn how to begin to think about these things. One way is to look at the effects of PCP on adult users. They often say they don’t know where their arms are in space. That appears to be true of the babies. The babies who are trying to learn to walk appear (not to) . . . know where their legs age.”

“But they are beautiful,” Howard added. “For reasons we also don’t know, they are the most gorgeous children I have ever seen.”

By contrast, she said, babies whose mothers consumed cocaine during pregnancy often developed chromosomal problems that resulted in congenital abnormalities--ears placed too low, eyes set too far apart.

These children often have been subjected to numerous small strokes because of abrupt changes in their mothers’ blood pressure during pregnancy, Howard explained. After birth, the babies are typically lethargic, almost catatonic. “I’ve noticed they have visual attention problems,” she said. “They often can’t focus on their parents’ faces.”

In many cases, doctors do not know how much of the children’s physical and mental problems are the result of poor nutrition and generally inadequate prenatal care, but there is general agreement that many of the problems must be at least partially the result of their mothers’ drug consumption.

So far, there is little more than anecdotal evidence of what happens to these children once they enter school. Medical researchers and public health officials only now are beginning to study the long-term effects. And their efforts, they say, are complicated by many factors.

In many cases, for example, researchers have been unable to track the children once they leave the hospital because their parents, who often remain drug users, are unlikely to make regular visits to a doctor. Even when the children are placed in foster homes it is difficult for the researchers to distinguish between the early physiological problems and later environmental factors that may affect the child’s normal development.

Experts in the field are not even certain they know who the typical pregnant drug abuser is.

Although the data suggests that the vast majority of the mothers are blacks and Latinos in their 20s, Bean points out that these studies are being conducted at county hospitals, which primarily serve black and Latino populations. Private hospitals, which serve mainly a white clientele, she said, simply do not report or collect data on prenatal drug abuse.

“Anybody who has ever watched TV knows that cocaine is the drug of favor in Beverly Hills and places like that. It’s extremely hard for me to believe that there are no women of child-bearing age having infants in those areas,” Bean said.

Concluded Howard, who is a physician trained as a child development specialist:

While many people may be critical of women for consuming illegal drugs while they are pregnant, “I must say, in their defense, I didn’t know there were problems. . . . How can we expect these young mothers to know? . . . What we need to do next is educate people about what the potential problems may be.”