If you're a woman in your childbearing years and you use cocaine, you are pushing your luck, warns a researcher at Penn State's Milton S. Hershey Medical Center.
Just one hit of cocaine taken by a pregnant woman may be enough to cause defects or even kill her fetus, according to Dr. Warren Wasiewski, who also is a pediatric neurologist at Hershey.
The physiologic response from a single dose of cocaine or crack may cause premature labor, stroke in the fetus, or stillbirth. And babies born to mothers who abuse cocaine have problems such as low-birth weight, small heads, kidney malformations and possible neurological injury.
Most drug-abusing women are not aware of these devastating effects, so there is a crying need for educational programs geared not only to inner-city women but to middle-class users who perhaps might be easier to reach, Wasiewski said.
"Women of childbearing age must realize that even if they stop using illicit drugs after they know they are pregnant, it may be too late for their babies," he added.
It's important to get the word out, he said, because research now reports that 17% of inner-city women are using cocaine. Cocaine is ubiquitous, and crack, the smokable form of cocaine, is even more dangerous because it is cheap and plentiful.
"If a woman stops taking cocaine two months into her pregnancy, the baby will not go through withdrawal outside the uterus, but it will go through withdrawal inside the uterus," Wasiewski said.
"That is, the baby will be exposed to the cocaine for a longer period than the mom because the cocaine metabolites hang around longer in a baby. And, the fetus may feel the effects of a single hit of cocaine for two days.
"Those two days may be very crucial to a variety of organ formations, including the kidneys, the brain, the heart and the lungs. And, we already know there are abnormalities of the genitourinary tract of babies whose moms use cocaine."
The fetus is fairly well formed and looking like a small human very early in pregnancy, and from then on, it's a matter of growth and development. By having exposed the fetus to cocaine early in the pregnancy, a mother may have altered the normal sequence of development, he explained.
"So, the kid may come out looking fine, but later on have developmental problems," said Wasiewski. "He doesn't walk when he should, he doesn't talk when he should, he doesn't do as well as predicted based on his parents' intelligence. And, you can spot these problems around 2 years of age."
The message this researcher wants to leave is: There is no "safe time" to use cocaine when a woman is pregnant. Wasiewski believes there are a lot of potential dangers for the fetus that have not yet been documented.
"When I hear a pregnant woman say: 'I only took a little bit early in pregnancy,' the red flag immediately goes up that this fetus is at risk," he said. "I don't care whether she stopped eight months ago, it's akin to thalidomide (the tranquilizer used by pregnant women in the '50s for nausea and sleeplessness that caused hundreds of babies to be born with malformed or missing limbs).
"It's great that they stopped, but it might be too late."
Kids in schools--as early as the second or third grades--must also be taught about problems associated with cocaine and crack, he said. "The school district in nearby Palmyra has just surveyed the surrounding community whether education should start in the early grammar school years, and the overwhelming response has been 'yes.' "
Wasiewski said this is a step in the right direction. "It would not be unusual, particularly for inner-city kids, to be approached about the purchase or use or attempt of use of drugs at 10 years of age."
Education must also be consistent and specific, he said. For example, it's not enough to say to an 8-year-old, "Don't do crack. It's bad for you."
"You have to be say something more explicit, like: 'This drug can hurt you. It can hurt you because it will make your heart go faster, it will make the blood in your veins run faster and it will change how you feel. It will make you feel dopey and you may not know what you're doing.' "
When a pregnant woman takes a hit, there is an almost immediate increase in her heart rate and blood pressure, Wasiewski said.
Adrenaline in the bloodstream rises rapidly. The fetus and the uterine artery, which supplies blood to the placenta, the structure in the uterus that circulates nourishment and oxygen to the fetus, are "exquisitely sensitive" to adrenaline. When a pregnant woman takes cocaine, the uterine artery squeezes tight, restricting the oxygen supply to the fetus.
Scientists are trying to explain how these events cause the problems seen in newborns who have been exposed to cocaine, he said.
Wasiewski has developed a rabbit model of intrauterine cocaine exposure. He specifically looks at how cocaine affects the fetus' developing breathing mechanisms. The researcher injects pregnant rabbits with cocaine during the latter part of pregnancy. The rabbits then go on to deliver their babies.
"We have demonstrated that the cocaine-exposed rabbit pups breathe twice as fast as normal and produce too much carbon dioxide so that they have to breathe faster," Wasiewski said.
"We have also found evidence that cocaine exposure causes problems in breathing control. In the cocaine-exposed rabbit pups, chemoreceptors, which send signals to the body to breathe faster or slower, respond in an abnormal manner in the first few days of life."
An interesting aspect of the research is that the cocaine dose given to the mother rabbits is equal to a single hit of cocaine in humans.
"And, what happens in the model could easily happen in the baby," Wasiewski said. The newborn rabbit is a well-accepted model for respiratory control in the newborn baby."