More babies seem to be dying from exposure to crack cocaine in the womb, alarming health officials who fear that they might be losing the battle against infant mortality in drug-plagued inner cities.
After decades of progress, infant-mortality rates have begun to creep upward in New York City, Washington, D.C., and some other spots where the use of crack has skyrocketed.
Researchers are cautious about blaming crack, but say the evidence is mounting.
"There are lots of conjectures," said Dr. Joel Klienman, an analyst with the National Center for Health Statistics, "but . . . one likely culprit, especially for the black population, is cocaine."
The National Commission to Prevent Infant Mortality, an independent panel that has members from both parties in Congress, warned recently that crack use is one of several reasons why infant deaths are likely to rise sharply in the 1990s.
"Progress in reducing infant mortality has stalled," said former Sen. Lawton Chiles of Florida, the commission's chairman. "In the 1990s we may see more infants die per year than the 40,000 we now lose before their first birthdays."
By now, nearly everyone has seen television pictures of premature infants, some scarcely larger than a doctor's hand, writhing in what seems to be the agony of drug withdrawal.
Research suggests that these babies of crack addicts are not actually addicted, says Dr. Ira J. Chasnoff, president of the National Assn. for Perinatal Addiction and Research.
They do, however, suffer from a distressing array of brain disorders and medical problems that appear to stunt their development for years, if not permanently. Drug-abuse expert Douglas Besharov of the American Enterprise Institute, a Washington think tank, calls these children the new "bio-underclass."
Sometimes their ailments are fatal.
Cocaine constricts the body's blood vessels, including those in the placenta, the maternal organ that supplies a fetus with its oxygen and nourishment.
"So, when a substance disrupts this vascular system, it sort of messes up the pipes, to put it in simple terms," said Dr. Leah Ziskind, New Jersey's acting health commissioner. "It's like you have a break in the plumbing."
That, she said, can cause "very, very serious" problems for a baby's brain development and frequently prompts premature labor. Some women have even been reported to use crack to induce labor prematurely.
Now researchers are beginning to discover that crack-exposed infants also appear to be unusually prone to sudden infant death syndrome, which kills babies mysteriously in their first months of life.
Chasnoff said other factors besides crack could play a part in the sudden deaths--"the poverty, the lifestyle factors, the adolescent mothers, the cigarette smoking." But crack is indisputably part of the mix, he said.
No national statistics document the problem, nor does any state keep thorough records on the number of cocaine-exposed babies who die. But the little information that is available is disturbing.
* In Massachusetts, the state Department of Social Services keeps a tally of those infant deaths that raise suspicion among hospital officials. There were 24 such deaths in 1988, at least seven of which involved cocaine use by the mothers. The number nearly doubled to 43 in 1989, with at least 17 involving maternal cocaine use.
"It seems to go along with the whole crack cocaine epidemic," department spokeswoman Lorraine Carli said. "It seems to have become the drug of choice for women."
* City officials in Washington, D.C., announced last September that infant mortality jumped nearly 50% in the first half of 1989. They directly blamed crack cocaine. The city's new infant-mortality rate was 32.3 deaths for every 1,000 live births--triple the national average and worse than the averages in Chile, Jamaica and Panama, among many other places.
* In New York City, which keeps exhaustive records on infant mortality and drug use, the number of infant deaths began rising in 1985, the year the crack epidemic began in earnest. That year, 5% of city birth certificates mentioned cocaine use by the mother. By 1988, the figure was 21%. The mortality rate for babies of coke-using mothers has been put at 35 per 1,000--roughly triple the citywide average.
* Infant mortality also has been rising in New Jersey, where 10 cities were targeted in 1985 for special prenatal attention. But even in these "Healthy Mother, Healthy Baby" cities, the infant-mortality rate rose the last two years. "We suspect very strongly that our increases in infant mortality in '88 and '89 are due to the drug-abusing pregnant woman, and especially her preference for crack," Ziskind said.
Crack-related infant deaths are setting off alarms in other states, including Ohio, Michigan, New Mexico and Rhode Island, and some states are beginning to consider changes in birth and death reports to gauge the extent of the problem more accurately.
Solutions are as elusive as an end to drug abuse itself, but health officials increasingly are looking to "one-stop shopping" clinics that would combine drug treatment with prenatal and obstetric care. The idea is to provide an easy alternative for women who might be reluctant to go to several clinics for pregnancy care.
"I think the most important thing we can do is set up a system that allows women, as soon as they are pregnant, to come in and be counseled by health-care professionals," Ziskind said. "I think we should use this time in a woman's life to let her focus on her body and her baby."
It is, she said, an opportunity to "capture" drug-abusing women and maybe--just maybe--get them to change.