Pregnancy and Cocaine

Cocaine is a drug that is derived from coca leaves. It has some uses as a local anesthetic in some areas of medicine and surgery. In fact, cocaine proved extremely useful when it was first isolated and processed as a drug in the late 19th century. In that era, when general anesthesia was new and somewhat dangerous, an Austrian ophthalmologist named Karl Koller (1857–1944) used a solution containing 2 percent cocaine his own eye to demonstrate that the drug worked as a local anesthetic on the cornea. After scientists and doctors learned about this, it led to more experiments, culminating with a surgeon August Bier (1861–1949) demonstrating what doctors call spinal anesthesia. Using cocaine injected through the spine, into the fluid around the spinal cord, Bier showed that it was possible to perform painless surgery without the patient inhaling a gas or a fumes of a volatile agent. Today, spinal anesthesia and a similar procedure called epidural anesthesia, which are known collectively as neuraxial anesthesia, have 19th century researchers like Bier and Koller to thank for this innovation.

You may have heard of epidural anesthesia in particular, since it is the most common type of anesthesia given for childbirth. You are a mother, you likely received an epidural for your deliveries. Epidural anesthesia differs from spinal anesthesia basically in how deep the anesthesiologist pushes the needle. Both of these types of neuraxial anesthesia are achieved with the same types of medicines, which are known as local anesthetics. It all began with cocaine although, as this type of anesthesia does not use cocaine today, because cocaine is dangerous on account of its potential to cause addiction. This is a lesson that, sadly, various, courageous surgeon-researchers learned in the late 19th and early 20th centuries from experimenting on themselves, even as they were helping patients with surgical procedures that otherwise would not have been possible. In place of cocaine, today, neuraxial anesthesia makes use of various medications that are not cocaine, but are in the same chemical family as cocaine.

One other interesting historical note about cocaine is that, around the same time that surgeons were testing it for spinal anesthesia, soft drink inventors and manufacturers were also using it in their formulas. Most notoriously, these included Coca ColaTM, the name of which derives from its history when it actually contained cocaine.

While cocaine does still have a few limited uses in medicine (such as in certain surgical procedures in the nose, ear, and throat, the drug is utilized mostly illegally, on account of a stimulatory effect that it produces in the brain. Cocaine also has stimulant effects outside the brain, for instance increasing heart rate, blood pressure, and the power of the heart’s contraction. As we mentioned earlier, cocaine is extremely addictive. People take it into the body through different routes, including oral, intranasal (snorting), intravenous injection, and inhalation of cocaine vapor (smoking). Among cocaine users, use of the drug varies from occasional to frequent, and from one to several routes of delivery.

So let’s move to specific issues of cocaine use in pregnancy, where using cocaine can be immediately dangerous for mother and baby alike, but even among those simply trying to become pregnant, there is an issue. Cocaine may interfere with your fertility; even more certain, it can reduce the fertility of your male partner if he uses the drug. As for women who are already pregnant, cocaine can cause uterine blood vessels to constrict. This can lead to spontaneous abortion (miscarriage) and to placental abruption, separation of the placenta from the uterine wall). In those babies who survive fetal life, maternal cocaine use can cause various congenital defects. These include neural tube defects, which are characterized as incomplete closure of the bones and other layers surrounding the brain or spinal cord. Also, maternal cocaine use can lead to preterm birth, low birth weight, and small head circumference, and can shorten the length of the newborn. Children of cocaine-abusing mothers also may develop mental disabilities, including subtle problems involving learning and speech. In terms of the amount of cocaine use, researchers are studying this issue, but it does appear that even habitual small doses of cocaine during pregnancy can do harm to the embryo or fetus. It’s also possible for a newborn of a cocaine-abusing mother to experience some level of drug withdrawal, although its the toxic effects of cocaine that comprise the main problem. It’s also possible that a cocaine-abusing mother will deliver a healthy neonate, but anyone who uses cocaine while pregnant is stacking the cards against her child.

As for breastfeeding, as you may have guessed, cocaine-use is also a problem. The drug concentrates in breast milk, meaning that the concentration of the drug is higher in your milk than in your blood subsequent to using the drug. On the other hand, if you wait several hours or days after using the drug and express and discard the milk that accumulated following cocaine use, your next batch of milk should be clear. This is not a good reason to use cocaine while nursing, however, so if you are a cocaine user, you should obtain treatment. Your primary care doctor can guide you to a treatment center or program.

David Warmflash
Dr. David Warmflash is a science communicator and physician with a research background in astrobiology and space medicine. He has completed research fellowships at NASA Johnson Space Center, the University of Pennsylvania, and Brandeis University. Since 2002, he has been collaborating with The Planetary Society on experiments helping us to understand the effects of deep space radiation on life forms, and since 2011 has worked nearly full time in medical writing and science journalism. His focus area includes the emergence of new biotechnologies and their impact on biomedicine, public health, and society.

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