Maternal and neonatal characteristics following exposure to cocaine in Toronto

We prospectively ascertained gestational cocaine use by neonatal urine and hair tests in 600 mother infant pairs in 3 nurseries in Toronto. The 37 (6.25%) babies who tested positive for cocaine and their mothers were compared to the 563 nonexposed with regard to pregnancy outcome and neonatal complications. Mothers using cocaine were not different in their ages, racial distribution, and obstetric history from those nonexposed. Cocaine-using women had significantly higher risk for vaginal bleeding (16% vs 6%, P < 0.05), hepatitis B carrier state (8% vs 0.8%, P < 0.005), and perhaps more urinary tract infections (8% vs 2.5%, P = 0.08). cocaine-using mothers were significantly more likely to smoke cigarettes (29% vs 10%, P < 0.001). Infants exposed to cocaine in utero were of lower birth weight (3162 ± 645 [SD] g vs 3391 ± 573, P < 0.05) and birth length (49.9 ± 2.9 cm vs 51.1 ± 3.1 cm, P < 0.05). Further stratification of babies exposed to cocaine by maternal cigarette smoking suggests that cigarette smoking accounted for most of this variability [birth weight of babies exposed to cocaine and cigarettes 2899 ± 7.50 g (and 50% of them weighed less than 2500 g), vs 3423 ± 612 (and only 8% less than 2500 g) in those exposed to cocaine only (P < 0.05). Babies exposed to cocaine in utero were significantly more likely to need initial medical support or resuscitation (52% vs 30%, P < 0.05). We conclude that gestational exposure to cocaine, ascertained by a sensitive biologic marker, is associated with substantial perinatal risks. It is probable that some of these risks are caused by clustering of other risk factors such as maternal smoking and hepatitis carrier state. Because routine clinical markers and urine testing often fail to distinguish fetal exposure to cocaine, more common use of the hair test should be considered, especially for babies with complicated perinatal courses.