Risks associated with cocaine use during pregnancy.

Prenatal cocaine use has become an increasingly important public health problem in the last decade. Interpretation of epidemiologic studies designed to assess the association between cocaine use and adverse pregnancy outcomes is limited by inaccurate measurement of cocaine use, misclassification of users as non-users, confounding by socioeconomic factors, and reporting bias. Studies have consistently documented placental abruption as a maternal reproductive risk associated with cocaine use. Although suggested, less evidence is available to link cocaine use with premature rupture of membranes, spontaneous abortion, pregnancy-induced hypertension, precipitate delivery, or fetal death. Infant outcomes consistently associated with prenatal cocaine use include decreased birth weight, prematurity, and decreased fetal growth. Data on the relationship between prenatal cocaine use and congenital anomalies are limited, but one large retrospective study has documented an association between maternal cocaine use and congenital abnormalities of the urinary tract. Evidence linking prenatal cocaine use and an increased incidence of perinatal cerebral infarction or sudden infant death syndrome is lacking. Future studies should focus on the effect of maternal cocaine use on pregnancy outcome in diverse socioeconomic groups, longitudinal follow-up of exposed children, and the relationship between cocaine use and maternal behaviors that may affect access to prenatal care.