Cocaine and pregnancy: clinical and methodologic issues.

Although many of the clinical studies of cocaine use in pregnancy completed thus far have suffered from the methodologic issues discussed here, they have been of great value in defining key risk factors and general clinical outcome. With the information now available, it appears safe to conclude that placental dysfunction due to cocaine's vasoconstrictive activity increases risk for intrauterine growth retardation and prematurity; fetal disruption due to acute cocaine-induced vascular compromise places the fetus at risk for structural anomalies; and neurotoxicity due to cocaine's action at the postsynaptic junction places the infant at risk for neurobehavioral abnormalities. There are now needed more sophisticated analytic techniques that can consider the additive and interactive effects of demographic and lifestyle characteristics that place the cocaine-using pregnant woman and her child at risk.