Polymalformative teratogenic syndrome characterized by
growth disturbances, abnormalities of the fingers and toes, gastrointestinal
and/or genitourinary tract, irritability, and arrhythmia with a danger of
heart attack or stroke.
Cocaine Antenatal Infection.
This “syndrome” has been challenged because even though
cocaine is a known teratogen, there is no specific set of malformations
associated with it, unlike the fetal alcohol syndrome.
Cocaine is used by approximately 1% of pregnant
women in the United States.
The condition is not genetic; rather it is a
toxic syndrome therefore acquired.
The main effects of cocaine are mediated via
dopamine and norepinephrine, the former being responsible for the euphoria
and the latter for the harmful effects. Cocaine inhibits norepinephrine
reuptake; thus it accumulates at the synaptic level and causes sympathetic
activation, which translates to tachycardia, vasoconstriction, hypertension,
and arrhythmias. During pregnancy, cocaine use can lead to decreased
uteroplacental blood flow, vasoconstriction of the uterine vasculature, and subsequently hypoperfusion of the placenta.
Finally, it also crosses the
placenta and affects the fetus directly.
In most of the studies, cocaine use was obtained through
history or positive urine testing from the mother. However, if cocaine is
not used for a few days (approximately 3 days), no metabolites will be
detected in the urine.
Initially more preterm labor, precipitous labor,
abruptio placentae, and small-for-gestational-age babies in women taking
cocaine were reported, but some studies concluded that these occurrences
were not related to cocaine use per se but to the absence of adequate
prenatal care. Many malformations and behavioral effects caused by cocaine
have been reported in the fetus, but with no specific pattern. Consequently,
it is thought that the abnormalities are related to the timing and amount of
drug used during the pregnancy and to the fact that abusers often use more
than one type of drug. Some of the anomalies reported are skull
malformations, cerebral infarcts, congenital cardiac defects (atrial septal
defect, ventriculoseptal defect, valve stenosis, tetralogy of Fallot,
hypoplastic left heart syndrome), neonatal arrhythmias and tachycardia,
intestinal atresia, necrotizing enterocolitis, genitourinary malformations,
limb defects, microcephaly, hypoplasia of the optic nerve, hypotonia,
irritability, and seizures. Behavioral problems associated with attention
deficit disorder are controversial. The association with an increased risk
for sudden infant death syndrome has been suggested but not confirmed.
Perform a complete physical
examination to rule out the more obvious anomalies and then obtain an ECG,
echocardiogram, and abdominal ultrasonogram based on the clinical findings.
The acute cardiovascular effects of
cocaine on the fetus last for approximately 2 days, so surgery should be
postponed to allow for elimination of the drug. If this waiting period is
not possible, a narcotic-based anesthesia, but not halothane and desflurane
because of their effects on the cardiovascular and sympathetic nervous
systems, respectively, is recommended. Continuous ECG monitoring and
postoperative stay in the neonatal intensive care unit ...