Risks of Fetal Exposure to Heroin and Cocaine

Women who are using prohibited drugs during the time of pregnancy are increasing at an alarming rate. Although cocaine is involved in the majority of cases of fetal exposure to illicit drugs, almost one-fourth of cases involve heroin as well. To assess the effects of fetal exposure to drugs, Fulroth and colleagues studied 86 infants who were born to women with a history of cocaine and/or heroin use during pregnancy. Of these 86 newborn/mother pairs, 35 mothers and/or newborns had test results positive for cocaine only, 14 had results positive for heroin only and 17 had results positive for both cocaine and heroin. Urine drug screening was negative in the remaining 20 pairs, despite the fact that these mothers admitted to cocaine use during pregnancy. The 86 infants were compared with 1,021 infants who were born to women without a history of drug use during pregnancy.

Of the infants who were born at term and exposed to cocaine only, 17 percent had growth retardation and 27 percent had microcephaly. The incidence of prematurity was increased in the group exposed to cocaine, compared with the incidence of premature births in the drug-free control infants. Tobacco use may have also been a contributing factor, since the majority of women who used cocaine or heroin, or both, also smoked cigarettes.

The majority of the drug-exposed infants showed some signs of withdrawal, including tremors, hypertonicity, tachypnea, diarrhea and decreased sleep. The combination of cocaine and heroin exposure in utero was associated with significantly more severe withdrawal symptoms than the use of either drug alone. American Journal of Diseases of Children, August 1989, vol. 143, p. 905 showed that there is no major differences were noted among the drug-exposed infants and the control infants in the occurrence of sepsis, congenital malformations or five-minute Apgar scores of less than 7.