Cocaine use during pregnancy poses significant risks to both the mother and the developing fetus, with potential for both immediate and long-term complications. The substance's potent vasoconstrictive properties, increased risk of thrombosis, and its ability to cross the placental barrier make it particularly hazardous during pregnancy.
- Placental Abruption: Cocaine's vasoconstrictive effects can lead to placental abruption, a serious condition where the placenta detaches from the uterus prematurely. This can result in heavy bleeding, posing a danger to both the mother and fetus, and can lead to preterm labor, fetal distress, or stillbirth.
- Preterm Birth: Women who use cocaine during pregnancy are at a higher risk of preterm labor and delivery. Premature babies face a higher risk of early health issues, long-term disabilities, and even death.
- Newborn Effects: Babies born to mothers who used cocaine during pregnancy may be irritable and jittery with feeding difficulties; a true withdrawal (abstinence) syndrome, as seen with opioids, is not well established for cocaine.
- Fetal Growth Restriction: Cocaine's impact on placental blood flow can restrict fetal growth, leading to intrauterine growth restriction (IUGR), where the fetus is smaller than expected for the gestational age.
- Cocaine usage can also lead to a decrease in platelet count and extended bleeding times, which is particularly concerning when considering neuraxial anesthesia. Therefore, it is critical to monitor the patient's platelet count prior to administering this type of anesthesia.
- For managing hypotension, phenylephrine is the recommended choice over ephedrine.
- The breakdown of ester local anesthetics might be slower in individuals who use cocaine, as these anesthetics and cocaine are both processed by plasma cholinesterases.
| System or setting | Effects |
|---|---|
| Cardiovascular | Tachycardia, elevated blood pressure, increased myocardial oxygen demand, dose-dependent coronary artery constriction, acute left ventricular dysfunction at high blood levels that can progress to heart failure, dysrhythmias, prolonged QRS and QTc; rarely aortic dissection or rupture. About 6 percent of patients presenting with cocaine-associated chest pain prove to have a myocardial infarction. |
| Central nervous system | Restlessness and agitation, seizures in about 3 to 4 percent of cocaine-related emergency department visits, unconsciousness, headache, intracranial bleeding, transient ischemic attack or stroke, and psychotic symptoms. Hyperthermia carries mortality up to 33 percent. |
| Pulmonary | Angioedema and thermal pharyngeal injury from hot vapors, alveolar hemorrhage, pneumothorax, pneumomediastinum, pneumopericardium, bronchospasm and "crack lung," and pulmonary infarction that can be mistaken for pulmonary embolism. |
| Endocrine | Raised cortisol through hypothalamic-pituitary-adrenal axis stimulation; chronic elevation brings immune suppression, altered metabolism, increased blood pressure, and higher cardiovascular risk. |
| Pregnancy | Placental abruption, preterm birth, irritability and jitteriness in the newborn, and fetal growth restriction. Platelet count may fall and bleeding time lengthen — check platelets before neuraxial anesthesia. Phenylephrine is preferred over ephedrine for hypotension. |
