Ultrasound diagnosis of fetal anomalies associated with in utero cocaine exposure: further support for cocaine-induced vascular disruption teratogenesis.
The dramatic increase in cocaine use over the past decade has led to a concern about its possible teratogenicity. We have identified 6 structural fetal anomalies which we postulate may have cocaine-induced vascular accidents as the teratogenic mechanism: 2 complex choroid plexus cysts, gastroschisis, meconium peritonitis, urethral stenosis, and radial hypoplasia. Two additional anomalous neonates were born to perinatal cocaine users. Eight of 51 (15.7%) cocaine-exposed perinates exhibited anomalies versus 120 of 2,194 (5.4%) perinates without known cocaine exposure during this time period. This represents a 3-fold relative risk (RR = 2.87, OR = 3.22, chi square = 9.68, p < 0.005) for the cocaine-exposed fetus. Subjects were all identified as cocaine users prior to ultrasound-detected anomaly and ultrasonologists were blinded to maternal drug history. The vascular disruption model as the plausible mechanism for cocaine-associated teratogenesis is supported by the type of anomalies reported. In addition, cocaine use was prospectively determined to have occurred at the critical developmental period in each case.
Hume
R F
RF
Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, N.C.
Gingras
J L
JL
Martin
L S
LS
Hertzberg
B S
BS
O'Donnell
K
K
Killam
A P
AP
D000014:Abnormalities, Drug-Induced / Q000000981:diagnostic imaging* / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D003042:Cocaine / Q000009:adverse effects*; D005260:Female; D005315:Fetal Diseases / Q000139:chemically induced*; D006801:Humans; D008431:Maternal-Fetal Exchange; D011247:Pregnancy; D012307:Risk Factors; D016216:Ultrasonography, Prenatal; D014652:Vascular Diseases / Q000139:chemically induced*
D003042:Cocaine