Effect of Cocaine Use on the Fetus

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Abstract
Dr. Volpe's excellent review (Aug. 6 issue)1 of the mechanisms by which exposure to cocaine in utero may produce teratogenic and destructive effects in the developing fetus focused on the damage that may be done to the nervous system. Other systems may also be severely compromised, even when the nervous system is apparently spared.2 One of the earliest reports concerned an association between fetal exposure to cocaine and urogenital malformations,3 and hydronephrosis and renal agenesis can also occur. There is evidence that several cardiovascular abnormalities (such as pulmonic stenosis, atrial and ventricular septal defects, and hypoplastic heart) may result from such exposure.2 , 4 The developing gastrointestinal tract seems to be particularly vulnerable; abnormalities associated with cocaine exposure range from intestinal atresia to widespread infarction of the bowel.5 Although certain underlying pathophysiologic processes (hypertension, hemorrhage, infarction, and hypoxemia) seem to occur in all organs, the timing of the insult may ultimately determine its target and specificity.2