Most women who are addicted to cocaine are of childbearing age. Estimates suggest that about 5 percent of pregnant women use one or more addictive substances,25 and there are around 750,000 cocaine-exposed pregnancies every year.26 Although women may be reluctant to report substance use patterns because of social stigma and fear of losing custody of their children, they should be aware that drug use while pregnant is associated with specific risks that may be reduced with appropriate care.
Cocaine use during pregnancy is associated with maternal migraines and seizures, premature membrane rupture, and separation of the placental lining from the uterus prior to delivery.25 Pregnancy is accompanied by normal cardiovascular changes, and cocaine use exacerbates these—sometimes leading to serious problems with high blood pressure (hypertensive crises), spontaneous miscarriage, preterm labor, and difficult delivery.26 Cocaine-using pregnant women must receive appropriate medical and psychological care—including addiction treatment—to reduce these risks.25
Sex-specific addiction treatment and comprehensive services—including prenatal care, mental health counseling, vocational/employment assistance, and parenting skills training—can promote drug abstinence and other positive health behaviors.27 Motivational incentives/contingency management (see "Behavioral Interventions") as an adjunct to other addiction treatment is a particularly promising strategy to engage women in prenatal care and counseling for substance use.28
It is difficult to estimate the full extent of the consequences of maternal drug use and to determine the specific hazard of a particular drug to the unborn child. This is because multiple factors—such as the amount and number of all drugs used, including nicotine or alcohol; extent of prenatal care; exposure to violence in the environment; socioeconomic conditions; maternal nutrition; other health conditions; and exposure to sexually transmitted diseases—can all interact to influence maternal and child outcomes.26,29,30 Similarly, parenting styles, quality of care during early childhood, exposure to violence, and continued parental drug use are strong environmental factors influencing outcomes.31,32
Babies born to mothers who use cocaine during pregnancy are often prematurely delivered, have low birth weights and smaller head circumferences, and are shorter in length than babies born to mothers who do not use cocaine.26,29,30 Dire predictions of reduced intelligence and social skills in babies born to mothers who used crack cocaine while pregnant during the 1980s—so-called "crack babies"—were grossly exaggerated. However, the fact that most of these children do not show serious overt deficits should not be overinterpreted to indicate that there is no cause for concern.
Using sophisticated technologies, scientists are now finding that exposure to cocaine during fetal development may lead to subtle, yet significant, later deficits in some children.31,32 These include behavior problems (e.g., difficulties with self-regulation) and deficits in some aspects of cognitive performance, information processing, and sustained attention to tasks—abilities that are important for the realization of a child’s full potential.32,33 Some deficits persist into the later years, with prenatally exposed adolescents showing increased risk for subtle problems with language and memory.34 Brain scans in teens suggests that at-rest functioning of some brain regions—including areas involved in attention, planning, and language—may differ from that of non-exposed peers.35 More research is needed on the long-term effects of prenatal cocaine exposure.