Patterns of cocaine binging: effect on pregnancy.

OBJECTIVE: The purpose of this study was to determine how cocaine and crack binging affected perinatal complications. STUDY DESIGN: Between Jan. 1 and Dec. 31, 1989, patterns of cocaine-crack binging and perinatal consequences in 905 pregnant women from multiethnic, multiracial, inner-city populations were studied. Binging cycles reflect the chaotic lifestyle of drug abuse and multiple obstetric at-risk cofactors as integral parts of binging and are more accurately defined than amount of drugs consumed. RESULTS: Binging patterns in 905 pregnant women who use cocaine-crack as their primary drug were as follows: group 1, 78 women with "erratic" binging that is variable in intervals, duration, and amounts but who are very aggressive drug seekers; group 2, 67 women who binged daily; group 3, 760 women who binged in cycles at 3-, 5-, 7-, or > 7-day intervals. Binges ranged from 26.4 to 34.4 hours. Complications were proportional to the frequency of binging, (linear association p < 0.0007). The prematurity rate in group 1 was unexpectedly as high as that in group 2 (35.9% vs 34.3%). Acute problems (vaginal bleeding 21.8%, abruptio placentae 14.3%, stillbirths 20.5%) were most significant in group 1, while chronic problems (small-for-gestational-age infants 32.8%, systemic infections 31.3%, anemia 35.6%, and low maternal weight [< 100 pounds] 32.8%) were more significant in groups 2 and 3. Odds ratios show that prematurity, abruptio placentae, and vaginal bleeding were two to three times more likely to occur if test results for cocaine were positive at delivery. However, in group 1 the likelihood of abruptio placentae was unchanged whether toxicologic test results were positive (14.3%) or negative (14.0%), reflecting the role of cofactors in binging. CONCLUSION: Erratic use of cocaine-crack results in perinatal complications that are as severe as those occurring with daily binging but the patterns differ. Cofactors play a significant role in outcomes.

Cocaine-related maternal death.

Hemodynamic overload, cardiac ischemia, and arrhythmia are postulated to originate from "sex-cocaine" syndrome resulting in maternal and fetal death. High concentrations of cocaine and metabolites in maternal blood, urine, and nasal secretions confirmed recent ingestion. Changes in the maternal life-style may have contributed to the poor pregnancy outcome.

Perinatal implications of cocaine exposure.

Obstetric outcome was reviewed for 139 women who volunteered information on cocaine abuse during pregnancy past 20 weeks. Information on the duration of use during pregnancy was not accurate enough for documentation. In previous pregnancies, only 44.6% of the infants were live born, with spontaneous or therapeutic abortions in 41.1% and stillbirths accounting for 3.6%. In the current pregnancies, 91 patients (66.1%) were nonwhite, and multiple-drug usage was found in 92%, with intravenous cocaine use in 44.6% and freebasing in 31.7% as the main routes of administration. Syphilis or another infection, no prenatal care and poor weight gain (less than or equal to 19 lb) in pregnancy was present in one-third of the patients, while 38% did not know their gestational age. Precipitate labor was found in 63.9% and meconium-stained amniotic fluid in 20.5%. The mean birth weight of the infants was significantly lower than that of the general hospital population; low birth weight (less than 2,500 g) occurred in 36.2%, small size for gestational age in 32.4%, neurologic problems in 30.9% and syphilis in 15.4% of the infants. Congenital abnormalities, in 17.4%, seemed to be multifactorial. The consistent pattern of poor outcome in both the previous and present pregnancies reflects the life-style peculiar to cocaine abusers. Prospective studies are in progress to identify the true incidence of cocaine usage and to outline the counseling of childbearing women against cocaine use during pregnancy, emphasizing prevention since cures are not available.

Low-dose danazol therapy in idiopathic thrombocytopenic purpura.

Although danazol is effective in the treatment of idiopathic thrombocytopenic purpura, its long-term safety and optimal dosage are not well established. We compared low (50 mg/d) and conventional (400 to 800 mg/d) dosages in 24 patients. Thirteen patients received the low dose 1 to 24 months after conventional doses had been discontinued (group 1). Five patients received low doses immediately after the conventional doses (group 2). Six patients were treated with low doses from the outset (group 3). In group 1, similar responses to either dose were seen in 9 patients, whereas there were better responses to conventional doses in 3 and to the lower dose in 1. All patients in group 2 maintained remissions with low doses. There were two excellent-good responses, one fair, and three poor responses in group 3. Side effects were generally less frequent and severe with the low doses. Low-dose danazol is better tolerated but took longer to obtain remissions, and is useful for maintenance therapy in the management of idiopathic thrombocytopenic purpura.