Brain and Ocular Abnormalities in Infants With In Utero Exposure to Cocaine and Other Street Drugs

Domínguez, Rodrigo; Vila-Coro, Antonio Aguirre; Slopis, John M.; Bohan, Timothy P.

doi:10.1001/archpedi.1991.02160060106030

Cited by 102 publications

(93 citation statements)

References 33 publications

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“…40 -42 Other studies in both species, however, have indicated that prenatal cocaine exposure may be teratogenic in a dose-dependent manner, resulting in abnormalities of the limbs, [43][44][45] cardiovascular, 43,46 genitourinary, 43,44,47,48 and central nervous systems. 43,44,46,47,49 Some human reports have likewise noted anomalies of the genitourinary 3,10,11,13,20,21 and cardiovascular systems, 1,8,14 -16 skull defects, 14 limb defects and intestinal atresias, 6,13,20,21,50 and a variety of central nervous system lesions 4,5,7,9,13,[51][52][53][54][55][56] in infants exposed to cocaine in utero. Two additional studies report mild facial abnormalities in exposed infants.…”

Section: Discussionmentioning

confidence: 99%

“…Concern has been aroused because of a variety of case reports, small patient series, and retrospective studies reporting abnormalities of the skull, heart, skeleton, gastrointestinal tract, and genitourinary tract in infants born to women who used cocaine during pregnancy. [1][2][3][4][5][6][7][8][9][10][11][12][13] Over the years, the results of prospective studies have yielded somewhat conflicting outcomes. 14 -28 Methodologic concerns in many of these studies have precluded widespread acceptance of their findings, either positive or negative, leaving unanswered the question regarding the association between prenatal cocaine exposure and congenital anomalies.…”

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The Search for Congenital Malformations in Newborns With Fetal Cocaine Exposure

et al. 2001

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ABSTRACT. Context. The association between prenatal cocaine exposure and congenital anomalies is not definitive.Objective. To determine whether prenatal cocaine exposure results in an increased number or identifiable pattern of abnormalities.Design. A prospective, longitudinal cohort enrolled between 1991 and 1993.Setting. Rural public health population delivering at a regional tertiary medical center.Patients. Two hundred seventy-two offspring of 154 prenatally identified crack/cocaine users and 154 nonusing controls were matched on race, parity, location of prenatal care (that related to level of pregnancy risk), and socioeconomic status. Drug use was determined through repeated in-depth histories and urine screens. Infants not examined within 7 days of birth were excluded.Outcome Measures. Assessments were made by experienced examiners masked to maternal drug history. Included were 16 anthropometric measurements and a checklist of 180 physical features defined and agreed upon in advance.Results. There were no differences on major risk variables between the included and excluded infants. There were significantly more premature infants in the cocaineexposed group. Cocaine-exposed infants were significantly smaller in birth weight, length, and head circumference but did not differ on remaining anthropometric measurements. There was no difference in type or number of abnormalities identified between the exposed and nonexposed groups. There was no relationship between amount or timing of exposure and any of the outcomes.Conclusions. This prospective, large-scale, blinded, systematic evaluation for congenital anomalies in prenatally cocaine-exposed children did not identify an increased number or consistent pattern of abnormalities. A search for congenital malformations related to prenatal cocaine exposure has been underway since physicians became aware of the epidemic of prenatal use in the mid-1980s. Concern has been aroused because of a variety of case reports, small patient series, and retrospective studies reporting abnormalities of the skull, heart, skeleton, gastrointestinal tract, and genitourinary tract in infants born to women who used cocaine during pregnancy. [1][2][3][4][5][6][7][8][9][10][11][12][13] Over the years, the results of prospective studies have yielded somewhat conflicting outcomes. 14 -28 Methodologic concerns in many of these studies have precluded widespread acceptance of their findings, either positive or negative, leaving unanswered the question regarding the association between prenatal cocaine exposure and congenital anomalies.The most commonly identified mechanism of the effects of prenatal exposure involves the vasoconstrictive properties of cocaine. The proper growth and development of the fetus depend on a wellfunctioning vascular system. Vasoconstriction resulting in disruption of blood flow to the fetus could result in the development of structural abnormalities throughout gestation. 29,30 The purpose of this study was to determine whether prenatal cocaine exposure was associat...

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Section: Discussionmentioning

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The Search for Congenital Malformations in Newborns With Fetal Cocaine Exposure

et al. 2001

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“…These lesions are the result of extense areas of necrosis of the cerebral tissue predominantly due to hypoxic-ischemic insults but it is well known that other kinds of insults can be involved such as congenital infections, maternal exposure to toxic substances and trauma 14,[17][18][19][20] . There are several lines of evidence indicating that the response of the brain to injury changes according to timing of in utero development 1,4,21,22 .…”

Section: Discussion Discussionmentioning

confidence: 99%

Congenital destructive hemispheric lesions and epilepsy: clinical features and relevance of associated hippocampal atrophy

Teixeira

Leone

Honorato

et al. 2000

Arq. Neuro-Psiquiatr.

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-We studied the clinical, EEG and MRI findings in 19 patients with epilepsy secondary to congenital destructive hemispheric insults. Patients were divided in two groups: 10 with cystic lesions (group 1), and 9 with atrophic lesions (group 2). Seizure and EEG features, as well as developmental sequelae were similar between the two groups, except for the finding that patients of group 2 more commonly presented seizures with more than one semiological type. MRI showed hyperintense T2 signal extending beyond the lesion in almost all patients of both groups, and it was more diffuse in group 2. Associated hippocampal atrophy (HA) was observed in 70% of group 1 patients and 77.7% of group 2, and it was not correlated with duration of epilepsy or seizure frequency. There was a good concordance between HA and electroclinical localization. The high prevalence of associated HA in both groups suggests a common pathogenesis with the more obvious lesion. Our findings indicate that in some of these patients with extensive destructive lesions, there may be a more circumscribed epileptogenic area, particularly in those with cystic lesions and HA, leading to a potential rationale for effective surgical treatment.KEY WORDS: epilepsy, magnetic resonance image, hippocampal atrophy.Epilepsia secundária a lesões destrutivas hemisféricas congênitas: achados clínicos e relevância de atrofia hipocampal associada RESUMO -Analisamos os achados clínicos, de EEG e RM de 19 pacientes com epilepsia secundária a insultos destrutivos hemisféricos congênitos. Os pacientes foram divididos em dois grupos: 10 com lesões císticas (grupo 1), e 9 com lesões atróficas (grupo 2). As características das crises e achados de EEG foram similares entre os dois grupos exceto pelo fato dos pacientes do grupo 2 terem apresentado mais comumente crises com mais de um padrão semiológico. A RM mostrou sinal T2 hiperintenso estendendo-se ao redor da lesão e à distância em quase todos os pacientes de ambos os grupos, de modo mais extenso no grupo 2. Observou-se atrofia hipocampal (AH) associada em 70% dos pacientes do grupo 1 e 77,7% do grupo 2 e não houve correlação com a duração da epilepsia ou freqüência das crises. Houve boa correlação entre a AH e localização eletroclínica. A alta prevalência de AH associada em ambos os grupos sugere uma patogenia comum com a lesão mais óbvia. Estes achados indicam que alguns destes pacientes com extensas lesões destrutivas, particularmente aqueles com lesões císticas e AH, a zona epileptogênica pode ser mais circunscrita possibilitando a indicação de uma ressecção restrita para o controle das crises. PALAVRAS-CHAVE: epilepsia, ressonância magnética, atrofia hipocampal.

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“…23 Prenatal cocaine exposure has been associated with developmental delay and structural brain abnormalities, such as septo-optic dysplasia, porencephaly, and bilateral cortical infarcts. 24 Newborns exposed to cocaine in utero may show marked vascular disruption in the retina manifested as superficial and deep haemorrhages. Although morphologically similar to retinal haemorrhages related to birth trauma, these haemorrhages take longer to reabsorb.…”

Section: Cocainementioning

confidence: 99%

Ocular teratogens: old acquaintances and new dangers

Tandon

Mulvihill

2009

Eye

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Recent research into animal studies has contributed significantly to understanding the pathophysiology of some well-known teratogens, such as alcohol. Techniques, such as positron emission tomography (PET) and retinal synaptogenesis studies, have helped determine the specific areas in the developing brain and ocular structures, which are targeted by various teratogens. In this article, we also highlight a few newer agents, such as benzodiazepines, with potential for ocular malformation and morbidity in the developing foetus.

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Brain and Ocular Abnormalities in Infants With In Utero Exposure to Cocaine and Other Street Drugs

Cited by 102 publications

References 33 publications

The Search for Congenital Malformations in Newborns With Fetal Cocaine Exposure

The Search for Congenital Malformations in Newborns With Fetal Cocaine Exposure

Congenital destructive hemispheric lesions and epilepsy: clinical features and relevance of associated hippocampal atrophy

Ocular teratogens: old acquaintances and new dangers

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