The permanent damage of the ‘crack baby’ epidemic

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Neonatal Abstinence Syndrome is the terminology for the withdrawal symptoms that a baby may experience after absorbing drugs (including alcohol and nicotine) through the bloodstream as a fetus. This can be very painful, and can cause the baby to have seizures,  have a fever and vomit, and to cry far more regularly than usual. These symptoms can start from 24 hours after birth, and can continue for up to 6 weeks postpartum.

I have chosen to focus here on the effects of cocaine on the newborn, as this carries the greatest connotation of the term- probably due to the phrase ‘crack baby’ after the spike in this in the 80s and 90s. Cocaine is a CNS stimulant that causes withdrawal symptoms on infants 2-3 days after birth. It rapidly crosses the placenta during pregnancy, and has led to proposals that it causes more than immediate withdrawal symptoms- with many suggesting that it limits head growth and brain development for life. 

Babies born with a cocaine addiction often have the unique symptoms of excessive suckling and shuddering attacks- although many say that this may be due to the effect of the drug rather than those of withdrawal. Cocaine has a particularly strong effect due to having a relatively low molecular weight and being highly lipophilic, meaning that it can easily cross fetal cell membranes. This causes a great build up of the drug in the fetus once it has crossed the placenta, due to the less developed renal and metabolic functions of the child.

Cocaine acts to stimulate release and block reuptake of catecholamines- hormones made by the adrenal glands (including dopamine and norepinephrine). These catecholamines increase blood pressure, which in turn can cause a greater danger of placental abruption occuring. This is where the placenta detaches from the inner wall of the uterus- depriving the baby of the oxygen and nutrients that are crucial for its survival. This can cause the low birth weight typical of ‘crack babies’ and may require forced early delivery. Placental abruption occurs naturally in about 1% of births and is usually due to a hypotensive mother. It is far more common with mothers addicted to cocaine due to the increase in blood pressure that this causes. Placental abruption has an approximate death rate of 15% for the fetus.

In reality, alcohol is a greater source of neonatal abstinence syndrome due to the greater availability and legality of the substance. Alcohol can also pass through the umbilical cord, and is also lipophilic. It can cause long term issues for the infant such as a low body weight, difficulty learning (especially mathematics), sleeping problems and issues with the heart, kidneys and bones. While part of neonatal abstinence syndrome, it is usually referred to as Fetal Alcohol Disorder. However, it is far more common for the mother to have a small amount of alcohol in the first few weeks of pregnancy- usually due to not realising that she was indeed pregnant. This is not enough alcohol to cause abstinence syndrome, but it has been shown that drinking alcohol in the first trimester can cause problems with brain development. It was suggested that the alcohol could change chemical processes relating to DNA, and the shape of embryonic stem cells (which would therefore change later developed adult tissue too). In fact, an experiment done with mice where they were given alcohol at 8 days gestation showed that the offspring had a very different brain structure than those without alcohol. That being said, a study also produced results to suggest that a small alcohol consumption in the first trimester for humans didn’t cause high blood pressure complications, low birth weight or premature birth- meaning that the results are currently inconclusive. 

In conclusion, neonatal abstinence syndrome has the potential to cause life-altering changes to the child’s body and future. While highly illegal substances such as cocaine may have the greatest connotations of the syndrome, it is actually substances such as alcohol and nicotine that can cause the most widespread effects on infants in the UK.


References

  1. Stanford, Neonatal Abstinence Syndrome: https://www.stanfordchildrens.org/en/topic/default?id=neonatal-abstinence-syndrome-90-P02387
  2. Medscape, What is the role of cocaine use in the Etiology of placental Abruption? https://www.medscape.com/answers/252810-185525/what-is-the-role-of-cocaine-use-in-the-etiology-of-abruptio-placentae
  3. WebMD, Catecholamines Test: https://www.webmd.com/heart-disease/catecholamines-test-facts#:~:text=Catecholamines%20are%20hormones%20made%20by,re%20physically%20or%20emotionally%20stressed.
  4. NCBI, Maternal Catecholamine Levels in Midpregnancy and Risk of Preterm Delivery: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2765364/
  5. Better Health, Placental Abruption https://www.betterhealth.vic.gov.au/health/healthyliving/placental-abruption#:~:text=Hypertension%20%E2%80%93%20high%20blood%20pressure%20increases,condition%20known%20as%20pre%2Declampsia
  6. Michigan Medicine, Catecholamines in Blood: https://www.uofmhealth.org/health-library/tw12861#:~:text=Catecholamines%20increase%20heart%20rate%2C%20blood,brain%2C%20heart%2C%20and%20kidneys.
  7. American Pregnancy, Placental Abruption: https://americanpregnancy.org/pregnancy-complications/placental-abruption/
  8. Medscape, Neonalatal Abstinence Sydrome: https://emedicine.medscape.com/article/978763-overview#a5
  9. CDC, Alcohol use in Pregnancy https://www.cdc.gov/ncbddd/fasd/alcohol-use.html#:~:text=Alcohol%20in%20the%20mother’s%20blood,alcohol%20spectrum%20disorders%20(FASDs).
  10. Healthline, Having Alcohol Before Realizing You’re Pregnant: How Dangerous Is It, Really?https://www.healthline.com/health/pregnancy/drinking-alcohol-while-pregnant-first-3-weeks#research
  11. Independent, Consuming Alcohol during Pregnancy can affect Birth Weight and Cognitive Function, Study Confirms https://www.independent.co.uk/life-style/health-and-families/pregnant-women-alcohol-affects-baby-study-drymester-a9306306.html

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