Genitourinary tract malformations and maternal cocaine abuse
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S P Greenfield1, E Rutigliano, G Steinhardt
1Department of Urology, Children's Hospital of Buffalo, State University of New York, Buffalo Medical School.
Insights
Maternal cocaine abuse is linked to congenital urologic anomalies in infants, including genital defects and hydronephrosis. Cocaine
Area of Science:
- Urology
- Developmental Biology
- Toxicology
Background:
- Congenital urologic anomalies represent a significant clinical challenge.
- Maternal substance abuse, including cocaine, is a potential teratogenic factor.
- Understanding the impact of prenatal exposures on fetal development is crucial.
Observation:
- Four new cases of congenital urologic anomalies in infants exposed to cocaine in utero are presented.
- A literature review identified 23 previously documented cases.
- Male infants exhibited isolated genital abnormalities, hydronephrosis, or prune-belly syndrome.
- Female infants presented with hydronephrosis, cloacal abnormalities, and masculinization.
Findings:
- Cocaine exposure during pregnancy is associated with a spectrum of congenital urologic malformations.
- Observed anomalies include genital abnormalities, hydronephrosis, prune-belly syndrome, and cloacal abnormalities.
- Masculinization of external genitalia in females suggests endocrine disruption.
Implications:
- Prenatal cocaine exposure poses a risk for significant congenital urologic anomalies.
- Cocaine's teratogenic effects may stem from intense vasoconstriction impacting fetal circulation and calcium metabolism.
- Further research is needed to elucidate the precise mechanisms and long-term outcomes.
Abstract:
We report on 4 cases of congenital urologic anomalies in association with maternal cocaine abuse and review all 23 cases documented in the literature. Male infants predominate and have either isolated genital abnormalities, hydronephrotic conditions, or classic prune-belly syndrome. Female infants present with hydronephrosis or cloacal abnormalities along with masculinization of the external genitalia. Cocaine disrupts morphogenesis by causing intense vasoconstriction of the uterine and fetal circulation. Interruption of calcium metabolism may also be responsible for the hydronephrosis observed.