Cocaine effects on pregnancy and infant outcome: do we really know how bad it is?

While cocaine abuse in pregnancy is associated with a number of negative outcomes for both mothers and infants, it is unclear to what extent cocaine is specifically responsible for these negative outcomes and how its effects are distinct from those associated with substance abuse in general. Use of other drugs commonly associated with cocaine abuse, such as alcohol, marijuana, and tobacco, has also been associated with adverse pregnancy outcomes. Untoward pregnancy effects often ascribed to cocaine abuse in pregnancy may be more appropriately attributed to these or other drugs or to the unhealthy life-style associated with the long-term abuser rather than to cocaine itself. Epidemiologic data concerning cocaine use in pregnancy describe only associations of drug use and do not prove causality. Future research and longitudinal studies are needed to examine the roles of maternal and environmental factors in predicting differences in cocaine-exposed and nonexposed pregnancies.