[Consequences of cocaine addiction during pregnancy on the development in the child]

Cocaine facilitates neurotransmitter release from the central nervous system, decreases their re-uptake at the synapse junction level and increases their blood level due to receptors blockade. During pregnancy cocaine inhibits uterine adrenergic beta receptors and easily crosses the placenta, the main obstetrical consequences of overstimulation of the noradrenergic system being miscarriage, retroplacental haematoma, ruptured uterus, short and premature labour. Fetal and neonatal consequences resulting from both a decreased uterine blood flow and a direct effect of cocaine on fetal development can be severe. Decreased uterine blood flow lowers oxygen and nutriment transport which in turn can induce intra-uterine growth retardation. The direct effect of cocaine on the fetus is responsible for an increased catecholamine plasma concentration leading to vasoconstriction episodes, increased heart rate and blood pressure, and subsequent oxygen requirement. Several malformations have been reported, sometimes severe (involving central nervous system, heart, digestive tract, urinary tract and bone) that are mainly due to fetal circulation failure. Cocaine can also directly alter brain development because of neuronal mistargeting within the cerebral cortex.