Crack Comes to the Nursery

By John Langone

When reports surfaced in the early 1980s that cocaine use by pregnant women could cause serious physical and mental impairment to their newborns, it was another warning that the snowy white drug was not as harmless as some believed. Doctors found that cocaine, like heroin and alcohol, could be passed from the user-mother to the fetus with disastrous results. Since then the epidemic of cocaine-afflicted babies has only become worse. The main reason: growing numbers of women are using crack, the cheap and readily available purified form of cocaine that plagues America's inner cities and has spread into middle-class suburbs. Says Dr. Richard Fulroth, a Stanford University neonatologist: "The women have tears streaming down their cheeks when they tell me, 'In the back of my mind I knew I was hurting my baby, but in the front of it, I needed more rocks.' "

Even dramatic new evidence of widespread cocaine use by pregnant women probably underestimates the extent of the problem. Addressing a meeting of the New York Academy of Sciences held in Bethesda, Md., last week, Dr. Ira Chasnoff of Chicago's Northwestern Memorial Hospital reported that a study he directed of 36 U.S. hospitals found that at least 11% of 155,000 pregnant women surveyed had exposed their unborn babies to illegal drugs, with cocaine by far the most common. "There are women who wouldn't smoke and wouldn't drink," he says, "but they can't stay away from cocaine." Chasnoff concedes that his numbers are probably low since many of the hospitals did not take full prenatal histories.

Doctors have little doubt that crack is driving the new epidemic of drug- affected infants. "When crack cocaine hit Oakland, the number of small, sick babies just went through the roof," says Fulroth. The statistics bear him out. In 1984 some 5% of the newborns at Highland General Hospital, which serves Oakland's rough inner city, were contaminated with the drug. So far this year, about 20% of all babies born at Highland have been afflicted by crack. The problem, however, is not confined to low-income, minority patients. Says Chasnoff: "Our findings cut across all socioeconomic backgrounds."

As doctors see more and more crack-damaged infants -- many of them premature -- a clearer picture of the effects of the drug on the fetus is emerging. It is not a pretty one. Because a mother's crack binge triggers spasms in the baby's blood vessels, the vital flow of oxygen and nutrients can be severely restricted for long periods. Fetal growth, including head and brain size, may be impaired, strokes and seizures may occur, and malformations of the kidneys, genitals, intestines and spinal cord may develop. If the cocaine dose is large enough, the blood supply can be cut so sharply that the placenta may tear loose from the uterus, putting the mother in danger and killing the fetus. The horrid litany is not just the result of binges. Even one "hit" of crack can irreparably damage a fetus or breast-fed baby.

At birth the babies display obvious signs of crack exposure -- tremors, irritability and lethargy -- that may belie the seriousness of the harm done. These symptoms may disappear in a week or more, but the underlying damage remains. While the long-term effects of crack are unknown, Stanford's Fulroth points out that children born with small heads often have lower than normal I.Q. levels by ages three to six.

Because there is no specific treatment for cocaine babies, therapists must work with the mothers. Parenting programs are teaching women how to handle the babies' long bouts of inconsolable crying and unresponsiveness. But such programs are usually designed for motivated women with some financial resources. Says Dr. Robert Cefalo, of the University of North Carolina School of Medicine: "We should be reaching these women before they conceive."

Too often, that is difficult to do. Crack mothers who show up at hospitals have often smoked up to the last stages of labor. Many are so high they do not notice when labor begins. Says Fulroth: "The crack cocaine mothers are the sickest you're going to see. They come in right when they're ready to deliver, and you just hold your breath waiting to see what you're gonna get." The message is clear: for expectant mothers -- and their babies -- crack is a nightmare.

With reporting by Shelagh Donoghue/Chicago and Dennis Wyss/San Francisco