Article: Edmonds, Patricia. "A Quick Fix for the Drug War". Seattle Times.
June 3. Page A16:
Focus: Drug war in general. Good information on Crack Babies.
Excerpt: Still, those interviewed for this article generally agreed
on one thing: its a perilous mix when leaders try to make war
on drugs, law on drugs and political hay on drugs at the same
time. On this point, a favorite cautionary tale concerns the
375,000 crack babies.
The story begins with Ira Chasnoff, a Chicago pediatritian,
and his 1988 study of 154,856 births in 36 hospitals. Through
interviews and tests, he learned that in 11 percent of the
births, the babies had been exposed to some quantity of some
illegal drug at some time during pregnancy.
Chasnoff did not say the babies were born addicted, or
afflicted. He did not say which mothers used cocaine daily
and which used marijuana one weekend. He said: some quantity
of some illegal drugs was used during pregnancy.
Then Chasnoff did the arithmatic. If there was drug exposure
in even 10 percent of the 3.75 million births in the U.S.
annually, that would be 375,000 babies.
"That," Chasnoff said, "is as far as it went".
[...goes on to detail how William Bennett used this study to
show that there were 375,000 crack babies in the U.S./year...]
---
>
> Author: Koren-G. Graham K.
> Article Title: Cocaine in Pregnancy: Analysis of Fetal Risk
> Source: Vet-Hum-Toxicol. 1992 Jun. 34(3). P 263-4
> Author: Owiny-J-R. Myers-T. Massmann-G-A. Sadowsky-D-W.
> Title: Lack of Effect of Maternal Cocaine Administration on
> Myometrial Electromyogram and Maternal Plasma Oxytocin
> Concentrations in Pregnant Sheep at 124-145 Days'
> Gestational Age.
2
AU - Koren G
AU - Graham K
AU - Shear H
AU - Einarson T
TI - Bias against the null hypothesis: the reproductive hazards of cocaine
[see comments]
AB - To examine whether studies showing no adverse effects of cocaine in
pregnancy have a different likelihood of being accepted for
presentation by a large scientific meeting, all abstracts submitted
to the Society of Pediatric Research between 1980 and 1989 were
analysed. There were 58 abstracts on fetal outcome after gestational
exposure to cocaine. Of the 9 negative abstracts (showing no adverse
effect) only 1 (11%) was accepted, whereas 28 of the 49 positive
abstracts were accepted (57%). This difference was significant.
Negative studies tended to verify cocaine use more often and to have
more cocaine and control cases. Of the 8 rejected negative studies
and the 21 rejected positive studies, significantly more negative
studies verified cocaine use, and predominantly reported cocaine use
rather than use of other drugs. This bias against the null hypothesis
may lead to distorted estimation of the teratogenic risk of cocaine
and thus cause women to terminate their pregnancy unjustifiably.
AD - Department of Pediatrics
AD - University of Toronto
AD - Ontario
AD - Canada.
SO - Lancet 1989 Dec 16;2(8677):1440-2
DP - 1989 Dec 16
TA - Lancet
PG - 1440-2
IP - 8677
VI - 2
qUI - 9008115
3
AU - Lutiger B
AU - Graham K
AU - Einarson TR
AU - Koren G
TI - Relationship between gestational cocaine use and pregnancy outcome: a
meta-analysis.
AB - Despite a growing number of studies that have investigated the
reproductive effects of maternal cocaine use, a homogeneous pattern
of fetal effects has not been established and there is little
consensus on the adverse effects of the drug. We used meta-analysis
to evaluate the reproductive risks of cocaine. We reviewed the 45
scientific papers published in the English language dealing with
effects of cocaine used during pregnancy on pregnancy outcome in
humans, and identified 20 papers eligible for meta-analysis (cocaine
use in pregnancy, pregnancy/fetal outcome studies, human studies,
original work, cohort or case control studies, control group present,
English language). Our analysis revealed that very few adverse
reproductive effects could be shown to be significantly associated
with cocaine use by polydrug users when compared to control groups of
polydrug users not using cocaine [genitourinary malformations; odds
ratio of 6.08 (95% CI 1.18-31.3); gestation age: Cohen's d 0.37 (CI
0.2-0.55)]. When the control groups consisted of no drug users, the
polydrug users abusing cocaine had a higher risk for spontaneous
abortions [odds ration 10.50 (CI 11.74-64.1)]. Similarly, comparison
of users of cocaine alone or no drug users revealed a higher risk for
in utero death, in addition to genitourinary tract malformations.
Analysis of continuous variables (head circumference, gestational
age, birth weight and length) revealed that the effect size was
dependent upon the nature of the comparison. Comparison of cocaine
users to no drug users consistently yielded a medium effect size
(Cohen's d) between 0.50 and 0.58, while comparison of
polydrug/cocaine users to polydrug/no cocaine users provided effect
sizes small to non existent (0.06-0.37). These discrepancies suggest
that a variety of adverse reproductive effects commonly quoted to be
associated with maternal use of cocaine may be caused by confounding
factors clustering in cocaine users.
AD - Department of Pediatrics
AD - Hospital for Sick Children Toronto
AD - Ontario
AD - Canada.
SO - Teratology 1991 Oct;44(4):405-14
DP - 1991 Oct
TA - Teratology
PG - 405-14
IP - 4
VI - 44
UI - 92074030
[note that Dr. Ira Chasnoff was responsible for a very great deal of the
original cocaine-baby research in the mid 1980s.]
4
AU - Chasnoff IJ
AU - Griffith DR
AU - Freier C
AU - Murray J
TI - Cocaine/polydrug use in pregnancy: two-year follow-up [see comments]
AB - The impact of cocaine on pregnancy and neonatal outcome has been well
documented over the past few years, but little information regarding
long-term outcome of the passively exposed infants has been
available. In the present study, the 2-year growth and developmental
outcome for three groups of infants is presented: group 1 infants
exposed to cocaine and usually marijuana and/or alcohol (n = 106),
group 2 infants exposed to marijuana and/or alcohol but no cocaine (n
= 45), and group 3 infants exposed to no drugs during pregnancy. All
three groups were similar in racial and demographic characteristics
and received prenatal care through a comprehensive drug treatment and
follow-up program for addicted pregnant women and their infants. The
group 1 infants demonstrated significant decreases in birth weight,
length, and head circumference, but by a year of age had caught up in
mean length and weight compared with control infants. The group 2
infants exhibited only decreased head circumference at birth. Head
size in the two drug-exposed groups remained significantly smaller
than in control infants through 2 years of age. On the Bayley Scales
of Infant Development, mean developmental scores of the two groups of
drug-exposed infants did not vary significantly from the control
group, although an increased proportion of group 1 and 2 infants
scored greater than two standard deviations below the standardized
mean score on both the Mental Developmental Index and the Psychomotor
Developmental Index compared with the control infants. Cocaine
exposure was found to be the single best predictor of head
circumference.(ABSTRACT TRUNCATED AT 250 WORDS)
AD - Department of Pediatrics
AD - Northwestern University Medical School
AD - Chicago
AD - IL.
SO - Pediatrics 1992 Feb;89(2):284-9
DP - 1992 Feb
TA - Pediatrics
PG - 284-9
IP - 2
VI - 89
UI - 92131597
5
AU - Graham K
AU - Dimitrakoudis D
AU - Pellegrini E
AU - Koren G
TI - Pregnancy outcome following first trimester exposure to cocaine in
social users in Toronto, Canada.
AB - Studies of drug-dependent women reveal high rates of adverse fetal
effects of cocaine. However, no data are available on the effect of
the chemical in social users who discontinue cocaine upon realizing
they are pregnant. We report the results of the first phase of a
prospective study examining the outcome of pregnancy in women seeking
counseling from the Motherisk Program in Toronto. Of 25 women seen in
our clinic for 1st trimester cocaine exposure, 92% reported use of
less than 10 g of cocaine and 36% reported marijuana use. Other
illicit drug use was rare; cigarette and alcohol use was common. The
study group did not experience adverse pregnancy outcome above the
rate expected in the general population. There were 23 single births
1 pair of twins, and 1 spontaneous abortion. Birth weight and
gestation were within normal limits. Only 1 child had a major
malformation, syndactyly. Infant development was within normal
limits, as measured by developmental milestones. All children are
scheduled for assessment using the Bayley Scales of Infant
Development. The results of the BSID will be compared to results from
a cannabis-exposed control group and a no-drug control group.
AD - Division of Clinical Pharmacology and Toxicology
AD - Research Institute
AD - Toronto
AD - Ontario
AD - Canada.
SO - Vet Hum Toxicol 1989 Apr;31(2):143-8
DP - 1989 Apr
TA - Vet Hum Toxicol
PG - 143-8
IP - 2
VI - 31
UI - 89188370
{
2
AU - Richardson GA
AU - Day NL
TI - Maternal and neonatal effects of moderate cocaine use during
pregnancy.
AB - Thirty-four women who reported using cocaine during pregnancy were
compared to 600 women who reported no cocaine use during pregnancy
and none for the year prior to pregnancy. Subjects were participants
in a prospective, longitudinal study of prenatal substance use. The
sample consisted of young, predominantly single, low-income women
attending a public prenatal clinic. Women were interviewed at the end
of their first, second and third trimesters regarding cocaine,
alcohol, marijuana, tobacco and other drug use. The majority of the
cocaine users were light to moderate users who decreased their use
during pregnancy. The cocaine group was more likely to be white and
to use alcohol, marijuana, tobacco and other illicit drugs more
heavily than the comparison group. The cocaine users had more
previous fetal losses but did not differ on other obstetrical
complications. Infant growth, morphology and behavior were not
affected.
AD - Western Psychiatric Institute and Clinic
AD - University of Pittsburgh
AD - PA 15213.
SO - Neurotoxicol Teratol 1991 Jul-Aug;13(4):455-60
DP - 1991 Jul-Aug
TA - Neurotoxicol Teratol
PG - 455-60
IP - 4
VI - 13
UI - 92017483
(From _The Boston Sunday Globe_ * January 12, 1992, pg 69)
(Permission to reproduce this article has not been sought)
THE MYTH OF THE `CRACK BABIES'
By Ellen Goodman
They are called "a biological underclass" and "a lost generation."
Those are just two of the milder name tags attached to the children we
have come to believe were permanently damaged by their mothers' use
of cocaine.
The poster in maternity clinics conjure up the same image of the
prenatally doomed: "Some people who smoke crack never get over it."
The schools too have been put on emergency alert: "The crack babies are
coming, the crack babies are coming."
Indeed, the phrases "crack babies" and "crack kids" are shorthand for
monster-children who are born addicted. These are the kids destined to
grow up without the ability to pay attention or to learn or to love.
But just when the name has stuck, it turns out that "crack baby" may be
a creature of the imagination as much as medicine, a syndrome seen in
the media more often than medicine.
Three years after the epidemic of stories about these children began,
six years after hospitals began to see newborns in deep trouble,
researchers are casting doubt on the popular demon of the war on drugs.
The very phrase "crack baby" is, in any literal sense, a misnomer.
Cocaine is rarely taken by itself. It's part of a stew of substances
taken in a variety of doses and circumstances. No direct line has been
drawn from the mother's use of cocaine to fetal damage.
Alcohol and tobacco may do as much harm to the fetus as cocaine. So
may poor nutrition, sexually transmitted diseases, and the lack of
medical care. Most important, it appears that the children born to
cocaine-using mothers are not hopeless cases, permanently assigned to
the monster track. Dr. Ira Chasnoff, who did some of the original work
identifying the problem babies of mothers who took cocaine in
combination with other drugs, has done a two-year follow-up study about
to be published. It says, in his words, "Their average developmental
functioning level is normal. They are no different from other children
growing up. They are not the retarded imbeciles people talk about.
This is not, he cautions, a green light for taking drugs during
pregnancy. Drugs remain a serious health problem, and cocaine
specifically contributes to premature birth and small head size. While
the children in his study - children who have been offered some help -
now function normally as a group, they are at risk individually.
But, says Dr. Chasnoff, "As I study the problem more and more, I think
the placenta does a better job of protecting the child than we do as a
society." The need now is to widen the lens from nature to nurture, and
from the environment of the unborn to that of the born.
Another researcher who has taken a responsible second look at the
"crack baby" syndrome is Claire Coles of Emory University. She
believes these children, labeled by their drug of origin, are in fact
"often victims of gross neglect, not brain damage."
The worst damage that drugs may do is to the world a child inhabits
after birth. Coles has a collection of horror stories about children
growing up neglected, especially by cocaine addicts. One "crack kid"
who couldn't concentrate in class was in fact hungry. Another poorly
developed "crack baby" was being "raised" by a 5-year-old sister.
The myth of the "crack baby" became a media hit, Coles believes,
because "crack is exotic and happening mostly in `marginal' populations
among `bad people' who are not like `us.'" It is easier to think about
crack than alcohol or tobacco. There is more than a touch of racism in
the attention.
But perhaps the worst effect of this distortion is the sense of
hopelessness dispensed with the title "crack kid." Hopelessness on the
part of mothers, teachers, and even the children themselves. As Coles
warns, "If a child comes to kindergarten with that label, they're dead.
They are very likely to fulfill the worst prophecies."
So, no more convenient and empty names. The children whose mothers
used cocaine are neither universally nor permanently nor uniquely
damaged. The so-called "crack kids" are just a portion of our growing
population of children in deep trouble. They are only children, like
so many others, growing up with a treacherous mix of nature's and
nurture's woes.
If you need a label, call them kids who need help.
- Ellen Goodman is a Globe columnist.
------------------------------------------------------------------------------
other references extracted from the Usenet News
Author: Koren-G. Graham K.
Institution: Department of Pediatrics & Research Institute,
Hospital for Sick Children, Toronto, Ontario, Canada
Article Title: Cocaine in Pregnancy: Analysis of Fetal Risk
Source: Vet-Hum-Toxicol. 1992 Jun. 34(3). P 263-4
Abstract: During the last decades there has been a substantial
increase in the recreational use of cocaine in young
adults and parallelly there has been an increase in
its use by pregnant women. We analyzed all published
papers on cocaine use in pregnancy and found that
for most endpoints studied (eg, prematurity, head
circumference) there were many studies showing
effects and many showing no effects. Upon meta-
analysis, most of the effects could not be shown
significant when compared to control groups. In
a prospective study in Toronto, babies exposed to
cocaine during the first trimester only had Bayley
scores at 18-mo of life that were identical to
unexposed babies or to those exposed to canabinoids.
Motherisk presently counsels women who discontinue
cocaine use in the first trimester of pregnancy that
there is no increased developmental risk for the baby.
Author: Neuspiel-D-R
Title: Cocaine-Associated Abnormalities May Not Be
Causally Related.
Source: Am-J-Dis-Child. 1992 Mar. 146(3). P 278-9
Author: Mayes-L-C. Granger-R-H. Bornstein-M-H. Zuckerman-B.
Institution: Yale Study Center, New Haven, Conn 06510
Title: The Problem of Prenatal Cocaine Exposure. A Rush
to Judgement
References: Review Article: 43 refs.
Source: JAMA. 1992 Jan 15. 267(3). P 406-8
Author: Owiny-J-R. Myers-T. Massmann-G-A. Sadowsky-D-W.
Jenkins-S. Nathanielsz-P-W.
Institution: Laboratory for Pregnancy and Newborn Research, College
of Veterinary Medicine, Cornell University, Ithaca,
New York.
Title: Lack of Effect of Maternal Cocaine Administration on
Myometrial Electromyogram and Maternal Plasma Oxytocin
Concentrations in Pregnant Sheep at 124-145 Days'
Gestational Age.
Source: Obstet-Gynecol. 1992 Jan. 79(1). P 81-4
This is from _Science_News_ some time in November 1991. Sorry I
don't have the exact date.
-----------------------------------------------------------------
"Smoking out cocaine's _in_utero_ impact"
Despite many reports of cocaine's ill effects on the developing
fetus, scientists lack definitive evidence specifically linking
cocaine to adverse reproductive effects (SN: 9/7/91, p.152).
Using a powerful statistical technique, a Canadian research
team has found that cocaine by itself causes very few problems
during pregnancy.
Gideon Koren of the University of Toronto and his colleagues
identified 20 previously published cocaine studies that in-
volved pregnant women and yielded mixed results. Those
studies often relied on small samples of cocaine users -- a
problem that limited each study's statistical power.
To home in on cocaine's reproductive risks, his team turned
to a method called meta-analysis, which statisticians use to
assess data by pooling a number of similar studies. Koren and
his colleagues identified women in the 20 studies who used
cocaine during pregnancy but did not use other illicit drugs or
alcohol, and compared them with those who reported no drug
or alcohol use during pregnancy. They found no statistical link
between prenatal cocaine use and premature delivery, low
birthweight or congenital heart defects in babies -- problems
often thought to result from cocaine.
The meta-analysis suggests that confounding factors -- such
as other drugs, alcohol and smoking -- may account for the fetal
growth retardation or prematurity commonly ascribed to
cocaine, the researchers assert in the October _TERATOLOGY_.
Koren says women who use cocaine tend to smoke more
cigarettes than women who use other illicit drugs and are more
likely to drink alcohol and take additional drugs.
The meta-analysis did reveal a chance that a pregnant
woman's cocaine use by itself might cause malformations of the
genito-urinary tract in a small number of infants. Koren says
this effect may trace to cocaine-induced constriction of the
placental blood vessels.
=============================================================================
From: dblake@lander.wbme.jhu.edu (Dave Blake)
Newsgroups: alt.drugs
Subject: Evidence for crack babies
Date: 3 Mar 1995 23:36:08 GMT
Message-ID: <3j8958$33a@jhunix1.hcf.jhu.edu>
I just got back from a talk given by Pasko Rakic, the emminent
neuroscientist from Yale. He showed evidence from someone else's
lab that crack babies are real. I do not want to misrepresent what
was done, so I'll give you the blow by blow.
First, he showed that when radioactive thymidine is given to a pregnant
primate on a certain day, all the radioactive label will go to
one cortical cell layer in the baby. This fits in well with Rakic's radial
migration hypothesis, in that cells proliferating on the day when the
thymidine is given will take up the label, and all cell's proliferating
on the same day migrate to the same cortical layer.
Then he showed that when the exact same experiment is done, except that
the mother is given coke from the day the thymidine is given until
the birth of the child, the cell migration is somewhat random. The cells
that migrate the furthest end up in their normal position. Most cells
end up somewhere between the cortical plate and their predestined layer.
So there is hard evidence that cocaine will affect brain development
in a primate fetus, if the mother is given coke.
As for dosage - he didn't say and I do not know.
As for whether this translates to humans - I think that you need to
think very carefully as to whether you would want to take that chance.
He seemed to think that it did translate to humans, but it does highlight
his hypothesis. If I run across a journal article I'll post it.
Dave Blake
