HaCKeRz KrOnIcKLeZ 3

home *** CD-ROM | disk | FTP | other *** search

/ HaCKeRz KrOnIcKLeZ 3 / HaCKeRz_KrOnIcKLeZ.iso / drugs / crack.baby.refs < prev next >

Wrap

Text File | 1996-05-06 | 21KB | 424 lines

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.