Around 2.4 million individuals in the United States use cocaine at least twice per week. It has also been estimated that 4% of women use drugs during the pregnancy. These high percentages make drug use a popular topic for researchers to study, especially in regards to cocaine use and the effects that it causes on the fetus (Bhuvaneswar, 2008). The results that have been obtained regarding drug use during pregnancy are likely to change for recent studies due to the increase in drug availability (Bhuvaneswar, 2008). Although effects of prenatal cocaine exposure may not be as severe as once thought, it can still lead to developmental, behavioral, and emotional struggles. In this paper, I will explain the potential growth, developmental, and behavioral abnormalities that appear in children due to prenatal cocaine exposure. I will also talk about the history of cocaine use, why it is such a highly addictive drug, and the withdrawal symptoms that arise from this continued use. In addition, I will evaluate gender differences considering the effects of prenatal cocaine exposure and how these results can be associated to animal models.
Cocaine use is a major risk during pregnancy because the drug can easily cross the blood brain barrier, therefore, blocking the reuptake of dopamine, norepinephrine, and serotonin. This restrictive effect has been studied on pregnant animals to see the different effects that arise with maternal cocaine use as compared to direct cocaine exposure to the fetus. Surprisingly there were more serious effects on the fetus when the cocaine was administered to the mother as compared to when the cocaine was directly given to the fetus (Miller, 2016). All women should be screened for drug use during pregnancy and many have argued that these tests should screen for any amount of drug use. This thorough evaluation is recommended because some of the mothers may use drugs occasionally or recreationally, therefore, not identifying with the addiction criteria in the DSM (Bhuvaneswar, 2008). Even small amounts of drug use can be harmful on the developing fetus; thus, teratogens cannot solely be associated with drug addiction or chronic drug use.
Cocaine originated from South America and was initially extracted from coca plants and used for ritualistic practices, food substitutions, and medical enhancements (Konkol, 1996). Individuals of low socioeconomic status were identified to be some of the main abusers of this drug following the price drop in the 1980s. The two common forms of cocaine include cocaine hydrochloride and crack cocaine. Cocaine hydrochloride comes in a powdered form and can be used as a local anesthetic to help diminish feelings of pain. Crack cocaine, on the other hand, comes in a crystal form and is found to be much more potent than other forms of cocaine. Smoking crack cocaine produces rapid effects on the body because of the drugs ability to reach the brain quickly (Konkol, 1996). The three primary routes of cocaine administration include smoking, snorting, and injecting. Cocaine hydrochloride is administered through snorting or injecting intravenously and crack cocaine is typically administered through smoking (Konkol, 1996).
Cocaine is highly addictive and can be viewed as a positive reinforcer due to the euphoric effects that it induces on the mind and body. Positive reinforcements can be associated with addiction because using drugs may allow the person to feel relaxed, less stressed, and carefree. The strong desire and craving for the pleasant effects of cocaine can lead the person into repeated administration of the drug (Konkol, 1996).
Knowing the way in which the drug was administered can help determine potential short-term effects on the body. If cocaine is absorbed into the body quickly, the high will be more intense but will not have as long of an effect (Gossop, 1994). Smoking cocaine leads to an immediate high that typically lasts around 10 minutes. In comparison, snorting is found to have a slower onset but can produce effects that last for about 30 minutes. Once the cocaine begins to wear off, the user may experience unpleasant feelings of withdrawal and choose to repeatedly administer the drug in order to reduce these negative effects. Although the withdrawal symptoms for cocaine are not as intense as other drugs, they still produce unpleasant sensations and experiences.
A few of the psychological symptoms of cocaine withdrawal include fatigue, increased appetite, restlessness, slowed mental processing, and the inability to experience pleasure (Filip, 2010). Aside from these symptoms, the addicted individual may also experience feelings of suicide, depression, and anxiety. These withdrawal states are likely to transpire because the use of cocaine blocks dopamine receptors, therefore, allowing the brain to be flooded with neurotransmitters that bring about feelings of happiness and excitement (Filip, 2010). As the cocaine begins to loose its effects, the user may experience cravings for the drug. This desire can be associated with the negative reinforcement model of addiction because the individual administers the drug repeatedly to curb the negative, withdrawal effects. If the symptoms of withdrawal do not diminish over time or are too intense, they may need to seek treatment so they can be monitored and medicated if need be.
Animal models have been used to support the positive reinforcement model because it has been revealed that rats will self-administer cocaine (Miller et al., 2016). In this study, they compared rat behavior based on whether they were injected with cocaine or saline. This article went on to mention that rats use certain cues to help form an association between their behaviors and the cocaine exposure (Miller et al., 2016). The incentive salience theory of drug addiction can also provide information as to why the rat’s behaved the way they did. This theory states that drug addiction develops due to the intense motivation for drugs and the effects that they produce (Robinson, 2008). This strong desire, also referred to as the “wantingâ€, is commonly activated by cues that are associated with the drug (Robinson, 2008). The rats may use things such as floor or wall cues to help them associate the drug with the feelings that they are experiencing. The euphoric effects of the drug and knowing the negative withdrawal symptoms that occur with diminished drug use allows addicts to be highly susceptible to drug relapse (Robinson, 2008).
Prenatal cocaine exposure (PCE) has been linked to many developmental and behavioral abnormalities in young children and adolescence. When a child is faced with developmental complications from prenatal cocaine exposure, it can be make maturation more challenging. Adolescence is already a difficult transitional period in ones life due to the vast amount of growth in areas concerning social skills, cognitive demands, and complex reasoning.
Prenatal cocaine exposure damages the child’s prefrontal cortex, which can lead to complications in emotional regulation, planning, and reasoning (Ackerman, 2010). It was discovered that children exposed to cocaine in utero tended to have lower IQ scores than children who were not exposed (Ackerman, 2010)). The Ackerman article goes on to talk about the different amounts of gray and white matter in the brain. Studies have shown a decrease in gray matter in the brain and an increase in white matter in the brain for children with prenatal cocaine exposure (Ackerman, 2010). The imbalance in white matter for the cocaine-exposed children was linked to a decreased volume of the corpus callosum. The corpus callosum is a part of the brain that is in charge of communication between the left and right hemispheres. Although symptoms of this poor brain connection may not appear until later in life, it can produce difficulties with motor coordination, vision, and cognitive processing (Ackerman, 2010). It was also noted that PCE causes increased levels of frontal white matter, which results in abnormal development and delayed performance on tasks. Additionally, the volume in the caudate nucleus is reduced which controls the part of the brain that is associated with language, processing, and learning (Landi, 2017). These studies have concluded that exposure of cocaine in utero can have disruptions in frontally mediated tasks, such as memory retrieval and recognition (Ackerman, 2010).
Through close evaluation of language functioning, results revealed that adolescence with PCE acquire difficulties with development, linguistic capabilities, reading comprehension, and listening comprehension (Landi, 2017). A study was executed that looked at how cocaine exposed 12 year olds performed on tests that evaluated their understanding of speech sounds. While comparing their results to the nonexposed children, it was clear that the exposure of cocaine correlated with poorer phonological processing for children at age 12 (Landi, 2017). The Landi article also evaluated event related potential (ERP) responses using a number of different tasks (e.g. rhyme priming, semantics priming, and semantic anomaly). The findings for these tests indicated that children with prenatal cocaine exposure had scattered mental processes and longer response times to the stimuli being presented. While reviewing all of the tests, researchers came to the conclusion that reading and comprehension abilities were lowered for children who were exposed to cocaine in utero. Children with PCE also had difficulties with repeating sentences and were not as accurate when making judgments associated with word rhyming (Landi, 2017). Adolescents who display signs of PCE early could be at risk of developing further difficulties in cognitive processing later in life (Landi, 2017).
Aside from speech and language difficulties, there have also been significant differences in growth rates for children with prenatal cocaine exposure. Studies have revealed that drug exposed children present slower growth rates when compared to non-exposed children. Longitudinal studies have been used to examine the growth of exposed and nonexposed children at different stages of their lives (Ackerman, 2010). Different outcomes of the child’s growth can be determined depending on when in the pregnancy the mother was using drugs. There was a decrease in drug use when comparing the amount of drugs that pregnant woman took during the first trimester with the amount of drugs that they took during the third trimester. It was reported that 4% used during the first trimester, while only 2% used during the third trimester (Bhuvaneswar, 2008). A longitudinal study was performed to measured height, weight and head circumference of 10 year old children with prenatal cocaine exposure (Richardson, 2013). These findings revealed that there was a positive correlation between cocaine use in the first trimester and low birth weight (Richardson, 2013). Children with prenatal cocaine exposure were found to be shorter in height and have a smaller head circumference than children in the control group (Ackerman, 2010).
Although the growth of cocaine-exposed children seems to be slowed for the first 10 years, it is difficult to tell if these effects last throughout their entire life. Researchers cannot be certain about whether or not they eventually meet the overall height average of their peers. According to studies relating to the topic of PCE, between 15 and 20 percent of children are born with birth defects. These birth defects may be linked to the growth of blood vessel that takes place in the infant’s body as a result of cocaine use. Some of the most common birth defects cause distress on the brain, heart, and reproductive organs (Ackerman, 2010). Deformities in certain ventricles of the heart is a common outcome of PCE and could leave the infant susceptible to heart failure. It is also possible for the growth of the fetus to be stunted or for children to be at risk of premature birth if the carrier is using cocaine during the pregnancy (Buckingham, 2013). The potential growth complications mentioned above could also appear due to the risk that comes with premature birth. Although this is the case, it has been discovered that some infants who are exposed to cocaine, but born earlier show less severe abnormalities. It may at times be beneficial for the child to be born earlier because it would reduce the amount of time that the fetus would be exposed to the drug (Andrews, 2000). Development is more likely to be distorted when the mother uses cocaine further along in the pregnancy, especially during the third trimester. Therefore, it may be more advantageous if the child is born prematurely rather than if they arrived at their expected due date and experience cocaine expose for a longer duration of time.
Aside from developmental abnormalities, prenatal exposure to cocaine can also lead to a number of behavioral complications. The Ackerman article talks about the enhanced possibility of aggression and the decreased levels of attention. Children who were exposed to cocaine in utero were found to have lower scores on the APGAR test, as well as on the Neonatal Behavioral Assessment Scale (NBAS) (Martin, 2016). The APGAR test is given to newborns as a way to check their overall health and well being. This test is performed on the baby twice, the first time when they are 1 minute old and the second time when they are 5 minute old. The APGAR assessment evaluates the infant’s health by examining five different categories including appearance, pulse, grimace, activity, and respiration. ADD MORE???? An APGAR score that is lower than seven indicates that the infant is not in good health, therefore, requiring a lot of supervision and monitoring. Another behavioral effect that is present in PCE individuals is the inability to control emotional and arousal states (Martin, 2016). Although many children exposed to cocaine in utero can still engage in complex reasoning during adolescence, studies have shown an increase in impulsive behavior. Adolescents may have a difficult time managing this quality, especially when they are faced with dangerous or harmful situations. Although premature birth can be beneficial for the child, parent and teacher ratings have indicated an increase in irritability for those who were born earlier (Martin, 2016). This challenging behavior may be difficult for school systems due to the uncertainty of how to control and discipline these children. Prenatal cocaine exposure has also been closely linked to drug-induced seizures in newborns. Results from a study showed that all of the infants who were prenatally exposed to cocaine had a seizure within the first 36 hours of being out of the womb (Martin, 2016). It is common for infants exposed to cocaine in utero to experience seizures because their body is used to the drug and essentially going through states of withdrawal. Infants who have seizures after birth can receive help through various medications and close observed while they are in the hospital.
The Buckingham article brings up the differences that lie between males and females when considering the effects that arise from PCE. It is important to take gender into account when evaluating the consequences of PCE because some effects are more prominent in either males or females. Studies have shown that girls who were exposed to cocaine prenatally had higher levels of emotional responses than girls who were not exposed (Buckingham, 2013). The responses of the girls were exposed to cocaine during the pregnancy showed statistically significant results when evaluating the amount of anxiety that the child was experiencing. Due to this increase in nervousness, girls may also have internalizing problems or encounter feelings of depression as they mature (Buckingham, 2013). In opposition, PCE boys may have issues controlling their stress responses, which could allow them to turn to substances to help regulate their arousal (Chaplin, 2015).
Another gender differences was that boys had weaker response inhibitions than both healthy boys and girls with no cocaine exposure (Chaplin, 2015). When someone has difficulties with response inhibitions, they struggle to think clearly or appropriately before they express their emotions (Buckingham, 2013). For example, someone with prenatal cocaine exposure may not have a filter and speak whatever is on their mind. Without this skill, children have a difficult time evaluating circumstances and determining how their own behaviors may be either beneficial or detrimental to the situation. Additionally, studies have shown that boys tend to have lower blood pressure if their carrier used cocaine during the pregnancy (Buckingham, 2013). Through close evaluation, it has been concluded that boys typically illustrate more serious effects of prenatal cocaine exposure than girls (Dow-Edwards, 2012). These findings illustrate that gender plays a role in determining the different oucomes that boys and girls experience from prenatal cocaine exposure.
This Dow-Edwards article goes on to compare humans and animal studies when looking at the effect that prenatal cocaine use has on the developing fetus. A few of the topics considered in this article included the possible developmental abnormalities, effects on growth and development, and differences in the mother’s frequency of cocaine use.