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February 20, 1987, Vol 257, No. 7 >
ARTICLE | February 20, 1987

Effect of Cocaine on Uterine Blood Flow and Fetal Oxygenation FREE

James R. Woods, Jr, MD; Mark A. Plessinger, MS; Kenneth E. Clark, PhD
[+] Author Affiliations

Reprint requests to Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642 (Dr Woods).


JAMA. 1987;257(7):957-961. doi:10.1001/jama.1987.03390070077027
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References

Five pregnant ewes and their singleton fetuses were instrumented at 115 to 120 days' gestation (term, 145 days) for heart rate, blood pressure, uterine blood flow, and arterial blood gas sampling. In separate studies, cocaine was given to the ewe or fetus as a 0.5-, 1.0-, or 2.0-mg/kg intravenous bolus, and cardiovascular and arterial blood gas values were obtained for 60 minutes after the injection. The results showed that maternal administration of cocaine produced dose-dependent increases in maternal blood pressure and decreases in uterine blood flow. Uterine vascular resistance increased by 52%, 96%, and 168%, respectively. These responses were accompanied by marked fetal hypoxemia, hypertension, and tachycardia. Direct cocaine administration to the fetus produced smaller increases in fetal heart rate and blood pressure than those observed following maternal cocaine injection, and no significant changes in fetal arterial blood gas values. The conclusions are (1) cocaine alters fetal oxygenation by reducing uterine blood flow and impairing oxygen transfer to the fetus; and (2) fetal cardiovascular changes to maternal administration of cocaine may reflect fetal hypoxemia, increased fetal levels of cocaine or fetal catecholamines, or a combination of these events.

(JAMA 1987;257:957-961)

REFERENCES

1 +
Fishburne PM, Abelson HI, Cisin I: National Household Survey on Drug Abuse: National Institute of Drug and Alcohol Abuse Capsules 1982 . Dept of Health and Human Services, 1983;.
2 +
Chambers CD, Griffey MS:  Use of legal substances within the general population: The sex and age variables . Addict Dis 1975;;2:7.
3 +
Rhoads DL:  Drug Use Trends in Phoenix, Arizona, June 1982: Report to the NIDA-CCG, 1982 . Ariz Med 1982;;39:658-659.
4 +
Lichtenfeld PJ, Rubin DB, Feldman RS:  Subarachnoid hemorrhage precipitated by cocaine snorting . Arch Neurol 1984;;41:223-224.
5 +
Schwartz KA, Cohen JA:  Subarachnoid hemorrhage precipitated by cocaine snorting . Arch Neurol 1984;;41:705.
6 +
Acker D, Sachs BP, Tracey KJ, et al:  Abruptio placentae associated with cocaine use . Am J Obstet Gynecol 1983;;146:220-221.
7 +
Chasnoff IJ, Burns WJ, Schnoll SH, et al:  Cocaine use in pregnancy . N Engl J Med 1985;;313: 666-669.
8 +
Bayorh MA, Zukowska-Grojec Z, Kopin IJ:  Effect of desipramine and cocaine on plasma norepinephrine and pressor responses to adrenergic stimulation in pithed rats . J Clin Pharmacol 1983;;23:24-31.
9 +
Rosenfeld CR, Morriss FH Jr, Makowski EL, et al:  Circulatory changes in the reproductive tissues of ewes during pregnancy . Gynecol Invest 1974;;5:252-268.
10 +
Barcroft J:  The range of weights of fetal sheep at various age . J Physiol 1945;;104:32P-33P.
11 +
Bagchi SP, Reilly MA:  Intraneuronal dopaminergic action of cocaine and some of its metabolites and analogs . Neuropharmacology 1983;;22:1289-1295.
12 +
Greiss FC Jr, Van Wilkes D:  Effects of sympathomimetic drugs and angiotensin on the uterine vascular bed . Obstet Gynecol 1964;;23:925-930.
13 +
Rosenfeld CR, West J:  Circulatory response to systemic infusion of norepinephrine in the pregnant ewe . Am J Obstet Gynecol 1977;;127:376-383.
14 +
Mahalik MP, Gautieri RF, Mann DE Jr.:  Mechanisms of cocaine-induced teratogenesis . Res Commun Substances Abuse 1984;;5:279-302.
15 +
Comline RS, Silver M:  The release of adrenaline and noradrenaline from the adrenal glands of the fetal sheep . J Physiol 1961;;156:424-444.
16 +
Phillippe M:  Fetal catecholamines . Am J Obstet Gynecol 1983;;146:840-852.
17 +
Cohen WR, Piasecki GJ, Cohn HE, et al:  Adrenal secretion of catecholamines during hypoxemia in fetal lambs . Endocrinology 1984;;114: 383-390.
18 +
Edelstone DI, Holzman IR:  Fetal intestinal oxygen consumption at various levels of oxygenation . Am J Physiol 1982;;242:H50-H54.

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1 +
Fishburne PM, Abelson HI, Cisin I: National Household Survey on Drug Abuse: National Institute of Drug and Alcohol Abuse Capsules 1982 . Dept of Health and Human Services, 1983;.
2 +
Chambers CD, Griffey MS:  Use of legal substances within the general population: The sex and age variables . Addict Dis 1975;;2:7.
3 +
Rhoads DL:  Drug Use Trends in Phoenix, Arizona, June 1982: Report to the NIDA-CCG, 1982 . Ariz Med 1982;;39:658-659.
4 +
Lichtenfeld PJ, Rubin DB, Feldman RS:  Subarachnoid hemorrhage precipitated by cocaine snorting . Arch Neurol 1984;;41:223-224.
5 +
Schwartz KA, Cohen JA:  Subarachnoid hemorrhage precipitated by cocaine snorting . Arch Neurol 1984;;41:705.
6 +
Acker D, Sachs BP, Tracey KJ, et al:  Abruptio placentae associated with cocaine use . Am J Obstet Gynecol 1983;;146:220-221.
7 +
Chasnoff IJ, Burns WJ, Schnoll SH, et al:  Cocaine use in pregnancy . N Engl J Med 1985;;313: 666-669.
8 +
Bayorh MA, Zukowska-Grojec Z, Kopin IJ:  Effect of desipramine and cocaine on plasma norepinephrine and pressor responses to adrenergic stimulation in pithed rats . J Clin Pharmacol 1983;;23:24-31.
9 +
Rosenfeld CR, Morriss FH Jr, Makowski EL, et al:  Circulatory changes in the reproductive tissues of ewes during pregnancy . Gynecol Invest 1974;;5:252-268.
10 +
Barcroft J:  The range of weights of fetal sheep at various age . J Physiol 1945;;104:32P-33P.
11 +
Bagchi SP, Reilly MA:  Intraneuronal dopaminergic action of cocaine and some of its metabolites and analogs . Neuropharmacology 1983;;22:1289-1295.
12 +
Greiss FC Jr, Van Wilkes D:  Effects of sympathomimetic drugs and angiotensin on the uterine vascular bed . Obstet Gynecol 1964;;23:925-930.
13 +
Rosenfeld CR, West J:  Circulatory response to systemic infusion of norepinephrine in the pregnant ewe . Am J Obstet Gynecol 1977;;127:376-383.
14 +
Mahalik MP, Gautieri RF, Mann DE Jr.:  Mechanisms of cocaine-induced teratogenesis . Res Commun Substances Abuse 1984;;5:279-302.
15 +
Comline RS, Silver M:  The release of adrenaline and noradrenaline from the adrenal glands of the fetal sheep . J Physiol 1961;;156:424-444.
16 +
Phillippe M:  Fetal catecholamines . Am J Obstet Gynecol 1983;;146:840-852.
17 +
Cohen WR, Piasecki GJ, Cohn HE, et al:  Adrenal secretion of catecholamines during hypoxemia in fetal lambs . Endocrinology 1984;;114: 383-390.
18 +
Edelstone DI, Holzman IR:  Fetal intestinal oxygen consumption at various levels of oxygenation . Am J Physiol 1982;;242:H50-H54.

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