There are no well-documented studies regarding the safety or efficacy of using drugs to medically withdraw pregnant, cocaine-using women. The evidence is extremely limited for all methods of medical withdrawal. Inpatient treatment is the ideal whenever possible, although these facilities may not always be available. Medical withdrawal is just the first step in the continuum of care for pregnant, cocaine-dependent women. Referral to ongoing alcohol and other drug treatment and relapse prevention services is essential.
Symptoms of Cocaine Withdrawal
Withdrawal from cocaine dependence is characterized by depression, anxiety, and lethargy, which begin to resolve after approximately 1 week. Less common are signs of a paranoid psychosis during withdrawal from chronic use of high doses of cocaine. In cocaine withdrawal, medication is rarely needed for the serious sequelae that are associated with alcohol, benzodiazepines, and opioid withdrawal.
Maternal and Fetal/Infant Effects of Cocaine
1. Possible effects of maternal cocaine use during pregnancy:
- Intrauterine growth retardation (IUGR)
- Abruptio placentae
- Premature labor
- Spontaneous abortion
- No effect
2. Possible effects on the fetus and newborn infant that have been reported:
- Increased congenital anomalies
- Mild neurodysfunction
- Transient electroencephalogram abnormalities
- Cerebral infarction and seizures
- Vascular disruption syndrome
- Sudden infant death syndrome
- Smaller head circumference
- No effect
Guidelines for Withdrawal from Cocaine: Treatment Options
There are no data about the effectiveness of the following guidelines in pregnancy. In those guidelines that substitute other drugs, many of the drugs are problematic to the newborn and some have not been confirmed to be safe. Some centers do not generally use antidepressants for cocaine withdrawal depression. However, other programs prescribe antidepressants for the first 5 days to try to reduce the high dropout rate that occurs during this period. Sedatives and/or antidepressants may cause excessive drowsiness in a cocaine-dependent woman.
Cocaine-dependent women who require sedatives and/or antidepressants for any significant length of time often have an endogenous depressive disorder. Psychiatric consultation is usually indicated.