Cocaine abuse and reproduction.

Cocaine abuse today is widespread and is on the increase in North America. It is estimated that one in every four Americans has used cocaine for its euphorigenic properties. With increasing participation of younger age subjects in the cocaine abuse, the effects of cocaine on the reproductive system have attracted considerable attention. The impact of cocaine abuse on the health and society has been repeatedly documented in the past, but its effects on human reproduction have only recently been appreciated. The initial reports, on the harmful effects of cocaine on pregnancy and neonatal outcome, documented high incidence of abortions, placental abruption and neonatal neurobehavioral abnormalities. Subsequent studies have confirmed these findings and have documented a high incidence of congenital malformations, intrauterine growth retardation, sudden infant death syndrome and premature labor and delivery following cocaine use. Additionally, since cocaine is freely excreted in the milk, its effects on nursing have raised serious concerns. In this review, the effects of cocaine on various elements of reproduction, namely endocrines, fertility, libido, intercourse, pregnancy, fetal development, childbirth, neonates and infants have been analyzed systematically. It is believed that a clearer understanding of the cocaine's effects on various aspects of reproduction is essential to counsel and treat the pregnant women and to protect the newborn.