Hyperbole as Harmful as Cocaine

Abstract

We read with interest the case report by Soster and col-leagues (2015) that attempts to draw a connectionbetween hydranencephaly in a newborn with FLVCR2genetic mutation and prenatal cocaine exposure. Themanuscript speculated that synergistic effects betweenFLVCR2 genetic mutation and prenatal cocaine exposurecreated a “susceptible brain.” Clearly, this is a timely andimportant issue, and given the potentially far-reachingimplications of the conclusions drawn, we believed at leasttwo issues warranted further discussion.The manuscript suggests a connection between prena-tal cocaine use and fetal abnormalities, but there is nocompelling evidence presented to support this conjecture.It is true, cocaine was found in the meconium indicatingprenatal cocaine exposure. But, this information alonedoes not inform about how much cocaine was consumed;nor does it convey any information about the time frameduring the pregnancy that the drug was used. An under-standing of these factors is critical for determining theteratogenic effects of any drugs, including cocaine or evennicotine and caffeine. Cocaine, like nicotine and caffeine, isa vasoconstrictor that at excessively large doses during theearly stages of pregnancy can enhance the risk of sponta-neous abortions and/or a torn placenta. Providing morecontext about the cocaine exposure would help the readerunderstand that the described deleterious effects on fetaldevelopment is not inevitable but are likely only undernarrow conditions. This point is further magnified whenone considers findings showing that prenatal tobaccoexposure produces markedly more detrimental effects onwhite matter integrity in adolescents, compared with pre-natal cocaine exposure (Liu et al., 2011). Importantly, thecurrent case report did not control for nicotine or caffeine.We recognize that cocaine use during pregnancyshould be discouraged. Our concern is that the conclusionsdrawn by Soster et al. (2015) appear somewhat hyper-bolic, which in itself can cause harm to pregnant womenand their children by enhancing unwarranted stigma asso-ciated with cocaine use. In some cases, intense stigma hasresulted in the removal of children from their mothers,and even in the incarceration of mothers. Either of theseoutcomes has been shown to produce harmful effects onchildren (e.g., Doyle, 2008).