The evening that my mother sat me down and told me the facts of life, as they were so quaintly and euphemistically called, we talked about the mechanics of puberty without covering sex. I learned about menstruation, sanitary napkins (anyone remember them?), a bit about the birth process and the womb. The womb, my mother told me, was a safe place for the baby where the food it needed flowed, predigested, down the umbilical cord through a filter that cleansed it of any impurities before it got to the unborn baby. I recall she used the term “placental barrier” but it’s likely I added that phrase to my memory when I learned about it in health class.
We are all too well aware now that the placental barrier is an undependable filter. One newborn exposed to a drug known to cause birth defects might be born fine, while another suffer the full consequences. In the 1970s we learned about the effects of alcohol on the developing fetus. Fetal alcohol syndrome was well- documented by the 1980s and pregnant women who drank before they realized they were pregnant were vilified and terrified. Cigarettes were the next to go, low birth weight and premature delivery were so feared that a pregnant woman seen smoking was scolded by strangers.
The baby was no longer safe in the womb. The placental barrier was some bedtime story like (spoiler alert) the fairies of tooth and godmother fame. Medical drug use in pregnancy had a few, spectacularly bad outcomes (note our blog) and sealed the conclusion that the placental barrier didn’t offer protection to the fetus. The message to pregnant women through the 1970s through today has been consistent and strong: anything that goes into the pregnant woman’s body affects the developing fetus.
So when the crack epidemic arrived and devastated the lives of wide swaths of fertile young women in their teens and twenties, the medical community cried Crack Wolf. We were going to see a generation of addled babies born to addicted mothers. Prenatal cocaine exposure (PCE) caused babies’ brains to be permanently scrambled, we were told. “Crack babies” were jittery and susceptible to addictions and would never be able to be part of society. There was talk of needing an entirely separate school system and after that facilities for cracked up lives when these babies aged because they would never be able to take care of themselves.
Thirty years later, we are seeing the crack generation that never was. Multiple studies have been conducted on PCE-children. A systematic review of those studies was recently published by Pediatrics medical journal. The conclusion? From crack-addicted birth through to young adulthood, “crack babies”‘ have shown themselves to be as intelligent and distracted, as focused and jittery, as prone to heroism and to illegal activities, as any other generation. They are just kids, not crack babies.
In the past few weeks articles have been piling up about how wrong the doctors were. The consensus seemed to be that crack didn’t do any harm, which leaves prospective pregnant partners with the real concern, how to know what will harm the fetus and what is safe.
Were the doctors so wrong? We reached out to Maureen Black, Ph.D. and lead author of the systemic review of studies, “There were some significant effects on children’s behavior, cognition/school performance, and brain structure. The point is that the differences were relatively small and of questionable clinical importance – certainly not consistent with the “crack baby scare” raised in the past. Cocaine use occurs in the context of a drug-using lifestyle, often marked by violence and a focus on the illegal acquisition of drugs. These environmental conditions do not support the nurturant and responsive caregiving and the opportunities for exploration and learning that children need.”
It should not go unsaid that many infants were born addicted to crack and had to go through the physical and mental pain of withdrawal within the few weeks of his or her life.
How did the medical community go so wrong? In answer to our questions, she noted that, “Cocaine does increase the risk for premature birth. Moreover as I note (above), there were some differences in functioning that could be attributed to either the drug or the accompanying lifestyle. During the 1970s we recognized the teratogenic effects of prenatal exposure to alcohol (Fetal Alcohol Syndrome) and when cocaine use because popular in the 1980s, we were primed for the possibility that cocaine would be equally dangerous. Fortunately it wasn’t. The jitteriness that sometimes appears in cocaine-exposed babies is relatively similar to the neurological immaturity seen in other premature babies.”
The medical community made reasonable assumptions. The effect of any substance on a developing fetus is extremely difficult to test for ahead of time. 79% of all medicines approved for us in the US have not been tested for their affect on a fetus. Nearly all tests on drugs seeking FDA approval don’t test on women for fear that they women might get pregnant during the trial and expose the fetus. Which leads to another issue for another blog, the differing effects of drugs on men versus women and how the medical community often ignores it.
This leaves pregnant women in an impossible position. For the first time in history we have medicines that can normalize lives for many with ADHD, depression, diabetes, MS and more. More people now than ever in history depend on daily medicines. Some of these drugs are needed for the mother’s health and 70% of all pregnant women take pills during pregnancy but the effects on a fetus are not fully known and are hard to predict. Two fetuses exposed to the same substance might result in one perfectly healthy baby and one with autism
Without better testing, taking even legal drugs during pregnancy is a crapshoot. The list is growing on drugs that have been banned (or contra-indicated) for women after a pattern of birth defects have been found. That’s too late. Our babies deserve better.
The big question: how do we learn from the past and avoid problems in the future? How do we know what will affect the fetus permanently, what will affect the fetus but is recoverable, and what doesn’t have any affect at all. Sadly, the answer continues to elude science. And until we get those answers the list of damaged babies and substances banned after the fact will get longer.
— Suzanne B Robotti