TERATOLOGY 46567-571 (1992)
The Perception of Teratogenic Risk of Cocaine GIDEON KOREN, DAVID GLADSTONE, CHRISTINE ROBESON, AND ISABELLE ROBIEUX The Motherisk Program, Diuision of Clinical PharmacologyiToxicology, Department of Pediatrics and Research Institute, The Hospital for Sick Children, Toronto, and Departments of Pediatrics and Pharmacology, The University of Toronto, Toronto, Ontario M5G 1x8
While there has been a substantial increase in recreational use of cocaine by young adults, conclusive evidence for cocaine teratogenicity in humans is lacking, and even those believing the drug is teratogenic agree that the rates are quite small. While counseling pregnant women on their teratogenic risk, it was our impression that there is a n unrealistically high perception of reproductive risk of cocaine. We wished to quantify the perception of teratogenic risk of cocaine by the public, physicians, and by pregnant women who were counseled following gestational exposure to the drug. Women taking cocaine during the first trimester of pregnancy (n = 54),controls with post secondary education (n = 30), and physicians (n = 30) were asked, using a visual analogue scale, to quantify the teratogenic risk of cocaine and the tendency to terminateicontinue the pregnancy after first trimester exposure; in the case of the “public” and physicians this was a hypothetical question. Both physicians and the controls perceived cocaine to be teratogenic (13.4 ? 11%risk of major malformations by physicians, and 56.5 22.8% by the “public”). The controls believed cocaine to be as hazardous as thalidomide (57.2 ? 25.6% risk for thalidomide). Asked whether they would wish to terminate such pregnancy in their family, most physicians (56%) and the controls (70%) had a greater than 50% tendency to terminate. In pregnant patients attending Motherisk, the counseling process resulted in a significant decrease in risk perception of cocaine (from 37.5 2 20.5% to 17.6 2 14.2% P50%) after the consultation eventually undergo abortion (Koren et al., 1990). Six to nine months after the expected date of confinement these women are contacted by the telephone to establish the outcome of pregnancy. In addition t o a detailed interview, a report from the physicians caring for the babies is sought t o validate the maternal report. At 18 months of age toddlers exposed in utero to cocaine are examined physically, neurologically, and developmentally (the Bayley test) in our clinic, together with an unexposed control group, by a psychometrist blinded to the nature of gestational exposure. In order t o study the perception of teratogenic risk of cocaine by the “public” and by physicians, we asked 60 individuals to rank cocaine risk for major malformations on a visual analogue scale identical to the one filled by our patients. Participating individuals were also asked to estimate the teratogenic risk of thalidomide as well as the baseline population risk. In addition, participants were also asked to quantify their tendencies towards continuationitermination of a hypothetical pregnancy if their wives (or themselves, in case of women) were found t o have used cocaine for 8 weeks into
569
TERATOGENIC RISK OF COCAINE
TABLE 1 . Perception of teratogenic risk (baseline risk, and risk of cocaine and thalidomide) by physicians and the general public’ Teratogenic risk 1%) Baseline Number risk (%) Cocaine Thalidomide “Public” 30 A a* 0” 13.4 2 11 56.5 2 22.8 57.3 f 25.6 Physicians
30
A 3.8t 3.9
a*
0’ 42 2 27
12.5 ? 12.9
‘Data are expressed a s mean ? SD; *, Significant differences from baseline a t P.rO.0005; A, denotes significant difference between physicians and the “public” a t P
The Perception of Teratogenic Risk of Cocaine GIDEON KOREN, DAVID GLADSTONE, CHRISTINE ROBESON, AND ISABELLE ROBIEUX The Motherisk Program, Diuision of Clinical PharmacologyiToxicology, Department of Pediatrics and Research Institute, The Hospital for Sick Children, Toronto, and Departments of Pediatrics and Pharmacology, The University of Toronto, Toronto, Ontario M5G 1x8
While there has been a substantial increase in recreational use of cocaine by young adults, conclusive evidence for cocaine teratogenicity in humans is lacking, and even those believing the drug is teratogenic agree that the rates are quite small. While counseling pregnant women on their teratogenic risk, it was our impression that there is a n unrealistically high perception of reproductive risk of cocaine. We wished to quantify the perception of teratogenic risk of cocaine by the public, physicians, and by pregnant women who were counseled following gestational exposure to the drug. Women taking cocaine during the first trimester of pregnancy (n = 54),controls with post secondary education (n = 30), and physicians (n = 30) were asked, using a visual analogue scale, to quantify the teratogenic risk of cocaine and the tendency to terminateicontinue the pregnancy after first trimester exposure; in the case of the “public” and physicians this was a hypothetical question. Both physicians and the controls perceived cocaine to be teratogenic (13.4 ? 11%risk of major malformations by physicians, and 56.5 22.8% by the “public”). The controls believed cocaine to be as hazardous as thalidomide (57.2 ? 25.6% risk for thalidomide). Asked whether they would wish to terminate such pregnancy in their family, most physicians (56%) and the controls (70%) had a greater than 50% tendency to terminate. In pregnant patients attending Motherisk, the counseling process resulted in a significant decrease in risk perception of cocaine (from 37.5 2 20.5% to 17.6 2 14.2% P50%) after the consultation eventually undergo abortion (Koren et al., 1990). Six to nine months after the expected date of confinement these women are contacted by the telephone to establish the outcome of pregnancy. In addition t o a detailed interview, a report from the physicians caring for the babies is sought t o validate the maternal report. At 18 months of age toddlers exposed in utero to cocaine are examined physically, neurologically, and developmentally (the Bayley test) in our clinic, together with an unexposed control group, by a psychometrist blinded to the nature of gestational exposure. In order t o study the perception of teratogenic risk of cocaine by the “public” and by physicians, we asked 60 individuals to rank cocaine risk for major malformations on a visual analogue scale identical to the one filled by our patients. Participating individuals were also asked to estimate the teratogenic risk of thalidomide as well as the baseline population risk. In addition, participants were also asked to quantify their tendencies towards continuationitermination of a hypothetical pregnancy if their wives (or themselves, in case of women) were found t o have used cocaine for 8 weeks into
569
TERATOGENIC RISK OF COCAINE
TABLE 1 . Perception of teratogenic risk (baseline risk, and risk of cocaine and thalidomide) by physicians and the general public’ Teratogenic risk 1%) Baseline Number risk (%) Cocaine Thalidomide “Public” 30 A a* 0” 13.4 2 11 56.5 2 22.8 57.3 f 25.6 Physicians
30
A 3.8t 3.9
a*
0’ 42 2 27
12.5 ? 12.9
‘Data are expressed a s mean ? SD; *, Significant differences from baseline a t P.rO.0005; A, denotes significant difference between physicians and the “public” a t P
