Cocaine

Cocaine is a potent central nervous system stimulant with toxic effects on all organs and systems. It is rapidly metabolized in the liver to benzoylecgonine and ecgonine methyl ester, both inactive metabolites.^{(Lizasoain 2002)}

Infants exposed to cocaine during pregnancy had a lower gestational age, lower weight, height, and head circumference, more tremors, irritability, and infections, less frequent breastfeeding, and a higher risk of developmental delay, sudden death, social problems. and child neglect, than the unexposed. ^{(Maya 2021, Bauer2005, Young 1992)}. Mothers who use cocaine have low breastfeeding rates ^{(Bauer 2005, England 2003)} and may have slightly elevated prolactin levels, without known consequences. ^{(Elman 2005, Patkar 2002)}

Cocaine and its metabolites are excreted in breast milk in extremely variable concentrations, from 5 to 138 micrograms/L, and a single case of 12 mg/L ^{(Dos Santos 2017, Silveira 2016, D'Avila 2015, D'Apolito 2013, Marchei 2011, Winecker 2001, Bailey 1998, Dickson 1997, Chasnoff 1987)}. Its low molecular weight, high lipid solubility, and binding to breast milk albumin facilitate the observed excretion in breast milk.

The infants are also exposed to accidental ingestion and passive inhalation of cocaine vapors (crack). ^{(Focardi 2024, Kharasch 1991, Heidemann 1990, Bateman 1989)}

Reportedly, cases of irritability, tremulousness, hypotonia, vomiting, diarrhea, dilated pupils, cyanosis, respiratory distress, tachycardia and arterial hypertension in infants whose mothers had taken this drug have occurred. ^{(Cardoso 2025, Sachs 2013, Joya 2011, Chasnoff 1987)}

Newborn and infants eliminate cocaine much more slowly than adults ^{(Moretti 2000)}. Cocaine can be detected in the urine of infants up to 60 hours after they have been breastfed and/or inhaled crack cocaine smoke consumed in close proximity. ^{(Cardoso 2025, Focardi 2024, Shannon 1989, Chasnoff 1987)}

Applying cocaine on mother's nipple as anesthetic is highly hazardous since seizures, lethargy or coma may occur. ^{(Howie 2006, Lee 1993, Chaney 1988)}

Drug abuse behavior incapacitates the mother for appropriate baby care and poses a life and health hazard for both, the mother and the infant. There is an increased risk of psychosis and other psychiatric disorders in mothers who use drugs such as cocaine. ^{(Vallersnes 2016, Gerra 2009)}

After exceptional cocaine consumption a free period of 24 hours should be observed before resuming breastfeeding. ^{(Cressman 2012)}

Some authors recommend continuing breastfeeding if cocaine use is not habitual, monitoring the levels of cocaine in breast milk and urine of the infant and controlling the clinical status of the infant. ^{(Sarqar 2005)}

Bed-sharing with the baby is not recommended if drugs are used due to increased risk of suffocation or sudden infant death. ^{(ABM 2020 &2008, UNICEF 2019, 2017, 2014 & 2013, Landa 2012, UNICEF 2006)}