The second major pathophysiologic pathway involves cocaine’s vasoconstrictive effects, which may indirectly impact fetal brain development through alterations in placental vasculature, elevations in plasma catecholamines17, and decreased placental blood flow18. These in turn can reduce the supply of oxygen and nutrients to the fetus which can contribute to intrauterine growth restriction19, hypoxemia, and in a small number of cases large vessel-distribution strokes20, 21. Others working in the field22 have shown that, at least in the mouse model, prenatal cocaine-induced CNS alterations are not mediated through maternal vasoconstriction.
