Cocaine decreases urinary prostacyclin release in pregnancy: Correlation with uterine and umbilical Doppler velocimetry

Objective: The purpose of this study was to determine maternal urinary prostacyclin and thromboxane excretion in patients with recent cocaine use, compared to cocaine-free controls, and correlate the findings with Doppler velocimetry. Study design: Seventeen patients admitted with premature rupture of membranes between the gestational ages of 24 and 34 weeks were tested for urinary cocaine metabolites. Eleven patients had positive screening and six patients were negative and served as controls. After initial stabilization, 24-h urine collections were obtained and were assayed for the prostacyclin metabolite 2,3-dinor-6-keto-PGF_1α, and the thromboxane metabolite 2,3-dinor TXB2. These patients underwent uterine and umbilical arterial Doppler velocimetry expressed as the pulsatility index. Statistical analysis was performed by the SPSS statistical package using the non-paired Student t test, and Spearman correlation coefficient with p < 0.05 being considered significant. Results: Compared with controls, urinary excretion of prostacyclin in pregnant women with recent cocaine use was significantly lower. The pulsatility index of the uterine arteries of the cocaine-positive individuals was higher than in controls and had a significant inverse correlation with prostacyclin metabolite excretion. Umbilical arterial velocimetry was similar in the two groups. Conclusion: Recent cocaine ingestion in pregnant women decreases production of prostacyclin and negatively affects the pulsatility index of the uterine artery.