Crack até no leite? Uma revisão da literatura sobre o processo de produção e contaminação do leite materno humano por crack/cocaína e seus efeitos na mãe e no lactente

Abstract

The consumption of abusive drugs by women has increased in recent decades worldwide, especially among pregnant women. Maternal exposure to drugs of abuse can have negative consequences for both pregnant women and the developing child. Cocaine is one of the most commonly consumed drugs by pregnant women, especially in its inhaled/smoked form, crack cocaine. Research has been onducted to clarify the effects of maternal exposure to crack cocaine/cocaine during pregnancy. However, little has been discussed about the implications of crack-cocaine consumption for breastfeeding. The objective of this literature review, of the narrative type, was to report the main findings, present in the literature, on contamination of human breast milk by crack-cocaine and its consequences for the mother and the infant. For this purpose, a search was carried out in the databases: PUBMED and Google scholar. To this end, the role of breast milk in the nutrition and defense of the newborn was initially investigated, in addition to the consequences of replacing it with infant formulas, in relation to the growth and development of the newborn. It also investigated how breastfeeding has historically occurred in Brazil, and the strategies used to expand this practice nationally. Regarding breast milk, research has been carried out into its production process through its five phases: mammogenesis; lactogenesis I and II; galactopoiesis; and involution; in addition to how the transport of molecular components from the interstitium to the alveolar lumen occurs. Understanding the transport pathways not only explains the existence of the three types of breast milk: colostrum, transitional milk and mature milk, but also allows us to understand how breast milk is contaminated by biological, chemical or pharmacological agents, such as drugs. Contamination of breast milk by crack-cocaine/cocaine occurs through passive diffusion associated with the substance's liposolubility, thus making breastfeeding inadvisable/prohibitive for mothers who use it. Toxicological analyses of breast milk samples allow us to identify not only the differential consumption of crack-cocaine and cocaine, but also the consumption associated with other drugs, such as alcohol. In this study, the analysis of the effects of crack-cocaine/cocaine consumption on the child was divided into two groups: the effects associated with the gestational period; and the effects of use during the postnatal period. The use of cocaine and/or crack-cocaine during pregnancy was associated with impaired placental function, resulting in changes in the intrauterine formation of the fetus, in addition to potentially triggering the so-called neonatal abstinence syndrome. Postnatal maternal consumption has been associated with poorer child neurodevelopment, neurological and neuropsychological changes. In the short term, the effects of exposure to crack-cocaine through breast milk in newborns include: sedation, reduced muscle tone, delayed child growth and decreased motor development. In the long term, the effects of post-gestational contact of the child with drugs of abuse can result in problems in learning and cognitive development. In addition, the consumption of these substances increases the chances of maternal neglect, which also has negative indirect consequences for child development. More research is needed to clarify the gaps in the literature regarding postnatal drug use, especially crack-cocaine/cocaine, and its relationship with contamination of breast milk.