Perinatal EvidenceCompass
Prepopulated workbenchMED-281

Nonprescription/emerging psychoactive — stimulant

Cocaine (nonmedical/illicit exposure)

Nonmedical stimulant exposure and stimulant use disorder

Not a categorical safety rating

This record organizes questions; it does not close them.

The clinical fields and position statements are prepopulated from the public-source corpus. They have not completed individual dual extraction, formal appraisal, exact-label reconciliation, or multidisciplinary sign-off. Do not use this page to justify abrupt discontinuation or reflexive switching.

Inventory identity

What this record represents

Canonical generic name
Cocaine (nonmedical/illicit exposure)
Entity type
illicit/nonmedical substance exposure
Active component(s)
Cocaine · contaminants/adulterants may vary
Formulation / route / interval
Oral; formulation varies
Attachment entry
Cocaine
Separate monograph status
No — cross-reference shared molecule monograph
Identity and cross-reference
Not populated in v0.95
Inventory verification confidence
High — direct status-changing or product-specific primary source

Decision taxonomy

Five positions kept separate

These are workbench statements for reviewer execution. They are not independently commissioned, patient-specific recommendations.

  1. 01

    Stable continuation

    Workbench statement

    Do not withhold or discontinue solely because of pregnancy or lactation. For this record, assess indication, prior response, relapse severity, dose/formulation, alternatives, exposure timing, and mapped evidence; individual commissioned adjudication remains pending.

  2. 02

    New initiation in pregnancy

    Workbench statement

    For a new start, prefer an effective option with the strongest diagnosis-specific efficacy and reproductive evidence when clinically suitable. This record has not received an individual, independently verified initiation ranking.

  3. 03

    Switch before conception

    Workbench statement

    Before conception, consider a switch only when expected benefit exceeds relapse, withdrawal, failed-switch, and dual-exposure risks. Build and monitor the plan before pregnancy when feasible; no universal switch direction is assigned here.

  4. 04

    Unplanned exposure

    Workbench statement

    After unplanned exposure, confirm product, route, dose, timing, indication, co-exposures, and symptoms; do not advise abrupt cessation. Use the mapped evidence and current label to decide whether any targeted fetal assessment is indicated.

  5. 05

    Delivery, postpartum & lactation

    Workbench statement

    Create separate delivery, postpartum-dose, neonatal-observation, and lactation plans. Do not infer breastfeeding suitability from pregnancy evidence or routinely taper before delivery without drug-specific support.

Linked evidence

2 mapped claim summaries

Mapping can include class-wide, framework, formulation, regulatory, or evidence-gap claims. A linked claim is not necessarily a drug-specific causal estimate.

C-058Provisional public source

Nonmedical stimulants can cause severe hypertension, ischemia, arrhythmia, stroke, hyperthermia, seizure and psychosis; pregnancy cohorts associate exposure with growth restriction, preterm birth and placental complications, especially cocaine-related abruption.

Public-source certainty descriptor
Moderate for acute toxidrome; low-to-moderate observational pregnancy certainty
Formal appraisal
Not started — full text and independent appraisal pending
Exposure window
Acute and chronic pregnancy exposure
Comparator
Nonmedical stimulant exposure versus no exposure
Effect or numbers carried forward

No single causal estimate adopted

Limitations

Dose, route, tobacco/alcohol/other drugs, poverty, trauma and prenatal-care access confound outcomes; congenital findings are inconsistent

Sources, citation controls, and verification state

Linked sources

PMID
Not populated in v0.95
DOI
Pending DOI verification
Exact locator
Pending exact table/figure/page/supplement locator
Access date
2026-07-29
Integrity check
Same-day source surveillance recorded; source-by-source correction/retraction verification remains pending
Internal verification
Source-linked; independent external verification pending
C-059Provisional public source

ABM advises avoiding breastfeeding during active nonprescribed stimulant use; a nonpunitive plan can support pumping and later reassessment when clinically appropriate.

Public-source certainty descriptor
Moderate protocol consensus; low direct infant-outcome evidence
Formal appraisal
Not started — full text and independent appraisal pending
Exposure window
Lactation
Comparator
Breastfeeding during active use versus temporary alternative feeding
Effect or numbers carried forward

No universal time-to-clearance estimate across products

Limitations

Unknown dose, adulterants, infant age, route and co-use prevent a single interval; prescribed stimulants are a different question

Sources, citation controls, and verification state

Linked sources

PMID
Not populated in v0.95
DOI
Pending DOI verification
Exact locator
Pending exact table/figure/page/supplement locator
Access date
2026-07-29
Integrity check
Same-day source surveillance recorded; source-by-source correction/retraction verification remains pending
Internal verification
Source-linked; independent external verification pending