As of January 1, 1997, the number of infants and children in USA diagnosed with AIDS was 6,891 and ninety percent of these cases had mothers who were drug users (Fauci et al., 1998; Al-Bayati, 1999). The prevalence of drug and alcohol abuse during pregnancy is very high both in the USA and Europe. The results of nine large studies surveying the prevalence of drug use in relation to the outcome of pregnancy in the USA showed that up to 15% of pregnant women used cocaine during pregnancy based on a positive urine test. The impact of illicit drug and alcohol abuse during pregnancy on infant health is very serious as shown in nine studies that included 1,295 drug using mothers and 4,293 nonusers. The use of cocaine during pregnancy was usually associated with a high prevalence of premature births and low birth weights. Drug exposed infants usually had immature lung profiles and other serious health problems that were treated with glucocorticoids (Al-Bayati, 1999).
Fauci et al., (1998) also explained the serious impact of illicit drugs on the pregnant mothers and her infants. They stated that "women who abuse cocaine have reported major derangement in menstrual cycle function, including galactorrhea, amenorrhea, and infertility. Chronic cocaine abuse may cause persistent hyperprolactinemia as a consequence of cocaine-induced disorders of dopaminergic regulation of prolactin secretion by the pituitary. Cocaine abuse, particularly the smoking of crack by pregnant women, has been implicated as causing an increased risk of congenital malformations and of prenatal cardiovascular diseases in the infants. Cocaine abuse per se is probably not the sole reason for these prenatal disorders since many problems associated with maternal cocaine abuse, including poor nutrition and health care status as well as polydrug abuse, also contribute to the risk of prenatal diseases". Furthermore, Fauci et al., (1998) also reported that a special case of opiate withdrawal is seen in the newborn passively addicted by the mother's drug misuse during pregnancy. Some level of addiction develops in 50 to 90 percent of children of heroin-dependent mothers. The syndrome consists of irritability, crying, and tremor in 80%; increased reflexes, increased respiratory rate, diarrhea, and hyperactivity in 60%; vomiting in 40%; and sneezing, yawning, and hiccupping in 30%. The affected child usually has a low birth weight and may be otherwise unremarkable until the second day, when symptoms are likely to begin.
The treatment of the mother expected to have a premature birth with glucocorticoids has been used as a standard procedure since 1970s. Glucocorticoids are used to facilitate the development of the lung and to reduce the incidence of necrotizing enterocolitis in premature infant. In addition, the natural cortisol levels in plasma and urine of the cocaine-exposed preterm neonates is significantly higher than in normal infants (Al-Bayati, 1999).
Infants and children with AIDS are dying from opportunistic infections as a result of malnutrition and the excessive use of therapeutic steroids to treat the wide range of illnesses in these children. For example, the opportunistic infections found at 74 autopsies of pediatric HIV/AIDS patients included 53 cases fungal infections, 31 cases viral infections, and additional opportunistic infections were due to toxoplasmosis and tuberculosis (Drut, et al., 1997).