Fetal Vascular Disruption With Prenatal Exposure to Cocaine or Methamphetamine

To the Editor.— Hoyme et al1 have described seven children from four states with congenital limb reduction defects associated with prenatal exposure to cocaine. I am concerned that digit and limb reduction following cocaine or methamphetamine exposure in utero may be much more common than the nine existing case reports1,2 indicate and that a Ross Laboratories patient education brochure is correct in stating, "cocaine can make a baby have missing fingers."3 We began recognizing cocaine-exposed infants in 1986.