In October 1999, the British medical journal The Lancet published the paper "Congenital anomalies after prenatal ecstasy exposure," reporting infants born to mothers who used MDMA (ecstasy) during pregnancy are at increased risk of congenital birth defects. This letter was covered widely by the press. There is an earlier study that was conducted in the Netherlands which failed to see any dramatic problems in 49 pregnancies (leading to 40 live births). It was referenced in the Lancet article, in the sentence, "There are few data on the effects of ecstasy exposure in human pregnancy, [2-4]." A bit of a clue that this study provided conflicting evidence would have been valuable in the Lancet article. Daniel Perrine, Ph. D.

(Loyola College Chemistry Department) comments: One thing about this study is that the anomalies only reach statistical significance when lumped together. As the authors admit: "Although this small case series has insufficient statistical power to confirm a causal relation with any particular congenital anomaly, we consider that these initial data are important." But it would be quite unusual for a single drug to cause such a diverse potpourri of birth defects. Thalidomide, e. g.

, causes phocomelia; alcohol causes fetal alcohol syndrome; dilantin causes fetal hydantoin syndrome (usually cleft lip or palate). I count about nine distinct birth anomalies in this list, affecting very different organs. This doesn't rule out the possibility that MDMA causes some of the problems, but it makes it seem less likely. But it would not be surprising if MDMA had an amphetamine-like effect on the embryo. Some animal studies should be done, and it is surprising that none have been published. On the other hand, considering the prevalence of amphetamine as a substitute for genuine MDMA, it would also not be surprising if the cardiac anomalies here reported were due to amphetamine ingestion.

Infants born to mothers who used (ecstasy) during pregnancy are at increased risk of congenital birth defects. Dr. Patricia R. McElhatton and colleagues of the National Teratology Information Service in Newcastle upon Tyne, UK, reviewed outcomes of 136 pregnancies that occurred between 1989 and 1998. Among the 136 women, 74 reported taking ecstasy only and 62 took a combination of ecstasy and some other recreational drug, including amphetamines, cocaine, marijuana, LSD or alcohol. A majority of the women, 127, reported exposure to ecstasy during the first trimester, and almost all women discontinued use of the drug after this time.

Of 78 live born infants, 12 (or 15. 4%) had congenital defects, a significantly higher rate than the .".. expected incidence of 2% to 3%." In an interview with Reuters Health, Dr. McElhatton said that it is unclear whether the birth defects result from a synergistic effect of combining compounds or whether the effect is caused by ecstasy alone. She added that although the data do not support a causal link between ecstasy and birth defects, the results led her and her co-authors to believe that either ecstasy or amphetamines played a causal role. The UK investigator pointed out that the compounds are structurally related, and that ."..

of the 12 babies [in this study] with birth defects, six of the mothers were on ecstasy alone and the remainder were either on [ecstasy plus] amphetamines or [ecstasy plus] alcohol." Prospective follow-up of 136 babies exposed to ecstasy in utero indicated that the drug may be associated with a significantly increased risk of congenital defects (15. 4% [95% CI 8. 2-25. 4]). Cardiovascular anomalies (26 per 1000 live births [3.

0-90. 0]) and musculo skeletal anomalies (38 per 1000 [8. 0-109. 0]) were predominant.