THE EFFECTS OF COMMONLY ABUSED SUBSTANCES ON MATERNAL, FETAL AND NEONATAL HEALTH

Victoria Hargan MA Forensic Psychology

Drug Abuse among Pregnant Women in the U.S.

According to the National Institute of Health (NIH) Exposure to substances abuse can affect individuals across the lifespan, starting in utero. While most pregnant women do not abuse illicit drugs, combined 2008 and 2009 data from the National Survey on Drug Use and Health found that among pregnant women ages 15 to 44, the youngest ones generally reported the greatest substance use (2011). Further, pregnant women ages 15 to 17 had similar rates of illicit drug use (15.8 percent or 14,000 women) as women of the same age who were not pregnant (13.0 percent or 832,000 women) (NIH, 2011).

A 2008-2009 Study

Placental Membrane
The placenta of pregnant women acts as a filter to the baby, and not a barrier as once believed. Virtually all drugs pass through the placenta and into the fetus. The placenta mediates substances from mother to child and vice versa.

Caffeine
Coffee, tea, cola, chocolate, cold remedies over the counter (otc) pills

Caffeine
Maternal Effects CNS and cardiac function stimulation Vasoconstriction and mild diuresis result Half-life triples during pregnancy Fetal Effects Placental barrier is crossed, stimulating fetus Teratogenic effects are undocumented

Tobacco and Nicotine

Cigarettes

Nicotine
Smoking during pregnancy is associated with adverse effects for the fetus, newborn, and mother.
According to NIH Carbon monoxide and nicotine from tobacco smoke may interfere with fetal oxygen supply and because nicotine readily crosses the placenta, it can reach concentrations in the fetus that are much higher than maternal levels. Nicotine concentrates in fetal blood, amniotic fluid, and breast milk, exposing both fetuses and infants to toxic effects (NIH, 2011).

Tobacco
Maternal Effects Decreased placental perfusion Anemia PROM< preterm labor, spontaneous abortion Fetal/Neonatal Effects Prematurely LBW Fetal demise Developmental delays Increased incidence of SIDS Pneumonia

Alcohol
Alcohol (beer, wine, mixed drinks, afterdinner drinks)

Alcohol
Maternal Effects Spontaneous abortion Fetal/Neonatal Effects Fetal demise IUGR, FAS (Facial and cranial anomalies developmental delay, mental retardation, short attention span), Fetal alcohol effects (milder form of FAS fetal alcohol syndrome)

Narcotics
Narcotics (heroin, methadone, morphine)

Treating Addiction During Pregnancy

According to NIH Research shows that some medications that are effective in drug-abusing populations can also be beneficial for pregnant women (and their babies). For example, methadone maintenance combined with prenatal care and a comprehensive drug treatment program can improve many of the detrimental maternal and neonatal outcomes associated with untreated heroin abuse, although newborns exposed to methadone during pregnancy typically require treatment for withdrawal symptoms (NIH, 2011). Medication buprenorphine used for opioid dependence has recently been shown to produce fewer neonatal abstinence symptoms in babies than methadone, resulting in shorter infant hospital stays. (NIH, 2011).

Narcotics
Maternal Effects Spontaneous abortion PROM, preterm labor, Increased incidence of STDs Increase HIV exposure Hepatitis Malnutrition Effects on Fetus IUGR Perinatal asphyixia Intellectual impairment Neonatal abstinence syndrome Neonatal infections Neonatal death (SIDS, child abuse and neglect)

Sedatives
Barbiturates, tranquilizers, anti-anxiety

Sedatives
Maternal Effects Lethargy Drowsiness CNS depression Fetal Effects Neonatal abstinence syndrome Seizures Delayed lung maturity Possible teratogenic effects

Cocaine
Cocaine and crack

Cocaine and Crack

Maternal Effects
Hyper -arousal state Generalized vaso-constriction Hypertension Increased spontaneous abortion Abruption placentae Preterm labor Cardiovascular complications (stroke, heart attack) Seizures Increased STDs

Fetal and Neonatal Effects

Stillbirth Premature IUR Irritability Decreased ability to interact with environmental stimuli Poor feeding reflexes Nausea, vomiting, diarrhea Decreased intellectual development Distended, flabby, creased abdomen (prune-belly syndrome) resulting from absence of abdominal muscles

Amphetamines
Amphetamines ( Speed or ice when processed in crystals to smoke) Methamphetamines ( ecstasy)

Amphetamines
Maternal Effects Malnutrition Tachycardia Withdrawal symptoms ( lethargy, depression) Fetal/Neonatal Effects Increased risk for cardiac anomalies Increase for cleft palate IUGR Withdrawal symptoms Fetal death

Marijuana
Marijuana (pot or grass)

Marijuana
Maternal Effects Often used with other drugs: alcohol, cocaine, tobacco Increased incidence of anemia Inadequate weight gain Fetal/Neonatal Effects Unclear, more study needed Believed to be related to prematurity IUGR Neonatal tremors Sensitivity to light.

Treatment
Treating substance abuse during pregnancy should begin as soon as the mother learns that she is pregnant.

Women who plan of becoming pregnant should talk to their doctors regarding prepregnancy health including the use of substances and addictions they may have.

Treatment
If a woman who uses substances such as tobacco, nicotine, caffeine, alcohol, or drugs and becomes pregnant unintentionally should immediately contact their doctor to develop a treatment plan for both the mother and developing embryo/fetus/neonatal.

Treatment
Treatment always includes a prenatal regimen of prenatal vitamins and nutritional diet to support both mother and baby. Regular doctors visits Regular exercise (per doctors orders) Adequate sleep Stress reduction Education on pregnancy and health

If the mother is a substance abuser, an individual treatment plan should be designed by her doctor.

References
DRUGS IN PREGNANCY: Effects on the Fetus and Newborn http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1575893/ Murray, S.S., McKinney, E.S., Gorrie, T., M., (2002) Foundations of Maternal Newborn Nursing (3rd Ed). St. Louis. W.B. Saunders Co.

National Institute of Health: Prenatal Exposure to Drugs of Abuse http://www.drugabuse.gov/publications/topics-in-brief/prenatal-exposure-to-drugs-abuse