Drug Abuse in Pregnancy

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Drug abuse during pregnancy has an adverse effect on the mother as well as the fetus. It is advisable to stop usage of illicit drugs well before pregnancy.

Drug addiction is a common problem around the world. This problem becomes particularly complicated in women who take these substances during their pregnancy, when the drugs can have damaging effects on the mother as well as the fetus.

As with many other medications, illicit drugs cross the placenta into the fetus and can affect fetal development. In fact, the drugs of abuse cross the placenta even more easily than some of the other medications. In addition, they can also cross into the baby via breast milk.

Effects of drug abuse on the mother include-

• Food Intake- A drug addict may neglect her food intake, which could result in anemia and other issues.
• Injections- The use of injections for administering the drugs could result in infections and disease like hepatitis.
• High Blood Pressure- Women may be more prone to the development of high blood pressure and pre-eclampsia during pregnancy.
• Adequate Care- The woman may not receive adequate care during the pregnancy due to general neglect of health.
• Complications- Complications during delivery like premature rupture of membranes may be more common.

Effects on the baby include-

• The fetus may get inadequate oxygen and nutrients through the placenta, thus affecting normal development.
• The risks of abortion and stillborn fetuses are higher.
• The babies may be neglected after they are born.

Some of the substances / drugs abused during pregnancy are-

Opioids- Opioids like heroin and morphine pass easily to the fetus via the placenta, and their levels can be higher in the fetus than in the mother due to poor degradation of the drugs by the fetus.

• Opioids increase the chances of stillbirth. Babies of women on opioids have low birth weight, tend to gain less weight and are neglected as compared to other babies.
• The babies may experience withdrawal symptoms following birth. These include irritability, high-pitched crying, tremors, increase in muscle tone, vomiting, diarrhea and rapid breathing.
• The functional and mental development may be affected. Attention and academic performance may be impaired.
• The children may be more prone to seizures. They may adapt worse to new environments and may suffer from personality disorders.

Psychoactive drugs- Drugs like cocaine, amphetamine and marijuana are psychoactive drugs. Though amphetamine is a prescription medication for certain conditions, some women abuse methylamphetamine once they know they are pregnant to help to control weight gain. Some of the effects of psychoactive drugs on pregnancy are-

• Amphetamine used in pregnancy can result in birth defects like cleft lip, heart and liver defects, low birth weight and low body fat, small head circumference, bleed in the brain, and undescended testicles. The baby may also be still born.
• Amphetamines may also cause an increase in muscle tone, tremors, irritability and irregular sleep. Heart rate may vary, but it usually comes back to normal once the drug effect wears off. It may cause developmental delays and result in poor performance.
• Cocaine can result in impairment of cognitive performance, information-processing, and attention to tasks. It may result in birth defects of the urinary tract or heart. It may also result in death of the fetus.
• The baby of a cocaine-addicted mother may suffer from withdrawal symptoms after birth.
• Marijuana may result in premature births, small birth size and prolonged labor. It could also affect the growth and mental abilities like paying attention or learning to read. The baby may also suffer from withdrawal symptoms after birth.

Benzodiazepine- Misuse of benzodiazepines often as sleeping pills during pregnancy has been associated with abnormal features, growth abnormalities including central nervous system abnormalities. The baby may suffer from withdrawal symptoms following birth.

Alcohol- Alcohol is a commonly abused substance during pregnancy despite its common adverse effects.

Alcohol use in pregnancy increases the chances of miscarriage and stillbirth.

Babies may suffer a group of birth defects, collectively referred to as fetal alcohol syndrome. These defects include low birth weight, facial defects, problem with learning and mental retardation.

Smoking- Smoking is also associated with adverse events during pregnancy. It may cause miscarriage, preterm labor or stillbirth. Babies are also likely to be smaller in size. They may suffer from birth defects like cleft lip and cleft palate.

How can Complications due to Drug Abuse during Pregnancy be Reduced?

Some of the ways that could possibly reduce drug abuse and its complications during pregnancy are-

• Health education for all women of child-bearing age: Women of child-bearing age should be warned about the dangers of drug abuse in pregnancy, so that they can avoid the drugs well before they are pregnant.
• Pregnant women should be adequately screened with urine tests for substance abuse, since they may not always inform their doctor regarding medication intake.
• Safer substitutes when available may be offered to the woman to avoid sudden withdrawal symptoms.

Besides these drugs, prescription and over-the-counter medications could affect the unborn child. It is best to keep the treating doctor well informed about any drug abuse, to ensure a healthy mother and a healthy baby.

References:

1. Slamberova R. Drugs in Pregnancy: the Effects on Mother and Her Progeny 2012; Physiol. Res. 61 (Suppl. 1): S123-S135.
2. Johnson K, Gerada C, Greenough A. British Journal of Psychiatry 2003. Substance misuse during pregnancy. 2003; 183: 187-9.
3. Drug Use and Pregnancy - (http://www.webmd.com/baby/drug-use-and-pregnancy)
4. Substance Use During Pregnancy - (http://www.ucsfhealth.org/education/substance_use_during_pregnancy/)

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