Socially used drugs
Alcohol and other drugs affect the health and well being of pregnant women and their children. Each drug acts on the body in its own unique way. Since each individual is different, reactions will differ among people using the same amount of the same drug.
The health of a substance affected pregnant woman, and her body's response to the substances, may depend upon several factors beyond drug use, including:
- A family or maternal history of reproductive problems;
- Multiple previous pregnancies;
- Concurrent medical problems, i.e., S.T.D., diabetes, lupus, hypertension, and heart, liver, or kidney disease;
- Obesity or poor nutrition;
- Age less than 15 years;
- Substandard living conditions;
- Minimal education;
- Lack of exercise;
- Excessive stress;
- Inadequate prenatal care; and
- Chronic exposure to lead or X-rays.
Predicting health and development outcomes for infants of substance abusing women is also difficult. Timing of fetal exposure to a drug is crucial in producing certain effects, many of which may be irreversible, even though the mother avoids further drug usage.
Consumption of alcoholic beverages during pregnancy is associated with a broad range of adverse pregnancy outcomes. Even moderate alcohol consumption (one ounce to two ounces per day) may carry a significant risk. Exposure during pregnancy and delivery produces the following obstetrical complications: vaginal bleeding, premature separation of placenta from the uterine wall, spontaneous abortion, stillbirth delivery, poor maternal nutrition, and pre-term labor. Maternal consumption of alcohol during pregnancy is now the leading somatic cause of mental retardation, surpassing Down Syndrome. Fetal alcohol syndrome (FAS) is the most severe of the live birth outcomes associated with alcohol abuse. The incidence of FAS in the general U.S. population is one to two per 1,000 live births. Fetal Alcohol Syndrome include:
- prenatal and postnatal growth retardation;
- central nervous system involvement such as neurologic abnormality, developmental delay, and intellectual impairment, abnormal facial features such as small palpebral fissures and epicanthal folds of the eyes (slanted eyes) flat nasal bridge, short nose, in either the nose or lip a poorly developed vertical groove above the lip, a flat mid-face (cheek) area, low set ears, microcephaly (small head), or small chin. Other effects on the newborn include low birth weight, decreased length, small head and chest circumference.
- There is early epidemiological and animal model evidence that paternal drinking prior to pregnancy may adversely affect sperm production. Heavy drinking by the father may contribute to increased marital stress and family violence. Response to the problems of alcohol should include, in addition to primary prevention efforts, alcohol avoidance counseling, development of effective programs for women needing treatment for alcohol abuse, and provision of support for alcohol abusing women to prevent unwanted pregnancies.
The association between maternal smoking during pregnancy and low birth weight (both pre-term and intrauterine growth retardation) has been well documented. Growing public awareness of the harmful effects of smoking is reflected in increased rates of quitting during pregnancy and by the decreased prevalence of smoking during pregnancy. Nevertheless, 21 percent to 30 percent of pregnant women in the United States report smoking throughout the pregnancy despite known risks to the developing fetus and the mother.
- Like many other adverse health risks, smoking prevalence is inversely correlated with years of education. Among white, married mothers over 20 years of age sampled in the 1980 National Natality Survey, the percentages of smokers were 43 percent (less than 12 years of school), 28 percent (12 years), 20 percent (13 to 15 years), and 11 percent (16 years or more). White, unmarried women are more likely to smoke and to be heavier smokers. In general, the prevalence of smoking among married women is higher among white women than black women and is higher for women less than 20 years of age, irrespective of ethnicity.
- Approximately 4,600 of 87,000 (five percent) perinatal deaths annually and 14 percent of all pre-term deliveries in the United States have been attributed to maternal smoking. A recent estimate of the average cost of neonatal care is $289 higher for infants born to smokers than those of non smokers. Intra-pregnancy smoking also is correlated with an increased incidence of early fetal loss, preeclampsia, abruptio placenta, and placenta previa. Adverse postnatal conditions associated with maternal smoking during pregnancy (and also exposure to passive smoke in the postnatal period) include acute respiratory conditions and sudden infant death. The long-term health risks for the mother (e.g., lung and other cancers and cardiovascular disease) are well documented.
- The most practical means of identifying smokers is via personal history. Ideally, at her first prenatal visit a woman is asked about her smoking history immediately prior to and during the early part of the pregnancy. Care must be taken to promote disclosure of this increasingly sensitive information. Instead of an oral questions with a "yes" or "no" response format, it is preferable to use a self-administered questionnaire that allows for gradations of response, in particular, an option such as "I smoke now but I have cut down since becoming pregnant."
- A substantial proportion of women entering care (16 percent to 41 percent) will report that they quite smoking after becoming pregnant. Some of them will resume smoking during pregnancyB20 percent in a health maintenance organization population to 35 percent in a primarily black, public maternity clinic population. Thus, this group should be asked from time to time about possible relapse. A high-priority subgroup is women who have not been abstinent for at least a week prior to their visit and/or who are not "very confident" that they could maintain abstinence.
- Over the past 30 years, research has shown the association between maternal smoking and reduced birth weight in diverse ethnic groups. The strength of this association is suggested by numerous studies that have adjusted for the effects of potential confounding factors, including maternal social class, age, parity, and height; maternal stress, diet and weight gain during pregnancy; fetal sex and gestational age; and perinatal mortality. Although the mechanism by which smoking retards intrauterine growth is not fully understood, the relationship is biologically plausible, as demonstrated by the higher concentrations than in maternal blood. Research of carbon monoxide suggest that the increase in carbo-oxyhemoglobin may deprive the fetus of adequate oxygen.