Fetal and Infant Substance Abuse Syndromes
From Encyclopedia of Sex and Sexuality
A fetus or newborn infant can be affected in several ways by drugs, alcohol, or other toxic substances taken by the mother during pregnancy. At the time of conception and during the first two to three months of pregnancy, the formation of body structures can be affected by drugs or other toxic substances, resulting in birth defects. Later in pregnancy, drugs may affect overall growth, with the result that the fetus or newborn infant does not reach its full potential for growth. Finally, drugs may affect the ability of the newly born infant to make a successful transition from fetal life to life outside the uterus (see also pregnancy and common medications and substances).
The first report of abnormalities in children of alcoholic mothers appeared in France only in 1968, and independently in the United States in 1973. Reported abnormalities include a significant reduction in intelligence to an average IQ of 60 to 70, hyperactivity, poor coordination and muscle strength, growth failure before and after birth, and an abnormal and characteristic facial appearance. By some estimates, as many as 5 percent of all birth defects may be attributable to alcohol exposure through the mother during pregnancy. The effects of alcohol become more apparent as the mother’s intake of alcohol increases, with the risk of fetal alcohol syndrome as high as 30 to 50 percent in chronically alcoholic women. An intake as low as two “standard” drinks (one ounce of absolute alcohol) per day has been associated with a reduction in birth weight, and partial expression of the fetal alcohol syndrome in some children may be quite common. Thus there is no “safe” level of alcohol consumption during pregnancy below which the effects of alcohol will not be seen in the newborn infant.
Drug abuse during pregnancy has been associated with a number of severe problems in the fetus. Many of these problems are probably related to the poor social situation of many drug abusers. Women (and men) who abuse narcotics have a high rate of infections, especially with sexually transmitted diseases. Drugs obtained illegally by abusers are frequently impure and contain chemicals which may have their own damaging effects on a pregnancy. Individuals who abuse narcotics often abuse other substances too, such as tobacco and alcohol, which also have significant damaging effects on the fetus.
While other factors may contribute to problems in infants of mothers who abuse narcotics, a clearly recognized pattern of fetal and infant risk associated with narcotic abuse during pregnancy has emerged. There is an increased risk of miscarriage associated with heroin use. Infants of narcotic addicts are often born prematurely, with all the problems associated with low birth weight. Even when born at term, these infants are frequently small for the length of the pregnancy. The most significant problem associated with narcotic use in pregnancy is withdrawal in the newborn after birth. Newborn infants undergoing withdrawal are jittery, tremulous, and cry inconsolably. They eat poorly, and may develop vomiting and diarrhea. In severe cases, restlessness can result in skin abrasions, and in some infants convulsions may appear. These symptoms are classically associated with heroin and methadone withdrawal, and appear because the fetus has become accustomed to receiving these drugs from its mother. While mildly affected infants may be treated by swaddling and comforting, more severely affected infants may require treatment with sedatives or tranquilizers.
Although no definite patterns of birth defects have been associated with maternal narcotic abuse, there are significant long term problems in infants of addicted mothers. These include learning and other developmental disabilities, sleep disturbances, and a greater incidence of crib death (sudden infant death syndrome/SIDS). Unfortunately, drug addiction is also associated with many serious social problems, and the help of community organizations, drug counselors, and social workers is often necessary for an optimal outcome. While withdrawal of a mother from narcotics will obviously avoid the medical complications of narcotic exposure for the infant, the decision to withdraw during pregnancy should be carefully considered by the mother and her medical advisor. Her fetus can also undergo withdrawal, and this may cause serious problems in certain cases.
Exposure to cocaine during pregnancy has many serious effects on the developing fetus. Cocaine use has been associated with a high rate of prematurity, often associated with separation of the placenta, resulting in increased fetal and neonatal distress. Retardation of fetal growth, absence of limbs, and severe defects of the brain and kidneys have also been attributed to cocaine use during pregnancy. These effects may be due to cocaine’s ability to interrupt uterine blood flow. While the exact mechanism by which cocaine acts on the fetus is not known, during pregnancy cocaine should be avoided.
The use of marijuana during pregnancy appears to result in infants who are more restless and have more sleep disturbances than infants not exposed to this substance. No definite withdrawal syndrome and no definite patterns of birth defects have been associated with marijuana use during pregnancy. Some reports indicate that infants of marijuana users are lower in birth weight than infants born to non-users, but these results have not been confirmed by all studies (see also birth defects).