Outline of some of the effects of drug abuse during pregnancy

1. Consequences of Drug
abuse during
Pregnancy
Chemicals and Neonates

2. Introduction
Scope of the problem
• Most drugs can cross the foetal blood brain barrier (BBB) in just a few
minutes.
• Recreational drug use is prevalent in reproductive age group.
• Effect of substance/ drug abuse on fetus and prevention mechanisms for
neonates = inconclusive
• High risk pregnancy  mothers who abuse substances/alcohol
• Prenatal exposure has consequences on developing fetus due to immaturity
of the fetus’ liver and excretory system
Others: Quality of pre-and post-natal care, malnutrition and social
environment

3. Introduction
Consequences
• Lower birth weight
• Poverty
• Maternal depression
• Child parent relationship
• Limited emotional
resources and the infants’
intense caregiving needs.

4. Fetal Alcohol Spectrum Disorder
• 13% of pregnant women use alcohol,10% on regular basis
(Chang,2006)
• Infants become unwilling participants to mothers alcohol use
– dependant mother = dependant infant.
• Baby experiences alcohol withdrawal 3-12 hours after delivery.
• Alcohol causes mental retardation

5. Fetal Alcohol Spectrum Disorder
• Alcohol use during pregnancy thought
to inhibit the production
(biosynthesis) of chemicals
(gangliosides) within the brain;
– Ganglioside play a role in brain
development.
• Attention deficit disorder in children.
• Lower than normal birth weight
• Smaller brain size
• Facial abnormalities
• Acute lymphoid leukaemia

6. Cocaine & Amphetamine use in Pregnancy
• Stimulant used as a recreational Drug
• Popular names: Blow, Coke, Crack,
Rock, Snow
• Made from Coca leaves
• Frequently used illegal drug after
cannabis globally
• Effects appear almost immediately-
disappear within few minutes
• Can be used as a snorted powder,
rubbed in the gums or injected

7. Cocaine & Amphetamine use in Pregnancy
Effects and Prognosis:
• Timing is critical (First Trimester)
• Prematurity
• Low Birth weight
• Smaller head circumference
• Shorter in length/height
• PCE effects are subtle but exist
• Difference in brain regions for
attention, planning & language

8. Cocaine & Amphetamine use in Pregnancy
Pathophysiology
• Small molecule- able to cross the BBB
• High concentration in the amniotic fluid
• Skin of fetus directly absorbs cocaine from the amniotic fluid
• Works by inhibiting the re-uptake of serotonin, NE & DA
• Results in greater concentration of the 3 NTr in the brain

9. Cocaine & Amphetamine use in Pregnancy
Possible Mechanisms of Harm
• Neurotransmission- Binding to
dopamine receptors
• Vasoconstriction- Hypoxia &
I.U.G.R
• Increased contractility of the
uterus- Placenta abruption
• Reduced maternal & vitamin
deficiency

10. Cocaine & Amphetamine use in Pregnancy
Challenges finding Maternal
Cocaine use
• Method of screening
• Poly drug nature of use
• Confounders
• No set characteristics
• Unknown prevalence of use in
pregnancy
• Inaccurate data due to stigma
& Fear

11. Opiate Abuse during Pregnancy
• 1-21 % of expectant mothers will use a narcotic analgesic at least
once during their pregnancy
• 700,000 women in the USA have used heroin at least once
• Most of these women are of child bearing age and a significant
number will do so while pregnant
• Symptoms of pregnancy are similar to the early withdrawal
symptoms of heroin

12. Risks Of Opiate Abuse to the Women and their Babies
• Anaemia
• Still birth
• Breech presentation during
child birth
• Placental insufficiency
• Spontaneous abortions
• Premature delivery
• And in babies leads to SIDS
(sudden infant death
syndrome)

13. Opiate Abuse during Pregnancy
Withdrawal
• Chronic use of narcotics during pregnancy = state of chronic exposure to
opiates for the fetus
• Infant withdrawal begins within 24-72 hours of birth
Symptoms: yawning, wakefulness, watery, fever, shrill or high-pitched, crying,
stuffy/runny nose, salivation, hiccups, vomiting, diarrhoea, poor weight gain,
apnoea, sneezing, tremors, and seizures
Surprisingly: not recommended that the mother withdraw from opioids
during pregnancy if addicted
• Research found that environment > exposure to heroin when it comes to
developmental delays
• Mothers should also avoid using narcotics when breastfeeding

14. Marijuana use during pregnancy
• Effects of THC on fetal growth and development are still unclear
• 2.9-12% of pregnant women in “non-ghetto” urban areas are
estimated to use marijuana
Scientists: placenta is able to provide the fetus with some protection
from the marijuana
• Studies on effects of maternal marijuana use on children are
inconclusive
• With breast milk THC levels go 6-8 times higher than what is in the
mother’s blood plasma
– can affect motor development for the first year of life

15. Benzodiazepine use in Pregnancy
• Early studies: First trimester use may lead to facial abnormalities
– cleft palate, congenital heart defects, inguinal hernia and pyloric stenosis. (
Barki etal., 1998, Iqbal, Sobhan & Ryals, 2002)
• Use during breastfeeding is discouraged
– crosses to breast milk
• Mothers should not use any of the benzodiazepines unless the
potential benefits to the mother outweigh the risks to the baby.

16. Hallucinogen use during Pregnancy
• Effects of maternal abuse on fetus unclear
– Use is not recommended
• PCP: in-utero exposure leads to intrauterine growth retardation,
premature birth extended hospitalization after birth.
– Mothers experience changes in levels of consciousness, fine tremors,
sweating and irritability
• MDMA /Ecstacy: congenital growth problems
– More research needed

17. Hallucinogen use during Pregnancy
• Disulfiram-use is not recommended while pregnant more research
needed
– Animal research indicates potential danger to fetus when used with alcohol.
A metabolite of disulfiram (diethyldithiocarbamate), may bind = neurological
disorders and mental retardation

18. Cigarette use During Pregnancy
• 20% women smoke during
pregnancy (Finnegan & Kandal,
2004)
• 2 out of every 5 children ages 3 to
in the United States were exposed
to secondhand smoke regularly
(CDC, 2015)
• 22% of all infants are exposed to
secondhand/ environmental
cigarette smoke after birth.

19. Cigarette use During Pregnancy
• Compounds in the cigarettes (nicotine etc. ) cross placental barrier
(Buka, Shenassa & Niaura, 2003)
– Constricts blood vessels in placenta
– Low birth weight , premature labor, perinatal deaths /stillbirths, spontaneous
abortion,
– vaginal bleeding ,premature rapture of the uterine membranes, delayed
crying time for the baby and decreased fetal breathing after birth (Higgins,
2006-There is a strong link between cigarette smoking during pregnancy and
asthma in children (Guilbert& Krawiee, 2003)

20. o.t.c Analgesic Use during Pregnancy
Aspirin
• Should not be used if one is/suspects
they are pregnant (unless under
medical supervision)
– Decreased birth weight
– Still birth/ perinatal mortality
– Growth retardation
– Ante-/postpartum hemorrhage
– Prolonged gestation
– Inability to form blood clots

21. o.t.c Analgesic Use during Pregnancy
Acetaminophen
• Not enough evidence to suggest
severe harm to child
– Is however execrated in breast milk
(low amount)
Ibuprofen
• Similar drugs known to inhibit labor,
retardation of inter-utero
development, prolonged pregnancy
– Does not enter breast milk
– “safest” non-steroidal anti-
inflammatory drug

22. Inhalant Abuse during Pregnancy
• Over 50% of chronical abusers are women in their prime child
bearing years
• Fetal neonatal syndrome/ growth retardation
– Microcephaly, ataxia, infant tremors
Toluene: known to cross the placenta into fetal circulation
– When inhaled, 50% transformed into hippuric acid
 fetus/ new born infnts do not have this ability

23. Inhalant Abuse during Pregnancy
• Several similarities between alcohol
and toluene on babies
– Premature birth
– Craniofacial abnormalities, develop
abnormalities, abnormal muscle tone,
renal abnormalities, abnormal scalp
hair patterns, retarded physical
growth

24. Summary
• Child becomes unwilling
participant in mothers
chemical use/abuse
• Impact is usually greater on
the growing fetus
• In extreme cases the child is
born addicted to mothers
drug/substance of choice