Several factors are common among female substance abusers including a history of abuse and mental illness. Pregnant women who abuse substances are more likely to experience domestic violence and their children often face developmental issues. Prenatal exposure to substances like opioids, cocaine, marijuana, alcohol, and tobacco can lead to low birth weight, birth defects, developmental delays, withdrawal symptoms, and behavioral problems. While not all exposed children are negatively impacted, the home environment plays a key role in development. Healthcare providers should assess home situations and provide supportive services to families affected by substance abuse.

1. DRUGS AND THE UNBORN
Several factors and issues are common among female substance abusers, i.e. mental
illness and a history of emotional, physical and/or sexual abuse. One community based study
found that over 60% of women drug users reported childhood sexual abuse, and over 55%
reported childhood physical abuse. This same study reported that 42% of women enrolled in a
substance abuse/prenatal care treatment program had been previous victims of both sexual and
physical abuse. Moreover, pregnant women experiencing domestic violence reported higher
proportions of substance abuse use compared to women not reporting current domestic violence.
Separate studies have also found that 40 – 60% of married or cohabitating partners in treatment
for substance abuse reported episodes of recent domestic violence.
These same social and psychological problems common to women substance abusers also
impacted the child’s development after birth. Some researchers maintain that the home
environment after birth has a greater bearing on growth and development of an infant than the
exposure to drugs prenatally. Similarly, research shows inconsistent care from an addicted
parent can have a more detrimental effect on a child through lack of attachment and bounding.
Attachment problems may include emotional withdrawal of the child, as well as maternal-child
relational difficulties, such as lack of responsiveness or engagement between the parent and the
child. For children who remain with the parents, the chaotic environment often associated with
substance abuse might require future counseling and services for a child raised in that
environment. [1], [4]
It is important to note that not all newborns exposed to illicit drugs during pregnancy will
have adverse short- or long-term health effects. There are several factors that play a role in that
determination, the length of exposure, what was used, etc. Equally as important to note is the
identification of a mother with a substance abuse disorder does not automatically infer the child
will become a victim of abuse or neglect. A protecting factor for a child can be the adequacy of
the home environment for the best neuro-developmental outcome possible. This further
highlights the need to use identification of a newborn exposed to illicit drugs in pregnancy as an
opportunity to be aware of problems that may manifest in the delivery room or nursery and
assess the safety of the newborn’s home environment along with the psychosocial situation of the
family for needed supportive services. [3]
DRUGS AND POSSIBLE EFFECTS ON THE UNBORN CHILD
Suboxone/Subutex
Suboxone (buprenorphine and naloxone) is a prescription medication used to treat opioid
dependence. This medication may not be safe to use during pregnancy, although the full risks
have not been fully studied. It may be safer than the continued use of opioids, especially illegal
ones. Studies (although limited at this time) have shown increased risk for miscarriage in
laboratory animals and newborn death. Developmental delays in offspring as well as minor
skeletal variations. Suboxone passes through the placenta to the fetus therefore placing the
developing fetus at risk of withdrawal and dependency with chronic usage. Symptoms of
withdrawal may include:
- Decreased respiration
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2. - Changes in behavior, such as irritability, jitteriness, or restlessness
- Excessive or high-pitched crying
- Poor feeding
- Seizures [9]
Methamphetamine
Studies show that women who use methamphetamine during pregnancy can result in a
wide range of problems including birth defects, fetal death, growth retardation, premature birth,
low birth weight, developmental disorder, and hypersensitivity to touch in the newborn. It is
known that methamphetamine passes to the fetus through the placenta and can cause elevated
fetal blood pressure, damaging the brain, heart and other major organs. Newborns that were
exposed to methamphetamine in the womb can be more difficult to care for because they can be
jittery and might eat and sleep poorly. Older children who were exposed prenatally to substances
may exhibit cognitive deficits, learning disabilities, and poor social adjustment. Some experts
believe that learning difficulties and behavioral problems may result as the child gets older.
Babies can be born addicted to methamphetamine and suffer withdrawal symptoms that include
tremors, sleeplessness, muscle spasms, and feeding difficulties. Methamphetamine acts on the
brain to release chemicals that affect the entire body. [2], [4], [6], [7]
Cocaine
Similar to methamphetamine, cocaine passes to the fetus through the placenta. The
elimination of cocaine is slower in the fetus than in an adult, meaning it is retained in the fetus’
body much longer than in the mother’s. During the early months of pregnancy cocaine use by the
mother may increase the risk of miscarriage. Later in pregnancy cocaine use can cause placental
abruption. Placental abruption can lead to severe bleeding, preterm birth and fetal death.
Newborns of mothers who have used cocaine throughout pregnancy are more irritable,
jittery, and have interrupted sleep patterns. Babies exposed to cocaine, especially those exposed
near birth, are at greater risk for birth defects such as abnormalities of the skull, face, eyes, heart,
limbs, intestines, genitals, kidneys and urinary tract.
Babies whose mother’s used cocaine tend to weigh less, be shorter in length and have
smaller heads than babies born without exposure to cocaine. Cocaine causes significant central
nervous system problems. Children exposed to cocaine while in the womb are at increased risk
for learning and behavioral problems that might not show up until school age.
Babies who are exposed to cocaine later in pregnancy may be born dependent and suffer
from withdrawal symptoms such as tremors, sleeplessness, muscle spasms, and feeding
difficulties. Some experts believe that learning difficulties and behavioral problems may result
as the child gets older. [2], [3], [4], [6], [7]
Marijuana
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3. Studies of marijuana in pregnancy are inconclusive because many women who smoke
marijuana also use tobacco and alcohol, therefore making it difficult to isolate solely the effect of
the THC.
Marijuana crosses the placenta to the baby. Marijuana, like cigarette smoke, contains
toxins that keep the baby from getting the proper oxygen that he or she needs to grow. Smoking
marijuana increases the levels of carbon monoxide and carbon dioxide in the blood, which
reduces the oxygen supply to the baby. Smoking marijuana during pregnancy can increase the
chance of miscarriage, low birth weight, premature births, developmental delays, and behavioral
and learning problems. Moreover, a study showed that prenatal marijuana use was significantly
related to increased hyperactivity, impulsivity, inattention symptoms, delinquency and
externalization of problems for children of age 10. Another study demonstrated links between
prenatal exposure to marijuana use and memory deficits.
Women who smoke marijuana during pregnancy are more likely to have low birth infants
possibly shorter gestation. The effects of maternal marijuana use on infant development have
not been systematically studied. However, the lipid solubility of THC allows for rapid transit in
breast milk, where it has been shown to accumulate and eventually pass to the newborn.
Recent studies have highlighted the long-term impacts of marijuana use during
pregnancy. Prenatal exposure to marijuana has been associated with increased levels of
depression during childhood, as well as initiation and frequency of marijuana use at age 14. [2],
[3], [4], [5], [6], [7]
Opiates/Opioids
Including - Heroin, morphine, codeine, oxycodone, hydrocodone, meperidine, fentanyl,
(and others)
Heroin is very addictive and crosses the placenta to the baby. Because the drug is so
addictive, the unborn baby can become dependent on the drug.
Using heroin during pregnancy increases the chance of premature birth, low birth weight,
breathing difficulties, low blood sugar, bleeding within the brain, and infant death. Babies can
also be both addicted to heroin and can suffer from withdrawal symptoms. Withdrawal
symptoms include irritability, convulsions, diarrhea, fever, sleep abnormalities, and joint
stiffness. Mothers who inject narcotics are more susceptible to HIV, which can be passed to
their unborn child.
In terms of prenatal drug exposure, heroin should be considered in conjunction with
methadone, the drug used for the treatment of heroin addicted individuals. Infants born addicted
to heroin or methadone often present with characteristics of neonatal opiate abstinence
syndrome. The symptoms for this syndrome vary but may include irritability, tremulousness,
hypertonia, excessive crying, voracious appetite, exaggerated sucking drive, abnormal
coordination between sucking and swallowing, regurgitation, pulmonary aspiration, and
abstinence associated seizures. The treatment of withdrawals varies according to the symptoms
presented, but could include medication treatment to wean the infant off the drug(s) gradually
without causing health problems.
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4. Although, as in the case with cocaine, conclusive data relating to long-term effects of
prenatal exposure to heroin and methadone is inconclusive, it is associated with premature birth
and lower birth weight. It has been found that opiate exposure was a marker for slightly
depressed motor performance and a tendency toward behavioral difficulties. In addition, a 2007
study found school performance of older heroin-exposed children was found to be effected by
early exposure to heroin and other environmental factors. [3], [4], [7]
Hallucinogens
PCP and LSD are hallucinogens; users can behave violently, which may harm the baby if
the mother hurts herself.
PCP use during pregnancy can lead to low birth weight, poor muscle control, brain
damage, and withdrawal syndrome if used frequently. Withdrawal symptoms include lethargy,
alternating with tremors as well as central nervous system issues and neuro-developmental
alterations. LSD can lead to defects if used frequently.
Sedatives
In the case of sedatives, low birth weight, Respiratory depression, and hypertonia have
been found. [3], [4], [7].
Tobacco
Almost universally, it is recognized that tobacco has detrimental effects on the fetus.
Tobacco is the most commonly used drug during pregnancy and is associated with adverse birth
outcomes, such as miscarriage, placental abruption, placental insufficiency, and low birth weight.
Additionally, babies of women who used tobacco while pregnant have reduced length, cranial
and thoracic measurements at birth. Research further suggests that children exposed to tobacco
in-utero suffer more respiratory infections and asthma. [4]
Alcohol
Drinking alcohol during pregnancy can have serious effects on fetal developmental.
Alcohol consumed by a pregnant woman is absorbed by the placenta and directly affects the
fetus. A variety of birth defects to the major organs and the central nervous system, which are
permanent, can occur due to alcohol use during pregnancy, though the risk of harm decreases if
the pregnant woman stops drinking completely. Collectively, these defects are called Fetal
Alcohol Syndrome (FAS). FAS is one of the most commonly known birth defects related to
prenatal drug exposure. Children with FAS may exhibit:
- Growth deficiencies, both prenatally and after birth.
- Problems with central nervous system functioning.
- IQ in the mild to severely retarded range.
- Small eye openings and poor development of the optic nerve.
- A small head and brain.
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5. - Joint, limb, ear, and heart malformations.
Alcohol-Related Neuro-developmental Disorder (ARND) and Alcohol-Related Birth
Defects (ARBD) are similar to FAS. Once known as Fetal Alcohol Effects, ARND and ARBD
are terms adopted in 1996 by the National Academy of Sciences Institute of Medicine. ARND
and ARBD encompass the functional and physiological problems associated with prenatal
alcohol exposure, but are less severe than FAS. Children with ARND can experience functional
or mental impairments as a result of prenatal alcohol exposure, and children with ARBD can
have malformations in the skeletal and major organ systems. Not all children who are exposed
prenatally to alcohol develop FAS, ARND or ARBD, but for those who do, these effects
continue throughout their lives and at the stages of development, although they are likely to
present themselves differently at each developmental stage. These effects can present
themselves as physical, mental, behavioral, and/or learning disabilities in various degrees. [2],
[4], [6], [7]
By Brenda A. Moulton, MEd May 6, 2013
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6. References:
[1] Child Welfare Information Gateway, (2012). Parental drug use as child abuse. Washington,
DC: US Department of Health and Human Services. Retrieved April 1, 2013 from Child
Welfare Information Gateway website: http://www.childwelfare.gov
[2] Child Welfare Information Gateway, (2009). Protecting children in families affected by
substance use disorders. Washington, DC: US Department of Health and Human
Services. Retrieved on March 4, 2013 from Child Welfare Information Gateway website:
http://www.childwelfare.gov
[3] Farst, K. J., Valentine, J. L., & Whit Hall, R. Drug testing for newborn exposure to illicit
substances in pregnancy: Pitfalls and pearls. (2011). International Journal of Pediatrics,
2011, doi: 10.1155/2011/951616
[4] National Abandoned Infants Assistance Resource Center, A Service of the Children's Bureau.
(2008). Prenatal substance exposure. Retrieved March 4, 2013 from UC Berkeley
website: http://aia.berkeley.edu
[5] Svrakic, MD, D., Lustman, PhD, P., Mallya, MD, A., Lynn, PhD, T., Finney, RN, R., &
Svrakic, N. (n.d.). Legalization, decriminalization & medicinal use of cannabis: A
scientific and public health perspective. (2012). Missouri Medicine, 109(2), 90-98.
[6] Think pregnancy: the effects of stimulants during pregnancy. Retrieved from March 4, 2013
from http://www.thinkpregnancy.org/english/meth.htm
[7] Using illegal drugs during pregnancy. (2011). Retrieved March 4, 2013 from
http://americanpregnancy.org/pregnancyhealth/illegaldrugs
[8] Young, N. K., Gardner, S., Otero, C., Dennis, K., Chang, R., Earle, K., & Amatetti, S. US
Department of Health and Human Services, Substance Abuse and Mental Health Services
Administration. (2009). Substance exposed infants: State responses to the problem. (HHS
09-4369). Rockville, MD:
[9] Suboxone and Pregnancy. Retrieved from May 3, 2013 from
http://pain.emedtv.com/suboxone/suboxone-and-pregnancy.html
6

7. References:
[1] Child Welfare Information Gateway, (2012). Parental drug use as child abuse. Washington,
DC: US Department of Health and Human Services. Retrieved April 1, 2013 from Child
Welfare Information Gateway website: http://www.childwelfare.gov
[2] Child Welfare Information Gateway, (2009). Protecting children in families affected by
substance use disorders. Washington, DC: US Department of Health and Human
Services. Retrieved on March 4, 2013 from Child Welfare Information Gateway website:
http://www.childwelfare.gov
[3] Farst, K. J., Valentine, J. L., & Whit Hall, R. Drug testing for newborn exposure to illicit
substances in pregnancy: Pitfalls and pearls. (2011). International Journal of Pediatrics,
2011, doi: 10.1155/2011/951616
[4] National Abandoned Infants Assistance Resource Center, A Service of the Children's Bureau.
(2008). Prenatal substance exposure. Retrieved March 4, 2013 from UC Berkeley
website: http://aia.berkeley.edu
[5] Svrakic, MD, D., Lustman, PhD, P., Mallya, MD, A., Lynn, PhD, T., Finney, RN, R., &
Svrakic, N. (n.d.). Legalization, decriminalization & medicinal use of cannabis: A
scientific and public health perspective. (2012). Missouri Medicine, 109(2), 90-98.
[6] Think pregnancy: the effects of stimulants during pregnancy. Retrieved from March 4, 2013
from http://www.thinkpregnancy.org/english/meth.htm
[7] Using illegal drugs during pregnancy. (2011). Retrieved March 4, 2013 from
http://americanpregnancy.org/pregnancyhealth/illegaldrugs
[8] Young, N. K., Gardner, S., Otero, C., Dennis, K., Chang, R., Earle, K., & Amatetti, S. US
Department of Health and Human Services, Substance Abuse and Mental Health Services
Administration. (2009). Substance exposed infants: State responses to the problem. (HHS
09-4369). Rockville, MD:
[9] Suboxone and Pregnancy. Retrieved from May 3, 2013 from
http://pain.emedtv.com/suboxone/suboxone-and-pregnancy.html
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