Substance Abuse in Pregnancy: Tips for Mothers-To-Be

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Obstetrician-gynecologist Dr. Kecia Gaither Offers Tips on Minimizing Risks Associated with Substance Abuse in Pregnancy.

Dr. Kecia Gaither

Everything a mother ingests – tobacco, alcohol, drugs – can harm the unborn baby and imperil the pregnancy.

A developing fetus receives oxygen and nutrients from the mother via the placenta and the umbilical cord. Prenatal nutrition, good or bad, can affect a baby well into adulthood and eating well is one of the most essential responsibilities of a mother-to-be. But molecules of food and oxygen are not the only particles that pass through the placenta and into the baby's bloodstream.

“Everything a mother ingests – tobacco, alcohol, drugs – can harm the unborn baby and imperil the pregnancy,” says obstetrician-gynecologist Dr. Kecia Gaither. “Even small amounts of many substances can cause health problems and abuse can have dire physical, mental, and emotional consequences for the child. Women who smoke, drink, and take prescription or illicit drugs must seek advice and support before, during, and after pregnancy to end their dependency and ensure the health and well-being of their children.”

Cigarette smoke contains 4,000 chemicals, the most harmful of which during pregnancy are nicotine and carbon monoxide. These pass from the mother's bloodstream through the placenta to the developing baby, where they work together to reduce the baby's supply of oxygen. As few as one or two cigarettes a day will both reduce the amount of oxygen in the red blood cells and narrow the blood vessels, making it harder for the cells carrying oxygen and nutrients to reach the baby. Smoking during pregnancy dramatically increases the risk of stillbirth, premature delivery, and low birth weight. These babies often have underdeveloped lungs and continuing breathing problems. They are at greater risk of sudden infant death syndrome (SIDS) and of developing asthma.

The more a pregnant woman drinks, the worse the life-long physical and behavioral consequences for her child. Regular heavy drinking and binge drinking – consuming four or more drinks per occasion – have the most serious effects but there is no known safe amount of alcohol for a pregnant woman to drink. Nor is there a safe time to drink. Alcohol that passes from the mother's bloodstream into her baby's blood can disrupt development of the brain and other critical organs and systems at any stage of the pregnancy and cause a lifetime of cognitive and behavioral problems. The resulting range of disorders and symptoms is known as fetal alcohol spectrum disorders (FASD) and may include physical abnormalities, particularly of the face, that are identifiable at birth, and developmental deficits that are not apparent until later.

“Prenatal exposure to alcohol is the leading preventable cause of birth defects in the United States,” says Dr. Gaither. “It can trigger problems in the earliest stages of pregnancy even before a woman knows she is pregnant. The best advice we can give women of child-bearing age who are not using adequate birth control is 'don't drink.'”

Illicit drugs
Illicit drugs, or street drugs, are harmful to both mother and baby as well as being illegal. They include cocaine; heroin; illicitly obtained prescription opioids; methamphetamine, Ecstasy, and other “club” drugs; hallucinogenics such as PCP and LSD; and, in most states, marijuana. The specific effects of any one of these drugs are difficult to pinpoint since they are often used in combination or along with alcohol and tobacco. Some may cause infertility; most increase the risk of miscarriage, stillbirth, preterm labor, and problems with the placenta. Babies born to mothers who use drugs are more likely to have low birth weight, reduced head circumference, various birth defects including of the heart, and infections such as hepatitis and HIV, which are common among intravenous drug users. Babies whose mothers used highly addictive drugs like heroin and opioids may be born addicted to those drugs and suffer debilitating withdrawal after birth.

“Quitting addictive drugs suddenly can cause devastating problems for the baby,” says Dr. Gaither. “Women who are addicted must get treatment that gradually reduces their dependency in a way that is safe for themselves and their babies.” Women who are taking prescription opioids or any other prescription drugs under a doctor's supervision must discuss the risks and benefits of the drugs with their doctors and continue the medication only as instructed.

Dr. Gaither concludes: “In every community, help is available to pregnant women to reduce their dependency on tobacco and alcohol and those who use illicit drugs must work closely with their doctors to ensure a safe and healthy pregnancy and give their babies the best possible start in life.”

Kecia Gaither, MD, MPH, FACOG, a perinatal consultant and women’s health expert, is a double board-certified physician in OB/GYN and Maternal-Fetal Medicine in New York City. Dr. Gaither is Director of Perinatal Services at Lincoln Medical and Mental Health Center, a member of NYC Health + Hospitals System in Bronx, New York.

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