During the late 1990s, the predicted 3% of pregnant ladies used unauthorized drugs in early gestation, according to the Centers for Disease Control and Prevention. Pregnancy complications and poor fetal outcomes are common in these women. However, drug abuse may not be solely responsible for these adverse outcomes; other contributing factors in this population include a lack of prenatal care, violence, and sexually transmitted diseases. Breast-feeding is contraindicated with all of the following agents:Marijuana
This drug disrupts neurodevelopment, but there is no evidence that it is a structural teratogen. Exposure in utero can cause fetal growth retardation and subtle, long-lasting neurobehavioral abnormalities related to effects in the prefrontal cortical regions of the brain. Marijuana also has been linked to transient irritability, tremors, and an exaggerated startle reflex in neonates, but after this early period, there is little evidence of adverse neurobehavior in children followed up to age 3 years. In studies of older children up to 12 years of age, however, exposure in utero, especially if heavy and/or long term, is associated with inattention, hyperactivity, increased impulsivity and delinquency, and deficits in short-term memory tasks and problem solving.
Cocaine is a human teratogen that causes anomalies of the genitourinary tract, heart, limbs, face, and bowel. The toxicity of cocaine in the mother and fetus is related to the dose taken and duration of use. Toxicities result from the drug’s sympathomimetic properties, which lead to hypertension and vasoconstriction, causing decreased uterine blood flow and fetal hypoxia.
Maternal toxicities include spontaneous abortions, premature labor and delivery, premature rupture of membranes, placenta previa, and abruptio placentae. Fetal and neonatal toxicities can result from maternal use at any point during gestation and include growth retardation, fetal distress, in utero cerebrovascular accidents, and abnormal neonatal neurobehavior.
This group of drugs includes amphetamine, dextroamphetamine, methamphetamine, Ecstasy (MDMA), and the structurally related agents mescaline (from peyote) and STP (4-methyl-2,5-dimethoxyamphetamine, or DOM). Amphetamine-induced malformations have been observed in some animals (pregnancy category C), but only at high doses. Various birth defects, such as oral clefts, cardiac defects, and biliary atresia, have been noted in the offspring of women taking amphetamines for therapeutic reasons or recreational use. A causative association has not been established, but the risk, even if it is eventually proved, appears to be low Mild neonatal withdrawal has also been observed. There is practically no information on the use of peyote during pregnancy, but it is teratogenic in one animal species. On the other hand, there is ample evidence that recreational use can present significant risks, including intrauterine growth retardation, decreased head circumference, premature delivery, and increased maternal, fetal, and neonatal morbidity. Amphetamine abuse during pregnancy, which is frequently combined with alcohol consumption, use of other drugs, and smoking, may cause altered growth and neurobehavior that are still evident after puberty.
LSD is a potent hallucinogen, but there is no published evidence that the pure chemical causes chromosomal abnormalities, spontaneous abortions, or major congenital malformations. Reports of adverse pregnancy outcomes in women using LSD were probably related to simultaneous ingestion of other drugs of abuse, selective reporting, and other factors not related to drug abuse.
These agents, which cross the placenta rapidly, do not cause structural defects, but neonatal withdrawal may occur at birth if the mother is addicted. Among newborns whose mothers have been on methadone, the incidence and severity of withdrawal were related to the dose. Lowering the maternal dose of methadone to less than 20 mg/day significantly reduced neonatal withdrawal and length of hospital stay.
In animals, PCP causes both structural defects and neurobehavioral effects. Congenital defects have been reported in children of women who used PCP while pregnant, but a causative association has not been proved, largely because PCP, a hallucinogen, is rarely used alone. Neonatal neurobehavioral dysfunction (irritability, jitteriness, depression, hypotonia, poor feeding, and poor sucking reflex) may be a effects of abuse during pregnancy, but these poor effects have not been observed at age 2 years in children exposed in utero.