Drugs and alcohol

Both drugs and alcohol are harmful during pregnancy. Substance abuse and addiction is a worldwide problem and women whose pregnancies are affected by substance abuse often have associated problems such as poverty, homelessness, social isolation, criminal activity, mental health issues, violence, abuse, and trauma. Many women stop drinking alcohol and using other drugs when they find out they are pregnant. If women continue alcohol and drug use in pregnancy, there can be wide-ranging effects on the mother and developing fetus. 

Alcohol 

There is no known safe level of alcohol in pregnancy. Alcohol is a teratogen and the susceptibility of the fetus to the adverse effects of alcohol can vary between women and the gestation. We know that drinking excessively during pregnancy damages the development of the fetus and risks the development of fetal alcohol spectrum disorder. The likelihood of there being an adverse effect on the fetus increases with the volume and frequency of alcohol consumption in pregnancy, and there is no known minimum level at which alcohol does not affect the pregnancy. Women who consume alcohol heavily are also at risk of alcohol related health problems, including cardiovascular, neurological, and gastrointestinal disease. 

This website gives a brief overview on fetal alcohol spectrum disorder if you are interested. One of your readings for this week is also a brochure by HealthEd for women which educates on alcohol use in pregnancy. If you are interested in more detail, alcohol.org.nz provides evidence and resources for pregnant women and health professionals.

Drugs 

There are two factors to consider when evaluating the effects of drugs on pregnancy- the effect on the mother's health and the effect on the fetus. As we have mentioned, substance abuse is often linked with social problems, but it also can cause medical problems for the mother, such as: 

• Poor nutrition 
• Malabsorption 
• Poor dentition
• Dermatological problems e.g. cellulitis 
• Cardiovascular problems e.g infective endocarditis 
• Respiratory morbidity e.g pneumonia 
• Neurological problems e.g. CVA, peripheral neuropathy
• Infectious diseases e.g. Hepatitis C, HIV 

Overall, there are increased risks of miscarriage, stillbirth, neonatal death, anaemia, placental abruption, preterm birth, and SGA. Women taking abusing opiates may need more analgesia for pain in pregnancy and during labour and birth. Babies born to mothers who take drugs during pregnancy may also experience neonatal abstinence syndrome and need to be admitted to NICU. Just like smoking, babies are at higher risk of SUDI. There is a higher chance of developmental delay and babies being removed from their mothers by social services. 

Specific drugs increase the risk of specific problems in pregnancy: 

Amphetamines

• Preterm birth
• SGA 
• Stillbirth and neonatal death 
• Gestational hypertension 
• Preeclampsia 
• Abruption 
• Maternal depression and insomnia 
• Neurodevelopmental disorders in the child 

Benzodiazepines

• Neonatal abstinence syndrome 
• Miscarriage 
• Preterm birth 
• The link between benzodiazepines and congenital malformations is unclear- more evidence is needed. 

Cocaine 

• Miscarriage
• Placental abruption 
• SGA
• Intrauterine hypoxia
• Preterm birth 
• Fetal intraventricular haemorrhage 
• Neonatal necrotising enterocolitis 
• Maternal cardiovascular problems e.g. HTN, arryhthmias, stroke, MI

Marijuana 

• Neurodevelopmental disorders in the child
• Preterm birth 

Opiates 

• Miscarriage
• Placental abruption 
• Stillbirth 
• SGA
• Fetal passage of meconium
• Preeclampsia 
• Preterm birth 
• PPH 
• Infective complications: intra-amniotic infection, septic thrombophlebitis 
• Neonatal abstinence syndrome 

For opioid-dependent women, the use of opioid substitution therapy such as methadone is recommended as this is safer in pregnancy and allows for engagement with obstetric and drug services.