Wednesday, April 1, 2015

Illicit drug use during pregnancy

Nearly 4 percent of pregnant women in the United States use illicit drugs such as marijuana, cocaine, Ecstasy and other amphetamines, and heroin (1). These and other illicit drugs may pose various risks for pregnant women and their babies. Some of these drugs can cause a baby to be born too small or too soon, or to have withdrawal symptoms, birth defects or learning and behavioral problems.

Because many pregnant women who use illicit drugs also use alcohol and tobacco, which also pose risks to unborn babies, it often is difficult to determine which health problems are caused by a specific illicit drug. Additionally, illicit drugs may be prepared with impurities that may be harmful to a pregnancy.
Finally, pregnant women who use illicit drugs may engage in other unhealthy behaviors that place their pregnancy at risk, such as having extremely poor nutrition or developing sexually transmitted infections. All of these factors make it difficult to know exactly what the effects of illicit drugs are on pregnancy.

What are the risks with use of marijuana during pregnancy?
Marijuana is the most frequently used illicit drug among women of childbearing age in the United States (1). Some studies suggest that use of marijuana during pregnancy may slow fetal growth and slightly decrease the length of pregnancy (possibly increasing the risk of premature birth). These effects are seen mainly in women who use marijuana regularly (six or more times a week) (2).

After delivery, some babies who were regularly exposed to marijuana before birth appear to undergo withdrawal-like symptoms, including excessive crying and trembling (2, 3). These babies have difficulty with state regulation (the ability to easily adjust to touch and changes in their environment), are more sensitive to stimulation and have poor sleep patterns.

Couples who are planning pregnancy should keep in mind that marijuana can reduce fertility in both men and women, making it more difficult to conceive (2).

What is the long-term outlook for babies exposed to marijuana before birth?
There have been a limited number of studies following marijuana-exposed babies through childhood. Some did not find any increased risk of learning or behavioral problems. However, others found that children who were exposed to marijuana before birth are more likely to have subtle problems that affect their ability to pay attention (2, 3). Exposed children do not appear to have a decrease in IQ.

What are the risks with use of Ecstasy, methamphetamine and other amphetamines during pregnancy?
The use of Ecstasy, methamphetamine and other amphetamines has increased dramatically in recent years. There have been few studies on how Ecstasy may affect pregnancy. One small study did find a possible increase in congenital heart defects and, in females only, of a skeletal defect called clubfoot (4). Babies exposed to Ecstasy before birth also may face some of the same risks as babies exposed to other types of amphetamines.
Another commonly abused amphetamine is methamphetamine, also known as speed, ice, crank and crystal meth. A 2006 study found that babies of women who used this drug were more than three times as likely than unexposed babies to grow poorly before birth (5). Even when born at term, affected babies tend to be born with low birthweight (less than 5½ pounds) and have a smaller-than-normal head circumference.

Use of methamphetamine during pregnancy also increases the risk of pregnancy complications, such as premature birth and placental problems (5). There also have been cases of birth defects, including heart defects and cleft lip/palate, in exposed babies, but researchers do not yet know whether the drug contributed to these defects (5).

After delivery, some babies who were exposed to amphetamines before birth appear to undergo withdrawal-like symptoms, including jitteriness, drowsiness and breathing problems.

What is the long-term outlook for babies exposed to Ecstasy, methamphetamine and other amphetamines before birth?
The long-term outlook for these children is not known. Children who are born with low birthweight are at increased risk of learning and other problems. Children with reduced head circumference are more likely to have learning problems than those with low birthweight and normal head size (5). More studies are needed to determine the long-term outlook for children exposed to amphetamines before birth.
What are the risks with use of heroin during pregnancy?
Women who use heroin during pregnancy greatly increase their risk of serious pregnancy complications. These risks include poor fetal growth, premature rupture of the membranes (the bag of waters that holds the fetus breaks too soon), premature birth and stillbirth.

As many as half of all babies of heroin users are born with low birthweight (6). Many of these babies are premature and often suffer from serious health problems during the newborn period, including breathing problems. They also are at increased risk of lifelong disabilities.

Use of heroin in pregnancy may increase the risk of a variety of birth defects (6). What is not entirely clear is whether these effects are caused by the drug itself or related to the poor health behaviors that women who take heroin often have. The substances that the heroin often is mixed with when it is made also may play a role.
Most babies of heroin users show withdrawal symptoms during the 3 days after birth, including fever, sneezing, trembling, irritability, diarrhea, vomiting, continual crying and seizures. These symptoms usually subside by 1 week of age. The severity of a baby's symptoms is related to how long the mother has been using heroin or other narcotics and how high a dose she has taken. The longer the baby’s exposure in the womb and the greater the dose, the more severe the withdrawal. Babies exposed to heroin before birth also face an increased risk of sudden infant death syndrome (SIDS).

While heroin can be sniffed, snorted or smoked, most users inject the drug into a muscle or vein. Pregnant women who share needles are at risk of contracting HIV (the virus that causes AIDS) and the hepatitis C virus. These infections can be passed on to the infant during pregnancy or at birth.

A pregnant woman who uses heroin should not attempt to suddenly stop taking the drug. This can put her baby at increased risk of death. She should consult a health care provider or drug-treatment center about treatment with a drug called methadone.

Infants born to mothers taking methadone have withdrawal symptoms that can be safely treated. Methadone-exposed babies have higher birthweights than babies born to women who continue to use heroin. It is important for families to be aware that infants who are withdrawing from narcotics, including methadone, may continue to have symptoms of withdrawal for weeks after discharge from the nursery. There are effective ways to reduce the baby's discomfort using pacifiers, swaddling and cuddling. Parents and caregivers benefit from support from family and friends and should seek out assistance if they are feeling stressed or overwhelmed.
What is the long-term outlook for babies exposed to heroin before birth? 

The outlook for these children depends on a number of factors, including whether they suffered serious prematurity-related or other complications. Some studies suggest that children exposed to heroin before birth are at increased risk of learning and behavioral problems (6).

What are the risks of use of "T's and Blues" and opioid painkillers during pregnancy? This is the street name for a mixture of a prescription opioid (related to morphine) painkiller called pentazocine and an over-the-counter allergy medicine. Individuals who abuse the mixture inject it into a vein. Babies of women who use T's and Blues during pregnancy are at increased risk of slow growth and may suffer withdrawal symptoms (7).
Babies of women who abuse prescription oral (taken by mouth) opioid painkillers, such as oxycodone (OxyContin), also may undergo withdrawal.

What are the risks with use of cocaine during pregnancy?
Cocaine use during pregnancy can affect a pregnant woman and her baby in many ways. During the early months of pregnancy, cocaine may increase the risk ofmiscarriage. Later in pregnancy, it may trigger preterm labor (labor that occurs before 37 completed weeks of pregnancy) or cause the baby to grow poorly. As a result, cocaine-exposed babies are more likely than unexposed babies to be born prematurely and with low birthweight. Premature and low-birthweight babies are at increased risk of health problems during the newborn period, lasting disabilities such as intellectual disabilities and cerebral palsy, and even death. Cocaine-exposed babies also tend to have smaller heads, which generally reflect smaller brains and an increased risk of learning problems (8).
Some studies suggest that cocaine-exposed babies are at increased risk of birth defects involving the urinary tract and, possibly, other birth defects (9, 10). Cocaine may cause an unborn baby to have a stroke, which can result in irreversible brain damage and sometimes death.

Cocaine use during pregnancy can cause placental problems, including placental abruption. In this condition, the placenta pulls away from the wall of the uterus before labor begins. This can lead to heavy bleeding that can be life threatening for both mother and baby. The baby may be deprived of oxygen and adequate blood flow when an abruption occurs. Prompt cesarean delivery, however, can prevent most deaths but may not prevent serious complications for the baby caused by lack of oxygen.

After birth, some babies who were regularly exposed to cocaine before birth may have mild behavioral disturbances. As newborns, some are jittery and irritable, and they may startle and cry at the gentlest touch or sound (11). These babies may be difficult to comfort and may be withdrawn or unresponsive. Other cocaine-exposed babies “turn off” surrounding stimuli by going into a deep sleep for most of the day. Generally, these behavioral disturbances are temporary and resolve over the first few months of life (11).
Cocaine-exposed babies may be more likely than unexposed babies to die of SIDS. However, studies suggest that poor health practices that often accompany maternal cocaine use (such as use of other drugs and smoking) may play a major role in these deaths (12).

What is the long-term outlook for babies who were exposed to cocaine before birth? Most children who were exposed to cocaine before birth have normal intelligence (13). This is encouraging, in light of earlier predictions that many of these children would be severely brain damaged. A 2004 study at Case Western Reserve University found that 4-year-old children who were exposed to cocaine before birth scored just as well on intelligence tests as unexposed children (13).

However, the Case Western and other studies suggest that cocaine may sometimes contribute to subtle learning and behavioral problems, including language delays and attention problems (13, 14, 15, 16). A good home environment appears to help reduce these effects (13, 15, 16). A recent study also suggests that cocaine-exposed children grow at a slower rate through age 10 than unexposed children, suggesting some lasting effect on development (17).

What are the risks of "club drugs," such as PCP (angel dust), ketamine (Special K) and LSD (acid)?
There are few studies on the risks of these drugs during pregnancy. Babies of mothers who used PCP in pregnancy may have withdrawal symptoms (7, 18). Babies exposed before birth to PCP or ketamine may be at increased risk of learning and behavioral problems (7, 18). There have been occasional reports of birth defects in babies of women who used LSD during pregnancy, but it is not known whether or not the drug contributed to the defects (7).

What are the risks of inhaling glues and solvents during pregnancy? Individuals, pregnant or not, who inhale these substances risk liver, kidney and brain damage and even death. Abusing these substances during pregnancy can contribute to miscarriage, slow fetal growth, preterm birth and birth defects (7). They also may cause withdrawal symptoms in the newborn.

How can a woman protect her baby from the dangers of illicit drugs?
Birth defects and other problems caused by illicit drugs are completely preventable. The March of Dimes advises women who use illicit drugs to stop before they become pregnant or to delay pregnancy until they believe they can avoid the drug completely throughout pregnancy. The March of Dimes also encourages pregnant women who use illicit drugs (with the exception of heroin) to stop using the drug immediately, because of the harm continued drug use may cause. Women who use heroin should consult their health care provider or a drug treatment center about methadone treatment.

Where can someone find more information on stopping drug use?
To learn more, ask a health care provider or contact:

Does the March of Dimes support research on illicit drug use during pregnancy? The March of Dimes has supported a number of research grants on drug use during pregnancy. For example, a recent grantee was studying physical and behavioral reasons that motivate pregnant women to abuse drugs such as cocaine, in order to improve drug treatment programs for pregnant women and reduce the risks to their babies. The March of Dimes also produces a variety of information and educational materials that inform pregnant women and others of the dangers of using drugs during pregnancy.

  1. Substance Abuse and Mental Health Administration. Results from the 2006 National Survey on Drug Use and Health: National Findings. Office of Applied Studies, NSDUH Series H-32, DHHS, Publication No. SMA 07-4293, Rockville, MD, 2007.
  2. Reproductive Toxicology Center. Cannabis. Updated 12/1/05.
  3. National Institute on Drug Abuse. Research Report Series–Marijuana Abuse. Updated 11/2/06.
  4. Reproductive Toxicology Center. MDMA. Updated 3/1/07.
  5. Smith, L.M., et al. The Infant Development, Environment, and Lifestyle Study: Effects of Prenatal Methamphetamine Exposure, Polydrug Exposure, and Poverty on Intrauterine Growth. Pediatrics, volume 118, number 3, September 2006, pages 1149-1156.
  6. Briggs, G.G., et al. Drugs in Pregnancy and Lactation 7th edition. Philadelphia, PA, Lippincott Williams and Wilkins, 2005.
  7. American College of Obstetricians and Gynecologists (ACOG). Your Pregnancy and Birth 4th edition. ACOG, Washington, DC, 2005.
  8. Bateman, D.A., Chiriboga, C.A. Dose-Response Effect of Cocaine on Newborn Head Circumference. Pediatrics, volume 106, number 3, September 2000, p.e33.
  9. Vidaeff. A.C., Mastrobattista, J.M. In Utero Cocaine Exposure: A Thorny Mix of Science and Mythology. American Journal of Perinatology, volume 20, number 4, 2003, pages 165-172.
  10. Reproductive Toxicology Center. Cocaine. Last updated 12/1/05.
  11. Bauer, C.R., et al. Acute Neonatal Effects of Cocaine Exposure During Pregnancy. Archives of Pediatric and Adolescent Medicine, volume 159, September 2005, pages 824-834.
  12. Fares, I., et al. Intrauterine Cocaine Exposure and the Risk for Sudden Infant Death Syndrome: A Meta-Analysis. Journal of Perinatology, volume 17, number 3, May-June 1997, pages 179-182.
  13. Singer, L.T., et al. Cognitive Outcomes of Preschool Children with Prenatal Cocaine Exposure. Journal of the American Medical Association, volume 291, number 20, May 26, 2004, pages 2448-2456.
  14. Linares, T.J., et al. Mental Health Outcomes of Cocaine-Exposed Children at 6 Years of Age. Journal of Pediatric Psychology, volume 31, number 1, January-February 2006, pages 85-97.
  15. Lewis, B.A., et al. Prenatal Cocaine and Tobacco Effects on Children’s Language Trajectories. Pediatrics, volume 120, number 1, July 2007, pages e78-e85.
  16. Bada, H.S., et al. Impact of Prenatal Cocaine Exposure on Child Behavior Problems through School Age. Pediatrics, volume 119, number 2, February 2007, pages e348-e359.
  17. Richardson, G.A., et al. Effects of Prenatal Cocaine Exposure on Growth: A Longitudinal Analysis. Pediatrics, volume 120, number 4, October 2007, pages e1017-e1027.
  18. Reproductive Toxicology Center. Phencyclidine. Updated 12/1/05.
January 2008

Most common questions

Can I keep taking all my prescriptions during pregnancy?

It depends on the drug. Tell your prenatal care provider about any prescription drugs you take. Some drugs may be harmful to a growing baby. You may need to stop taking a drug or switch to a drug that's safer for your baby. Don't take anyone else's prescription drugs. And don't take any prescription drug unless your prenatal care provider knows about it.

I drank before I knew I was pregnant. Is my baby hurt?

It's unlikely that an occasional drink before you realized you were pregnant will harm your baby. But the baby's brain and other organs begin developing around the third week of pregnancy, so they could be affected by alcohol in these early weeks. The patterns of drinking that place a baby at greatest risk for fetal alcohol spectrum disorders (FASDs) are binge drinking and drinking seven or more drinks per week. However, FASDs can and do occur in babies of women who drink less. Because no amount of alcohol has been proven safe during pregnancy, a woman should stop drinking immediately if she even suspects she could be pregnant. And she should not drink alcohol if she is trying to become pregnant.

Is it OK to drink wine in my third trimester?

No amount of alcohol has been proven safe during pregnancy. To ensure your baby's health and safety, don't drink alcohol while you're pregnant. Alcohol includes beer, wine, wine coolers and liquor. If you need help to stop drinking alcohol, tell your health care provider.

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