SUBSTANCES

This resource is not meant to be used as medical advice. If you need medical advice, please discuss with your doctor.

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Alcohol in Pregnancy

QUICK FACTS:
  • There is no safe amount of alcohol consumption during pregnancy.

  • Effects of fetal exposure to alcohol may be lifelong for the baby

  • There is no exact way to determine the relationship between the amount of alcohol consumed, and the potential damage caused by alcohol in an infant.

  • Alcohol exposure during pregnancy may cause physical abnormalities, brain and behavioral effects, or no detectable problems (1).

  • A fetus in utero is especially susceptible to the effects of alcohol, because they do not process alcohol as efficiently as an adult and they are at a critical stage of development (2).

  • In some studies, Fetal Alcohol Spectrum Disorder (FASD) has been diagnosed in up to 5% of live births (3).

 

 

POSSIBLE RISKS:

The following risks are POSSIBLE risks. They are not guaranteed and this list is not comprehensive. Alcohol in pregnancy may affect 2 major areas: structural growth and brain development.

 

Structural Growth Impairment:

  • Overall growth restriction

  • Head growth

  • Heart and other organ growth abnormalities

  • Skeletal growth abnormalities

  • Vision and hearing impairment

 

Brain Development Impairment:

  • Microcephaly (small head) is a sign of brain growth restriction

  • Seizures and nerve problems are signs of improper brain development

  • Cognitive, executive function, memory, and behavioral problems

 

Fetal Alcohol Spectrum Disorder (FASD):

Broad term used to describe the effects of alcohol exposure in an infant and includes the following (4):

 

Possible Risks by Trimesters:

Alcohol exposure is dangerous to a fetus in all stages of gestation, but may have different effects at different times. Exposure in any trimester may cause neurobehavioral effects (brain development that will later affect behavior).

First Trimester:

Facial and structural abnormalities (classic facial features of FASD and small head) (5)

Second Trimester:

Risk of miscarriage

Third Trimester:

Weight, length, and brain growth (5-7)
 

Takeaways:

- Exposure earlier in pregnancy may typically cause physical abnormalities and risk of miscarriage.

- Exposure later in pregnancy may typically cause more cognitive problems and overall growth restriction.

- Neurobehavioral effects may occur with alcohol exposure at any point in gestation.

 

 

WHAT TO LOOK FOR:

Signs of Brain Development Impairment (8-13):

  • Infancy:

- Irritability, jitteriness, problems regulating states of sleep or arousal, developmental delay

  • Childhood:

- Hyperactivity, inattention, cognitive delay, emotional reactivity, learning disabilities, memory difficulty

  • Adolescence:

- Deficits in social skills, executive function (decision making, school, work, following social norms)

 

 
WHAT TO DO:

Early Detection and Intervention is very important for improving outcomes. The initial workup to diagnose Fetal Alcohol Spectrum Disorder is performed by a multispecialty team.

  • Talk to your pediatrician or family physician

- They can get you started with a multispecialty team to start the workup for a potential diagnosis of FASD

- Bring up any concerns you may have that will aid them in early diagnosis

- You can receive more education about what to look for and when to bring your child in

  • Most children with FASD benefit from a variety of therapies including physical, speech, occupational, behavioral, and educational therapy.

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Tobacco & Nicotine in Pregnancy

QUICK FACTS:
  • A study in 2016 showed that 7.2% of women reported smoking at any point during pregnancy in the United States (1). Utah had a rate of 3%.

  • Electronic Nicotine Delivery Systems (ENDS)/ Electronic cigarettes contain less toxins than cigarettes, but may cause developmental harm based on data from animal studies (2).

  • Tobacco can cause harm through decreased oxygenation, altered development, and exposure to toxins

  • The most well studied effect of tobacco use is low birth weight. 

 
POSSIBLE RISKS: 

Risks to the pregnancy:

  • Modestly increased chance of miscarriage

  • Nearly 50% increase in stillbirth (3)

  • Increased chance of pregnancy complications and birth complications

- Preterm labor

- Placental abruption

- Preterm premature rupture of membranes

  • 1.5 to 3.5 times Increased chance of Low Birth Weight Infant (4)

  • Decreased risk of preeclampsia (5)

 

Risks after birth:
  • Neurobehavioral effects (effects on the brain that may impact behavior) (6,7)

- Higher stress response

- More excitable brain (irritable, restless)

- Increased muscle tone

- Behavioral problems (conduct disorders, ADHD) (8-11)

- Tourette’s syndrome or Tic disorders (12)

  • There is no good evidence that prenatal nicotine exposure causes neonatal withdrawal syndrome.

  • Sudden Unexpected Infant Death (also called SIDS) (13)

- Risk of SIDS is much lower if infant is not exposed to cigarette smoke after birth

  • 4 times increased chance of Diabetes as young adult if exposed to heavy smoking (14)

  • Unclear evidence of cognitive problems 

  • Increased chance of asthma (15)

 

WHAT TO LOOK FOR:
  • Risk is minimal after a successful pregnancy and birth.

  • After birth you can look for irritability, restlessness and increased muscle tone, however the only treatment is to help them feel comfortable 

  • Stay aware of the child’s behavior but behavioral disturbances may or may not be related to tobacco exposure

 

WHAT TO DO:
  • Talk to your pediatrician about any concerns you may have

  • Once you have a healthy baby, there are likely no major issues to be worried about from tobacco exposure

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Stimulants in Pregnancy

QUICK FACTS:
  • The most common stimulants are Cocaine, Methamphetamine (Meth), and Amphetamine (ADHD medication known commonly as Adderall)

  • Cocaine, Meth, and Amphetamine cross the placenta

  • Cocaine causes vasoconstriction (narrowing of blood vessels) which can cause problems associated with poor blood flow (1)

 

POSSIBLE RISKS:
Cocaine:
  • Growth Related Issues (2):

- Small for gestational age (measures small during pregnancy)

- Reduced birth weight (measures small at birth)

- Shorter gestational age at delivery (earlier birth than the average)

- Preterm birth (born before 37 weeks)

  • Neurobehavioral effects (3,4) (brain and behavior symptoms) may occur within the first 3 days of life. These are likely transient and do not show long term effects. 

- Tremors/jitteriness

- High pitched cry

- Irritability

- Excessive suck 

- Vital sign changes (blood pressure, heart rate, respiratory rate)

  • Other rare risks may include miscarriage, placental abruption, and small intestinal atresia (poor formation of the small intestine)

 

Amphetamine and Methamphetamine: 
  • Growth related issues (5-8): 

- Fetal growth restriction

- Preterm birth

- Reduced birth weight

- Smaller head circumference 

- Small for gestational age

  • Pregnancy and Birth risks:

- Preeclampsia

- Placental abruption

- Neonatal and Infant death (9)

  • Risk of cognitive problems is unclear. 

 

WHAT TO LOOK FOR:
Cocaine: 
  • Look for signs of growth restriction

- Size

- Weight

- Head circumference 

  • Look for signs of neurobehavioral problems within the first 3 days of life:

- Tremors/jitteriness

- High pitched cry

- Irritability

- Excessive suck 

Vital sign changes (blood pressure, heart rate, respiratory rate)

  • Look for long term cognitive problems:

- Risk for long term cognitive and behavioral issues is unclear. Some studies show no evidence for cognitive and behavioral issues while some show (10,11):

- Attention deficits

- Behavioral self regulation (self control) deficits

- Some minimal language and cognitive delays

- Minor processing and executive function deficits

Amphetamines: 
  • Look for signs of growth restriction

- Size

- Weight

- Head circumference 

  • Look for long term cognitive problems:

- Risk of cognitive problems is unclear. Some studies show no evidence for cognitive problems while others show (12,13):

- Learning and memory difficulty

- Motor delays (movement/muscle tone)

- Brain structure changes

- Attention deficits 
 

WHAT TO DO: 
  • Watch for any growth related delays and seek appropriate medical treatment and/or therapy as early as detected. 

  • Watch for any behavioral problems as listed above and seek early intervention.

  • Talk to your pediatrician about any concerns you may have about your child’s health and development including social and behavioral concerns.

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Opioids in Pregnancy

QUICK FACTS:
  • Types of opioids:

- Natural opiates such as Morphine, Heroin, and Codeine

- Synthetics commonly known as the pain pills Oxycodone, Hydrocodone, and Hydromorphone

- Opioid use in pregnancy has become a public health crisis.

- Maternal Opioid-related Diagnosis (MOD) in hospital deliveries more than doubled between 2010 and 2017 (increased from 3.5 to 8.2 per 1000 deliveries) (1)

- Individuals who use opioids typically have other coexisting problems (medical, psychological, financial, social) that make it difficult to distinguish the direct effect of opioids on pregnancy and birth related complications.

 

POSSIBLE RISKS:

Increased risk of obstetric complications including (2-4):

  • Intrauterine growth restriction (slow growth during pregnancy)

  • Placental abruption (placenta separation from uterus)

  • Preterm Labor

  • Miscarriage or Stillbirth

*It is difficult to determine how much risk is associated with Opioid use versus other coexisting medical problems and substances

 

Neonatal Abstinence Syndrome (NAS):
  • NAS is withdrawal from any substance in an infant that was exposed during pregnancy.

  • Most commonly due to Opioids

  • Symptoms include (5,6):

- Fragmented sleep cycle

- Difficulty staying alert

- Hypertonicity (stiffness) or jitteriness

- Autonomic dysfunction (sweating, sneezing, fever, nasal stuffiness, frequent yawning)

- Sensitivity, irritability, and crying with any stimuli

- Difficulty feeding/swallowing

  • Withdrawals can occur as early as within the first 24 hours and almost always occur within the first week (5-8).

- Infants will be observed for 3-7 days if NAS is suspected

  • NAS is NOT associated with death

 

WHAT TO LOOK FOR:
  • Watch for the above symptoms within the first week of life.

  • Keep in mind that any time illegal substances are used, other substances are much more likely to be used concurrently. 

 

WHAT TO DO:
  • NAS is almost always going to occur at the hospital under the care of the medical team, so you will likely not need to do anything besides be there for your baby. 

  • The long-term effects of opioid use in pregnancy are not well understood, so there is no action that you need to take to help your child long term. 

  • If you have any concerns, talk to your pediatrician.

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Marijuana in Pregnancy

QUICK FACTS:
  • The impact of marijuana use in pregnancy on the baby is poorly understood. More studies are warranted. 

  • There is some limited data suggesting marijuana can affect the babies growth and brain development, but the data is conflicting.

 

POSSIBLE RISKS: 
Growth Related Issues
  • Some evidence of decreased birth weight or small for gestational age (1-3)

  • Some evidence of preterm birth, complications during delivery, and the need for Neonatal Intensive Care Unit (NICU) care (2)

  • Some studies found that after adjusting for confounding variables, there was no association between marijuana use in pregnancy and adverse outcomes for the baby (4)

Brain Development 
  • Some limited evidence of increased rates of autism and intellectual disability in babies that were exposed to marijuana in utero (5)

  • Some evidence of a negative effect on brain development including (6-16):

- Attention

- Visuospacial function

- Hyperactivity

- Problem solving

The bottom line is that the impact of marijuana exposure in utero is not clear, so the guidelines continue to recommend avoidance of marijauna use during pregnancy and breastfeeding. 

 

WHAT TO LOOK FOR:
  • Signs that your baby is not growing adequately 

  • Signs of autism or intellectual disability 

 

WHAT TO DO: 
  • Talk to your pediatrician about any concerns you have about your child’s development.

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