Alcohol and Drugs of Abuse in Pregnant Women: Effects on the Fetus and Newborn, Mode of Action, and Maternal Treatment.

Offspring of mothers using ethanol, heroin, cocaine, or cannabis during pregnancy are known to suffer from developmental delay and/or a variety of behavioral changes. It is yet unknown how many of these changes result from intrauterine exposure, genetic causes, or postnatal environmental deprivation. Hence, the therapeutic approach toward children and their mothers may be influenced by each one of these factors. In this chapter, we discuss separately the effects of each of these substances on the developing embryo and fetus, the mechanism of action, and the modes of treatment to mothers and children. Ethanol, the most teratogenic agent of this group of substances, may affect the developing fetus in a dose-dependent manner. With very high repetitive doses, there is a 6-10% chance of the fetus developing fetal alcohol syndrome manifested by prenatal and postnatal growth deficiency, specific craniofacial dysmorphic features, mental retardation, behavioral changes, and a variety of major anomalies. With lower repetitive doses, there is a risk of ˵alcoholic effects″ mainly manifested by mild intellectual impairment, growth disturbances, and behavioral changes. By ingesting high doses of ethanol (binge drinking) several times during pregnancy, there seems to be some danger of mild intellectual deficiency. Maternal continuous use of heroin and opiates (i.e., addiction) during pregnancy may cause stillbirths, prematurity, and fetal growth retardation. The children may suffer from mild intellectual impairment, learning and behavioral problems, and a high rate of inattention and/or hyperactivity. It does not seem to increase the rate of major congenital anomalies. Cocaine may affect the developing fetus in a way similar to heroin. It increases the rate of intrauterine death mainly as a result of placental abruption, intracerebral hemorrhage, prematurity, and growth retardation, but probably not of congenital anomalies. It also increases the rate of perinatal complications. Postnatally, it may impair intellectual abilities and increase the rate of behavioral problems including attention deficit hyperactivity disorder. Cannabis use during pregnancy may cause decreased birth weight and gestational age at birth, but apparently only few postnatal sequelae. Lactation is contraindicated if the mother uses any of these substances. The long-term intellectual outcome of children born to drug-dependent mothers is influenced to a large extent by the environment in which the exposed child is raised. It is advised to offer maternal abstinence programs prior to pregnancy, but they may also be initiated during pregnancy with accompanying close medical care. [ABSTRACT FROM AUTHOR]