In addition to alcohol, prenatal exposure to drugs and other substances can also harm fetal development.
Tobacco use during pregnancy has been linked to an increased risk of miscarriage, premature birth, low birth weight, and certain birth defects.
Although the number of scientific studies examining prenatal exposure to marijuana is limited, there is evidence of growth deficiency at birth and of impaired impulse control, visual memory, and attention in adolescents exposed to marijuana before birth.
The use of recreational opioids such as heroin and prescription opioid painkillers increases the risk of stillbirth and preterm labor, and can cause Neonatal Abstinence Syndrome (NAS). NAS occurs when a newborn has been prenatally exposed to opioids and goes through withdrawal from the drug(s) at birth.
The use of cocaine, methamphetamine, and other illicit substances of abuse are also associated with adverse birth outcomes and birth defects.
Due to several factors, it can be difficult to predict the risk of a specific substance to the unborn child and to determine the long-term consequences. These factors include the lack of research regarding the risks associated with individual and various combinations of substances, the status of maternal nutrition and quality of care prior to and after birth, parenting decisions and resources, and the status of parental substance use.
Addiction is a brain condition or disorder that influences a person’s use of substances, even if they are harmful and lead to adverse consequences for the user. Addiction affects the user’s ability to stop taking a substance or substances. If you or your partner is having difficulty abstaining from addictive substances during pregnancy or at any time, visit the Behavioral Health Treatment Services Locator, a confidential and anonymous source of information for persons seeking treatment facilities in the United States for addiction to alcohol and drugs and/or mental health problems.
Science has long established that smoking makes it harder for a woman to get pregnant, increases miscarriage (the spontaneous loss of a woman’s pregnancy before the 20th week), and placental insufficiency, problems with the flow of oxygen and nutrients from the mother to the developing baby.
Smoking during pregnancy can cause a baby to be born too early or to have low birth weight, a cleft lip or cleft palate. Smoking during and after pregnancy is a risk factor for Sudden Infant Death Syndrome (SIDS). SIDS is an infant death for which a cause of the death is not known.
Holbrook, B. Tobacco: The Effects of Nicotine on Human Fetal Development. Birth Defects Research Part A: Clinical and Molecular Teratology vol. 108 pgs 181-192. June 2016 Source
Hoyt, A et al. Associations Between Maternal Periconceptional Exposure to Secondhand Tobacco Smoke and Major Birth Defects. American Journal of Obstetrics and Gynecology. June 2015 Source
The growing legalization of medical and recreational marijuana has triggered an increase in research into the potential risks of prenatal marijuana use to the embryo or fetus. Since a large proportion of marijuana users also smoke tobacco and use other substances, studies are underway to identify the specific effects associated with prenatal marijuana exposure.
A January 2017 article in the Journal of the American Medical Association suggests that there is cause for concern. “A recent review and meta-analysis found that infants of women who used marijuana during pregnancy were more likely to be anemic, have lower birth weight, and require placement in neonatal intensive care than infants of mothers who did not use marijuana. Studies have also shown links between prenatal marijuana exposure and impaired higher-order executive functions such as impulse control, visual memory, and attention during the school years.”
Volkow, N. The Risks of Marijuana Use During Pregnancy. Journal of the American Medical Association. January 2017.
Prescription opioids are medicine prescribed by a health care provider to relieve pain after an injury or surgery. Opioids include codeine, fentanyl, morphine and oxycodone. If you take opioids during pregnancy, they can cause problems for your baby, such as premature birth and drug withdrawal called Neonatal Abstinence Syndrome (NAS). Even if you use an opioid exactly as your health care provider prescribed, it still may cause NAS in your baby. Don’t stop taking an opioid without talking to your health care provider first. Quitting suddenly could increase the risk of preterm labor.
Heroin is a highly addictive illegal street drug often mixed with other potentially harmful substances. In addition to the enormous risks to the user, heroin can cause NAS in newborns. Like prescription opioids, heroin has also been linked to premature birth, stillbirth (fetal death at or 20 to 28 weeks of pregnancy) and birth defects including heart defects.
NAS is a group of problems that occur in a newborn who was exposed to addictive opioid drugs while in the mother’s womb such as heroin, codeine, oxycodone, methadone or buprenorphine. These and other opioids pass through the placenta that connects the baby to its mother. The baby becomes dependent on the drug along with the mother. If the mother continues to use the drugs before delivery, the baby will be dependent on the drug at birth. Because the baby is no longer getting the drug after birth, withdrawal symptoms may occur as the drug is slowly cleared from the baby’s system.
The symptoms of NAS depend on the type of drug the mother used and how much and how often, genetic factors that determine how her body breaks down and clears the drug, and whether the baby was born full-term or early. Symptoms often begin within a day after birth but could take up to a week to appear, and may include, blotchy skin (mottling), diarrhea, excessive crying and sucking, fever, hyperactive reflexes, poor feeding, rapid breathing, seizures, and sleep problems.
Opioids are the most commonly abused prescription drugs in this U.S. Some people who take a prescription opioid will become addicted. Or, they can become addicted and have other serious health problems if they use prescription opioids differently than their health care provider prescribes. When a person becomes addicted to prescription opioids, they may seek to obtain them illegally or start using other opioids such as heroin.
McQueen, K et al. Neonatal Abstinence Syndrome. New England Journal of Medicine. December 2016 Source
Although not nearly as prevalent as the science on alcohol and tobacco exposure, currently there is more research on the effects of cocaine and pregnancy than prenatal exposure to marijuana, opioids, and methamphetamine. Initial studies regarding prenatal cocaine exposure suggested profound adverse effects on child development. However, subsequent long-term studies have found more subtle effects.
Babies born to mothers who use cocaine during pregnancy are often premature, have low birth weights and smaller head circumferences, and are shorter in length than babies born to mothers who do not use cocaine. Reports of reduced intelligence and social skills in babies born to mothers who used crack cocaine while pregnant during the 1980s—so-called “crack babies”—were exaggerated. Scientists are now finding that exposure to cocaine during fetal development may lead to behavior problems (e.g., difficulties with self-regulation) and deficits in some aspects of cognitive performance, information processing, and sustained attention to tasks. Some deficits persist into the later years, with prenatally exposed adolescents showing increased risk for subtle problems with language and memory.
Keller, R et al. Prenatal Cocaine Exposure. Annals of the New York Academy of Sciences. January 2000 Source
Knowledge of the effects of prenatal methamphetamine exposure is limited because studies have used small samples and have not been able to account for the possibility that mothers used other drugs besides methamphetamine. The available research points to increased rates of premature delivery, placental abruption (separation of the placental lining from the uterus), and effects on newborns such as growth deficiency and heart and brain abnormalities. A large ongoing study funded by the National Institute on Drug Abuse, a component of the U.S. Institutes of Health, is examining developmental outcomes in children born to mothers who abused methamphetamine. Thus far, researchers have found neurobehavioral problems such as increased stress and subtle but significant attention impairments in these children.
Kiblawi, Z et al. Prenatal Methamphetamine Exposure and Neonatal and Infant Neurobehavioral Outcome: Results from the IDEAL Study. LABiomed Institute at Harbor-UCLA Medical Center and David Geffen School of Medicine. 2014 Source