Counseling Women About Childbearing and Childrearing Risks

Although prenatal drug exposure is associated with a variety of effects on the fetus and the developing child, there are a number of similarities in the consequences resulting from maternal use of the different drugs discussed in this booklet. Here are some generalizations that can, be made about the childbearing risks involved and other findings from research in this area: When a mother uses drugs, her unborn or nursing infant is also affected. During gestation, almost all drugs cross the placenta and enter the bloodstream of a developing baby. A breastfeeding mother's milk also contains the drugs she takes. Drug use during the early weeks of pregnancy, from the fourth to the eighth weeks following conception, is more likely to cause spontaneous abortions or noticeable physical abnormalities in the newborn than use later in the pregnancy. Many women do not even realize they are pregnant during this very important period when the major skeletal and organ systems are forming and are most vulnerable to toxic effects from drug exposure. After the eighth week of pregnancy, maternal drug use is more frequently associated with growth retardation, prematurity, and neurological damage to the infant. Drug use near the time of delivery may precipitate labor and can be hazardous. Both prematurity and low birth-weight are related to very serious problems in young infants, including increased rates of respiratory illness, sudden infant death syndrome, infections, and developmental delays. Sometimes a mother's physical health requires medications that pose some risk for her unborn baby. Then, physician-patient agreement is needed on the most sensible course of treatment, balancing the mother's need against potential harm to her fetus. Medically supervised maintenance on methadone for heroin-using mothers is an example of this type of decision-making, as is the choice of an appropriate anticonvulsant for a pregnant woman with epilepsy. Women who smoke cigarettes, drink alcoholic beverages, or use illicit drugs during pregnancy increase their risks for obstetrical complications and for premature labor and delivery. They are also more likely than abstaining mothers to suffer fetal losses through spontaneous abortions, miscarriages, and stillbirths. * Prenatally drug-exposed infants are also at risk for a variety of adverse consequences, including death before their first birthdays. In utero drug exposure is additionally associated with an increased rate among newborns of (1) low birth-weight, with small-for-gestational-age length and head size, (2) central nervous system damage that may delay or impair neurobehavioral development, (3) mild to severe withdrawal effects, and (4) certain congenital physical malformations (e.g., cleft palate, heart murmurs, eye defects, and abnormalities of facial features and other organ systems). Risks are related to the amount of the drug taken by the mother and the stage of pregnancy when embryonic or fetal exposure occurs. The heavier and more persistent the mother's drug use, the more likely there will be adverse consequences. The sooner a woman stops using drugs during pregnancy, the greater her chances for having a healthy baby. Even cutting down on tobacco, alcohol, and other drug use while pregnant can reduce the risks to the unborn. * The surest way to avoid harming the baby is to stop taking all unnecessary drugs, preferably before pregnancy begins. Chronic drug abuse can also interfere with a woman's fertility, causing menstrual cessation or irregularities, ovulation problems, and changes in sexual functioning. Not all babies show negative effects from prenatal exposure to drugs. A variety of genetic factors in the unborn baby and maternal characteristics, as well as differences in the chemical structure of drugs and their use patterns, interact to influence the vulnerability of the unborn baby. No one can say for certain which baby will be all right and which will have abnormalities. Drug-related effects may be worse if the mother has a poor diet, little exercise, medical illnesses, inadequate prenatal care, or other complications of pregnancy. The majority of pregnant women can and do stop using alcohol and other drugs—or cut back considerably—once they realize the dangers. Chemically dependent women, however, are not so likely to change their addictive drug use patterns without help. For them, giving up drugs, whether cigarettes, alcohol, or other psychoactive drugs, is more easily said than done. These expectant mothers often need professional treatment and certainly need a comprehensive and reliable support system to help them abstain and remain drug free. Because of legal and social interests in protecting babies, a pregnant woman who continues to take drugs against medical advice risks losing custody of her baby after it is born. In some States, she also risks criminal prosecution. Although maternal consumption of specific drugs can produce particular effects in the developing fetus and growing child, the negative consequences of alcohol, cigarette, and illicit drug use in pregnancy often seem more alike than different. This is partly because many women use more than one drug while pregnant, making it difficult to separate confounding and interactive effects of multiple drug use in the research findings. Women who drink are also very likely to smoke. Many others use, but do not reliably report, illicit drugs, prescription medications, and over-the-counter remedies while pregnant. Newborns with drug-related impairments are often difficult to handle. To avoid maternal-infant bonding problems and feelings of failure or rejection in the mother, expert guidance and dependable support services are needed after the babies are born, sometimes for months. In many cases, drug-associated deficits only become apparent as a child matures. Mental retardation, lowered intelligence, hyperactivity, shortened attention spans, learning and organizational disorders, impaired physical coordination, continuing growth delays in height, weight, and head size, and social-interpersonal adjustment problems are found with greater regularity among prenatally drug-exposed youngsters than in similar children whose mothers did not use drugs during pregnancy. In the long run, a baby's caretakers and learning environment are as important as the mother's prenatal drug use for healthy growth and development. A stimulating and supportive family life is vital for overcoming or ameliorating damage to the child from drug exposure in the uterus. Many mothers—and fathers—from impoverished backgrounds need help with parenting skills, as well as with other psychosocial and economic problems. Ultimately, the best hope for any child is a healthy and nurturing family.