Pregnancy & Substance Use

"Research and clinical experience teach that when, as here, the personal risks of seeking medical care are raised to intolerably high levels, it is more likely that prenatal care and patient candor - and not drug use - will be what is deterred, often with tragic health consequences."

(2008) "Among pregnant women aged 15 to 44 years, 5.1 percent used illicit drugs in the past month based on data averaged for 2007 and 2008. This rate was significantly lower than the rate among women in this age group who were not pregnant (9.8 percent). Among pregnant women, the average rate of current illicit drug use in 2007-2008 (5.1 percent) did not change significantly from 2005-2006 (4.0 percent) and was similar to the rate observed in 2003-2004 (4.6 percent)."

(1996) "Many economic, psychosocial, behavioral, biological, and health services factors have been implicated in these adverse perinatal outcomes.^14,15 Among them are two that seem to be inextricably associated, namely low levels of PNC [inadequate prenatal care] utilization and exposure to IDU [illicit drug use] in pregnancy.^16–21 The overlap between these factors is evident in the population we studied, with a prevalence of 4.2% IDU in mothers with adequate PNC, 26.2% in women with inadequate PNC, and 55.2% in mothers with no PNC."

(cocaine - law) A case argued before the US Supreme Court (Ferguson, Crystal v. City of Charleston, et al.) involved the rights of mothers to seek medical care during pregnancy without fear of prosecution for a positive urine drug test. The Medill School of Journalism at Northwestern University reported that "because a live fetus was a "person" under South Carolina law, a woman who used cocaine after the 24th week of pregnancy could be found guilty of the crime of distributing an illegal substance to a person under the age of 18."

(drug testing and pregnancy) "Ferguson v. City of Charleston (2001) is an important case in the family law domain because MUSC’s policy of testing pregnant women for illegal drugs raises issues at the intersection of public health and constitutional law. The public-health aspects concern the very real and significant risks to maternal, fetal, and societal well-being of drug use during pregnancy; in addition, the policy raises constitutional questions about what constitutes a reasonable search and seizure and women’ s privacy right to reproductive autonomy. Ultimately, the case addresses how best to strike the sometimes competing interests between mothers and their unborn children.

"Although the policy was discontinued before the Supreme Court’s ruling and the Court held the policy to be unconstitutional, all the components of the decision—majority, concurring, and dissenting opinions—point to ways in which a similar policy could be designed so as to avoid the constitutional pitfalls encountered by the policy in Ferguson (2001). The petitioners won, but their victory is likely to be short lived. Recent developments in a number of states, combined with ongoing public concern about drug abuse, especially by pregnant women, suggest that despite Ferguson’s outcome, pregnant women should not feel too secure from state intervention when receiving prenatal care. Such interventions are likely to have significant consequences for pregnant women’s legal rights, as well as for their health, their fetuses’ health, and their behavior during pregnancy."

"Our study found significant cognitive deficits with cocaine-exposed children twice as likely to have significant delay throughout the first 2 years of life. The 13.7% rate of mental retardation is 4.89 times higher than that expected in the population at large, and the percentage of children with mild or greater delays requiring intenvetion was 38%, almost double the rate of the high-risk noncocaine- but polydrug-exposed comparison group. Because 2-year Mental Development Index scores are predictive of later cognitive outcomes, it is possible that these children will continue to have learning difficulties at school age.^37,38

"Cognitive delays could not be attributed to exposure to other drugs or to a large number of potentially confounding variables. Further, poorer cognitive outcomes were related to higher amounts of cocaine metabolites in infant meconium as well as to maternal self-reported measures of amount and frequency of cocaine use during pregnancy, providing further support for a teratologic model." . . .

"Some limitations to this study should be considered. Although examiners were masked to infant drug status, it may have been possible to identify drug exposure through maternal or caregiver characteristics, since all children were assessed with the caregiver present. The sample was also recruited according to hospital screening measures and reflects outcomes only of more heavily exposed infants. Also, the drug assessments were made retrospectively, making reliability of maternal report problematic."

"After controlling for confounding variables, prenatal cocaine exposure was not associated with lower full-scale, verbal, or performance IQ scores at age 4 years, but did predict significant deficits in specific cognitive skills underlying intellectual functioning and attenuated the incidence of IQ scores above the normative mean, even for children in better home environments. Further, higher concentrations of cocaine metabolites in infant meconium were significantly related to lower verbal IQ and arithmetic scores. Importantly, however, the quality of the caregiving environment appeared to have substantial compensatory effects on cocaine-exposed children placed in adoptive or foster care. Cocaineexposed children placed in adoptive care achieved performance similar to nonexposed children living in less stimulating, lower socioeconomic status home environments. Indeed, environmental intervention through foster or adoptive care was associated with a lower likelihood of mental retardation among cocaine-exposed children, despite heavier drug exposure."

"In utero exposures due to smoking during pregnancy may increase the risk of both diabetes and obesity through programming, resulting in lifelong metabolic dysregulation, possibly due to fetal malnutrition or toxicity. The odds ratios for obesity without type 2 diabetes are more modest than those for diabetes and the scope for confounding may be greater. Smoking during pregnancy may represent another important determinant of metabolic dysregulation and type 2 diabetes in offspring. Smoking during pregnancy should always be strongly discouraged."

"Consistent with previous studies, we found that maternal cigarette smoking was associated with reduced birth weight and an increased risk of LBW,^3-8 shortened gestation and an increased risk of preterm birth,^8,27-29 and intrauterine growth restriction.^3,9,10 Our data indicate that maternal cigarette smoking likely affects infant birth weight via both reduced fetal growth and shortened gestation. More importantly, our study shows consistent evidence that the adverse effects of maternal cigarette smoking on infant birth weight and gestational age were modified by maternal CYP1A1 and GSTT1 genotypes. Our data demonstrate that a subgroup of pregnant women with certain genotypes appeared to be particularly susceptible to the adverse effect of cigarette smoke, suggesting an interaction between metabolic genes and cigarette smoking."

"The popular preception is that any prenatal exposure to cocaine is almost certainly associated with devastating effects on the neonate. However, these data suggest that most potentially detrimental effects (including neonatal size,³⁸ neonatal behavior,^12,13 and central nervous system lesions⁴⁷) of prenatal cocaine exposure occur disproportionately among the heaviest users, a phenomenon also noted for alcohol and cigarette exposure.²³"

Research paid for by the National Institute on Drug Abuse (NIDA) and the Albert Einstein Medical Center in Philadelphia states, "Although numerous animal experiments and some human data show potent effects of cocaine on the central nervous system, we were unable to detect any difference in Performance, Verbal or Full Scale IQ scores between cocaine-exposed and control children at age 4 years."