Effect of Maternal Substance Abuse on the Fetus, Neonate, and Child

Abstract

1. Nicole A. Bailey, MD*,† 2. Magaly Diaz-Barbosa, MD*,† 1. *Division of Neonatology, Kidz Medical Services, Coral Gables, FL 2. †Division of Neonatology, Nicklaus Children’s Hospital/Florida International University School of Medicine, Miami, FL * Abbreviations: AAP: : American Academy of Pediatrics ACOG: : American College of Obstetricians and Gynecologists ADHD: : attention-deficit/hyperactivity disorder AMPH: : amphetamine CNS: : central nervous system FAS: : fetal alcohol syndrome LBW: : low birthweight MDMA: : 3,4-methylenedioxymethamphetamine METH: : methamphetamine NAS: : neonatal abstinence syndrome NIDA: : National Institute on Drug Abuse PCP: : phencyclidine SSRI: : selective serotonin reuptake inhibitor Clinicians should be able to describe the short- and long-term effects on the newborn of exposure to substance abuse in utero. After completing this article, readers should be able to: 1. Describe the placental transfer of drugs and their effect on embryogenesis. 2. Identify the methods to screen for drugs in the mother and neonate. 3. Understand the short- and long-term adverse effects of legal and illicit maternal substance abuse in the newborn. 4. Identify therapies for the drug-exposed neonate. 5. Describe American Academy of Pediatrics recommendations for breastfeeding mothers who abuse substances. The abuse of certain drugs or medications during pregnancy can have detrimental effects on the fetus and neonate. Previous research has shown that 5% of pregnant women use 1 or more addictive substances. (1)(2) Approximately 1 in 20 infants is exposed to illicit drugs. (3) Marijuana, cocaine, heroin, hallucinogens, and inhalants are examples of illicit drugs. (4) According to a 2010 survey conducted by the National Institute on Drug Abuse (NIDA), 16% of pregnant women aged 15 to 17 years, 7.4% of pregnant women aged 18 to 25 years, and 1.9% of pregnant women aged 26 to 44 years abuse illicit substances. (5) From 2002 through 2010, the rate of reported illicit drug use among pregnant women aged 15 to 44 years rose from 3% to 4.4%. (1)(5)(6) The maternal abuse of narcotics has also risen because of “more liberal use of prescription opiates in pregnant women to palliate acute and/or chronic pain.” (7) As a result, the incidence of infants born addicted to drugs has increased. (1) The rise in substance use disorders among pregnant …