Alcohol and illicit drugs are toxic to the developing fetus and can cause congenital syndromes and withdrawal symptoms. Most drugs of abuse easily cross the blood-placental barrier and can affect fetal brain development. Intrauterine drug exposure (IUDE) can have long-lasting implications for brain structure development and function. When drugs and/or alcohol have been identified in the baby’s stool/urine, the healthcare team will work alongside social workers and child protective services to evaluate the home situation and determine whether or not the infant will be safely cared for after discharge. If not, foster home care or an alternative care plan may be best. A fetus that has been exposed to drugs in utero can become dependent on the drug during gestation and will experience withdrawal following delivery. Refer to my post on Neonatal Abstinence Syndrome (NAS) for more information! Here is a list of the most commonly used substances and their effects on the fetus/infant:
Alcohol
Acute ingestion can cause hyperactivity and tremors for up to 72 hours followed by lethargy for 48 hours. Chronic ingestion can lead to Fetal Alcohol Syndrome (FAS). This can cause abnormalities in the central nervous system, reduced brain and birth weight, growth deficiencies, dysmorphic limb and facial features, cognitive delays and impairments, as well as cardiac and musculoskeletal anomalies.
Barbiturates
May cause neonatal drug withdrawal symptoms including jitteriness, irritability, and fussiness that often do not develop until 7 to 10 days postpartum.
Cocaine
Can cause placental abruption and spontaneous abortion. It is also associated with a higher incidence of prematurity, intrauterine death, or severe neurological damage if the infant survives. Neurological complications can include infarction, intraventricular hemorrhage, and cystic lesions. Neonates born to addicted mothers have low birth weight, reduced body length and head circumference, and lower Apgar scores. Cerebral infarcts may occur, in addition to other complications including genitourinary malformations, and gastrointestinal anomalies. In addition, short and/or long term neurobehavioral abnormalities have also been observed, including decreases in attention and alertness, lower IQ, and impaired gross and fine motor skills.
Heroin
Can cause low birth weight and fetal growth restriction in utero. Often associated with STIs and congenital syphilis/herpes.
Marijuana (THC)
Cannabis use can cause higher incidence of tremors and altered visual responses. It can also cause stunted growth and sleep disturbances.
Opioids
Illicit opiate use can cause fetal distress after delivery. A “honeymoon” period typically lasts from birth to about 72 hours of life. On the third day, however, withdrawal symptoms begin to manifest. Refer to my post Neonatal Abstinence Syndrome (NAS) for the characteristic signs of withdrawal.
Psychostimulants
These include amphetamine (“Speed''), methamphetamine (“Meth”), and MDMA (“Ecstasy”). Abuse can cause preterm birth, intrauterine growth restriction, fetal distress, placental abruption, cardiac anomalies, and abnormal neurobehavioral patterns. Prenatal exposure can cause long-term effects on neonatal brain structure and function, which leads to adverse neurotoxic effects on behavior, cognitive skills, and physical dexterity.