Cigarette smoking Smoking and Other Tobacco Use Tobacco use is a major individual and public health problem. Dependence develops rapidly. Major consequences include premature death and morbidity caused by cardiovascular disease, lung and... read more is the most common addiction among pregnant women. Carbon monoxide and nicotine in cigarettes cause hypoxia and vasoconstriction, increasing risk of the following:
Neonates whose mothers smoke are also more likely to have anencephaly, congenital heart defects, orofacial clefts, sudden infant death syndrome Sudden Unexpected Infant Death (SUID) and Sudden Infant Death Syndrome (SIDS) Sudden unexpected infant death (SUID) is a term used to describe any unexpected and sudden death in a child less than 1 year of age, which often occurs during sleep or in the infant's sleep... read more , deficiencies in physical growth and intelligence, and behavioral problems. Smoking cessation Smoking Cessation Most people who smoke want to quit and have tried doing so with limited success. Effective interventions include cessation counseling and pharmacologic treatment, such as varenicline, bupropion... read more or limitation reduces risks.
Exposure to secondhand smoke may similarly harm the fetus.
Alcohol Alcohol Toxicity and Withdrawal Alcohol (ethanol) is a central nervous system depressant. Large amounts consumed rapidly can cause respiratory depression, coma, and death. Large amounts chronically consumed damage the liver... read more is the most commonly used teratogen. Drinking alcohol during pregnancy increases risk of spontaneous abortion. Risk is probably related to amount of alcohol consumed, but no amount is known to be risk-free. Regular drinking decreases birth weight by about 1 to 1.3 kg. Binge drinking in particular, possibly as little as 45 mL of pure alcohol (equivalent to about 3 drinks) a day, can cause fetal alcohol syndrome Fetal Alcohol Syndrome Alcohol exposure in utero increases the risk of spontaneous abortion, decreases birth weight, and can cause fetal alcohol syndrome, a constellation of variable physical and cognitive abnormalities... read more . This syndrome occurs in 2.2/1000 live births; it includes fetal growth restriction, facial and cardiovascular defects, and neurologic dysfunction. It is a leading cause of intellectual disability Intellectual Disability Intellectual disability is characterized by significantly subaverage intellectual functioning (often expressed as an intelligence quotient < 70 to 75) combined with limitations of adaptive... read more and can cause neonatal death due to failure to thrive Failure to Thrive (FTT) in Children Failure to thrive in children is weight consistently below the 3rd to 5th percentile for age and sex, progressive decrease in weight to below the 3rd to 5th percentile, or a decrease in 2 major... read more .
Stimulants such as cocaine Cocaine Alcohol and illicit drugs are toxic to the placenta and developing fetus and can cause congenital syndromes and withdrawal symptoms. Prescription drugs also may have adverse effects on the fetus... read more or methamphetamine have indirect fetal risks (eg, maternal stroke or death during pregnancy). Their use probably also results in fetal vasoconstriction and hypoxia. Repeated use increases risk of the following:
Congenital malformations (eg, central nervous system, genitourinary, and skeletal malformations; isolated atresias)
Although the main metabolite of cannabis Marijuana (Cannabis) Marijuana is a euphoriant that can cause sedation or dysphoria in some users. Psychologic dependence can develop with chronic use, but very little physical dependence is clinically apparent... read more can cross the placenta, recreational use of marijuana use does not consistently appear to increase risk of congenital malformations or fetal growth restriction. Marijuana use during pregnancy has been linked to adverse pregnancy outcomes including small-for-gestational-age, preterm labor Preterm Labor Labor (contractions resulting in cervical change) that begins before 37 weeks gestation is considered preterm. Risk factors include prelabor rupture of membranes, uterine abnormalities, infection... read more , and infant neurodevelopmental and behavioral problems. A trend toward easier recreational access to and broader use of marijuana in several states may lead to an improved understanding of marijuana's effects over time.
Bath salts refers to a group of designer illicit drugs made from a variety of amphetamine-like substances; these drugs are being increasingly used during pregnancy. Although effects are poorly understood, fetal vasoconstriction and hypoxia are likely, and there is a risk of stillbirth, placental abruption, and possibly congenital malformations.
Hallucinogens may, depending on the drug, increase risk of the following:
Withdrawal syndrome in the fetus or neonate
Hallucinogens include methylenedioxymethamphetamine (MDMA, or Ecstasy), rohypnol, ketamine, methamphetamine, and LSD (lysergic acid diethylamide).
Opioids Opioid Toxicity and Withdrawal Opioids are euphoriants that cause sedation. Respiratory depression may occur with high doses and can be managed with antidotes (eg, naloxone) or endotracheal intubation and mechanical ventilation... read more (eg, heroin, methadone, morphine) readily cross the placenta and thus may result in opioid dependence Opioids Alcohol and illicit drugs are toxic to the placenta and developing fetus and can cause congenital syndromes and withdrawal symptoms. Prescription drugs also may have adverse effects on the fetus... read more in the fetus. The neonate may have withdrawal symptoms Opioids Alcohol and illicit drugs are toxic to the placenta and developing fetus and can cause congenital syndromes and withdrawal symptoms. Prescription drugs also may have adverse effects on the fetus... read more 6 hours to 8 days after birth. However, use of opioids rarely results in congenital malformations. Opioid partial agonist therapy, such as buprenorphine, may be associated with a lower risk for neonatal withdrawal versus methadone and is being increasingly used for patients with opioid dependence during pregnancy.
Use of opioids during pregnancy increases the risk of pregnancy complications, such as
Abnormal fetal presentation
Heroin increases the risk of having a small-for-gestational-age infant.
Whether consuming caffeine in large amounts can increase perinatal risk is unclear. Consuming caffeine in small amounts (eg, 1 cup of coffee/day) appears to pose little or no risk to the fetus, but some data, which did not account for tobacco or alcohol use, suggest that consuming large amounts (> 7 cups of coffee/day) increases risk of stillbirths, preterm deliveries, low birth weight, and spontaneous abortions. Decaffeinated beverages theoretically pose little risk to the fetus.
Use of aspartame (a dietary sugar substitute) during pregnancy is often questioned. The most common metabolite of aspartame, phenylalanine, is concentrated in the fetus by active placental transport; toxic levels may cause intellectual disability Intellectual Disability Intellectual disability is characterized by significantly subaverage intellectual functioning (often expressed as an intelligence quotient < 70 to 75) combined with limitations of adaptive... read more . However, when ingestion is within the usual range, fetal phenylalanine levels are far below toxic levels. Thus, moderate ingestion of aspartame (eg, no more than 1 liter of diet soda per day) during pregnancy appears to pose little risk of fetal toxicity. However, in pregnant women with phenylketonuria Phenylketonuria (PKU) Phenylketonuria is a disorder of amino acid metabolism that causes a clinical syndrome of intellectual disability with cognitive and behavioral abnormalities caused by elevated serum phenylalanine... read more , intake of phenylalanine and thus aspartame is prohibited.
Drugs Mentioned In This Article
|ARYMO ER, Astramorph PF, Avinza, DepoDur, Duramorph PF, Infumorph, Kadian, MITIGO, MORPHABOND, MS Contin, MSIR, Opium Tincture, Oramorph SR, RMS, Roxanol, Roxanol-T
|Belbuca, Brixadi, Buprenex, Butrans, Probuphine, Sublocade, Subutex