American Public University

Substance Abuse and the Innocent Fetus

CHDD 307 Instructor Susan Shepard
shawna callan

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Drug abuse in pregnant woman has become a growing issue across the United States of America. The effects of legal and illegal substances to a fetus or unborn child can and does affect a fetus or unborn child from the time they are in the womb until their death. Woman that Have been reported to use illegal substances while they are pregnant, have been studied and surveyed. In 2008 through 2009 the National survey On Drug Use reported that woman who ranged from fifteen through forty four years of age were the woman who used illegal substances the most (Samhda studies NSDU, 2009).The effects of this substance abuse amongst pregnant mothers has been suggested to have a wide range of very serious short and long term heath issues and developmental complications, an unborn child or fetus. The National Survey On Drug Use in pregnant woman have also found that some of these health issues or complications can be overcome if the child born from a mother of substance abuse is placed in a healthy environment with parents who provide a nutritionally balanced home, as well as a positive socioeconomically balanced home. it is further suggested by the National Survey On drug Use that children born of a mother who abused drugs can overcome the effects of substance abuse if the proper medical and physiological treatment is provided.

In this paper the issues and complications of substance abuse on the fetus and children born of mothers who abused drugs while pregnant. The effects of nicotine, alcohol, medications, cocaine, heroin and LCD or PCP will be discussed. In addition to providing the side effects and complications of these drugs the paper will uncover the various treatments and programs that are available to help not only the fetus or unborn child but the children born addicted to substance abuse. It is suggested that mothers who are pregnant and have a substance abuse problem can be treated as well. Programs and treatment programs will be suggested for mothers as well.

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Nicotine use while pregnant has been known to have very diverse effects on an unborn child or fetus. The nicotine and carbon monoxide that is produced from tobacco can and does affect how much oxygen supply the fetus or unborn child receives while in the womb. Nicotine has been reported to cross over into the placenta, and because of this cross over into the placenta the amongt of tobacco use of the mother greatly controls how much exposer of nicotine and carbon monoxide enters the womb. The amount of carbon monoxide and nicotine or elevated exposure levels can increase the negative effects on the fetus or unborn child (The science of addiction unkown, 2010).

Nicotine concentrates in the blood system as well as the amniotic sac. Nicotine also concentrates in the breast milk of the mother, which can cause the fetus or unborn child to directly be in harms way of the negative and toxic effects of nicotine and carbon monoxide.

The toxic effects of nicotine while pregnant have been known to include still births, infant or fetal mortality, as well as sudden infant death syndrome. Preterm birth, low birth rates, respitory issues or complications, and possibly delayed development in infants and children can occur. Low birth weight is known the most common nicotine related side effect for infants born to mothers who used tobacco while pregnant. The severity of the low birth rate is directly related to how much nicotine the mother used while pregnant. Some studies have suggested that smoking during pregnancy can and has caused certain behavioral issues in infants and children through their childhood, as well as an increased risk that children will at some point in their life also abuse tobacco.

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The mother may only smoke a half a pack a day but is subjecting her unborn child or fetus to second hand smoke. Second hand smoke has been suggested to be just as serious if not more serious than smoking alone. Reports on second hand smoke have also shown a fetus or child to be born with low birth weights, and possible preterm labor. Sudden infant death syndrome and repository issues such as Asthma or bronchitis have also been reported to be directly related to second hand smoke espouser. In some cases reports of frequent ear infections and cavities are also related to nicotine and second hand exposure to nicotine or carbon monoxide.

Alcohol is known to be used by pregnant woman more than any other drug. The damage alcohol can and does cause to a fetus or unborn child has been an area of study for a long time, and continues to be studied. The national Institute On Alcohol Abuse suggest that fetus exposed to alcohol have damaging effects that vary, but all fetus of mothers who abuse alcohol daily will have some side effects((The science of addiction unknown, 2010).

The National Institute on Alcohol Abuse also states that no amount of alcohol is a safe amount for pregnant woman to consume ((The science of addiction unknown, 2010).

Data has also been compiled from research and various surveys conducted and obtained from prenatal clinics across the United States , that suggest twenty to thirty percent of woman have drank at least in moderation while they were pregnant.

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Alcohol is known to cause serious fetal development issues and delays in all stages of pregnancy. The most common stage for fetal development issues or complications is known to take place in before most women even are aware they are carrying a fetus or child.

Binge drinking is a serious cause of what is known as fetal alcohol syndrome. Binge drinking is when people have more than four alcoholic beverages in a sitting or session, or heavily drinking on a daily basis. Heavy drinking or consumption of alcohol while pregnant is the most common risk for fetal development and does cause the most serious fetal development risks and complications.

Fetal alcohol syndrome or FASD is a disorder caused by the women who consume alcohol heavily throughout their pregnancy. The fetus is severely affected and brain damage is caused. The brain damage causes a wide variety of developmental issues and complications. Cognitive and behavioral problems have been known to occur to children born with fetal alcohol syndrome at some point in their childhood. Children born with fetal alcohol syndrome have been known to have side effects such as poor hand and eyed coordination (Gordis MD, 2001) ,emotional control issues, a lack of attention that cause poor school work or learning, socialization problems , as well as reports child and adult behavioral problems such as blending in with society and abiding by laws. It has also been reported that the socialization problems make keeping a job and maintain a healthy lifestyle hard to accomplish. Children born with fetal alcohol syndrome or even partial fetal alcohol syndrome are reported to have emotional control issues and are known to make bad judgment calls , getting involved with the wrong crowd and feeling they will suffer no consequence for their actions. Some reports of children born with fetal

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alcohol syndrome have shown that mothers who drink throughout their pregnancy and give birth to children with fetal alcohol syndrome also place their child at risk for poor health issues and complications, as well as poor nutrition exposing their child to stress and even poor living environments (Gordis MD, 2001)

Cocaine and other illegal drugs used during pregnancy have also been known to cause a great deal of damage to the fetus. The effects on the fetus range from what type of illegal drug is abused to how often an illegal or legal drug is abused by a pregnant mother. The damage to the fetus can be light to sever depending on once again how often and what type of drug is being abused by the expectant mother. Low birth weights are once again a common side effect as well as developmental issues or complications such as behavioral problems from birth through childhood even expanding into adulthood. Cognition is also reported to be an issue for cocaine related births. Mothers who use cocaine and marijuana while pregnant have had children who show late signs of low attention spans, delayed language development issues, and delayed learning issues. Some studies conducted on fetal exposure to cocaine have shown that fetal brain development is severely disrupted. Research has proved that cocaine crossed over into the placenta and when this happens cocaine enters the fetus circulation The process in which cocaine leaves the fetuss system is slower than the amount of time it takes to leave the mothers system (Parker and Gauvain, 2009). The Organization of Teratology Information Server of the (OTIS), states that in the first trimester of a womans pregnancy cocaine can increase the chance of miscarriage (Miller RK, Carey JC. 2005, OTIS).

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The OTIS also reported from their research that as the fetus grows and a woman enters her second and third trimester, cocaine can cause Placental Abruption (Miller RK, Carey JC. 2005, OTIS) Witch can make a woman begin to bleed and cause a woman to go into preterm labor and ultimately cause a woman to go into preterm labor. In some sever cases the death of the fetus or child can occur. The OTIS also stated that the more a woman uses cocaine the more the side effects of cocaine will affect the fetus or unborn child (Miller RK, Carey JC. 2005, OTIS). The OTIS states that babies that are subjected to cocaine later in the pregnancy such as the third trimester are at a great risk of becoming addicted to cocaine when born (Miller RK, Carey JC. 2005,OTIS). Cocaine addicted babies do go through withdrawals at the time of birth. Withdrawal symptoms vary from uncontrollable tremors, muscle spasm, sleep deprivation, and eating disorders. It has also been suggested and is currently being studied that children born addicted to cocaine will suffer from learning difficulties as well as deformed genitals, deformed kidneys, and brain disorders.

Fetus exposed to drugs such as Methamphetamines have had some very severe side effects as well. Side effects from methamphetamines include damage to the growth of the fetal process, and physical development issues in infants such as restricted movement. Methamphetamine use in pregnant woman mimics the use of cocaine addicted mothers and fetus, increasing the chance of once again low birth rate weights, miscarriage, sudden infant death syndrome.

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Heroin addicted mothers are a common issue that is ever growing in The United States Of America in todays society. Heroin is said to be extremely addictive for both mother and baby. Mothers who use heroin while pregnant are subjecting their fetus and or unborn child to being born highly addicted to heroin. Heroin crosses over into the placenta and causes an increase in the chance that a mother will self abort the fetus or unborn child An increase in pre term labor is present as well as low birth weights; respiratory issues, low blood sugar levels or counts, sudden infant death syndrome, and a bleeding brain are also some severe common side effects of babies born addicted to heroin. If a child is born addicted to heroin than that child will experience withdrawal and withdrawal symptoms. Withdrawal symptoms can and will include convolutions, diarrhea, fever, sleep deprivation or disorders, joint pain and discomfort, and colic or irritability in the infant ((The science of addiction unknown, 2010).

In some case death can occurs if a child is not monitored and the addiction is severe enough.

PCP and LCD are hallucinating drugs and if a mother uses these drugs while pregnant they are subjecting the fetus or unborn child to be born with once again low birth weights, severe brain damage, and muscle spasm.

APPLICATION

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We are aware of the damaging effects that legal and illegal drugs pose to a fetus or unborn child, for that matter to a child through their lives. Now we must focus on what treatment programs and medications are available to pregnant woman and children born with substance abuse problems.

Research has been conducted that suggests that there is help in some medications for mothers with substance abuse problems. Methadone is a common medication used commonly amongst opiate addicted people. Methadone has been researched and is said to be safe for a pregnant woman to use while pregnant. Methadone treatment can be combined and is supposed to be combined with a drug treatment program as well as therapy sessions on how to recover from drug addiction and remain drug free. Methadone has proved helpful to improve the side effects of the neonatal damage inflicted on a fetus or unborn child. Infants born to a mother who is prescribed methadone usually do have some withdrawals but they pale in comparison to the withdrawal symptoms associated with opiate or heroin usage. Infants who are born with methadone withdrawals have to be treated for the methadone withdrawals, but there is no long term damage associated with methadone withdrawals like there is with heroin withdrawals.

Buprenorphine is another opiate and heroin treatment medication that has been studied and used on pregnant woman. Buprenorphine has shown to cause even less side effects in pregnant woman as well as much less impact to the fetus or unborn child. The infants who have been treated with Buprenorphine have typically had to spend less time in the hospital after birth.

Behavioral treatment programs are available as well for any and all types of addictions. Behavioral programs that have been researched by the NIDA on the non pregnant population

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have proved to be successful in pregnant woman as well. Contingency management is a behavioral program where people are given a reason to stay clean and sober by way of rewards and in some cases and programs money is the reward. Standard treatment programs use more of a motivation tactic to their program, such as remaining drug free for themselves and their family. The studies conducted by the NIDA have suggested that traditional treatment programs do work and woman do abstain from drug use, especially from drugs such as cocaine and opiate addictions even nicotine addiction (Gordis MD, 2001). As with any person who is in a treatment program for drug or alcohol addiction pregnant woman must be closely watched and monitored by medical professionals. The monitoring by a medical professional is necessary to ensure both mother and fetus or baby is safe and that the treatment program is adjusted according to their individual needs.

Research shows that expectant mothers who have physiological disorders such as OCD, anxiety disorders, or mental health issues are at an even greater risk to be substance abusers In woman who have both a physiological disorders and are substance abusers require a more intense treatment program to help keep the mother and the fetus or unborn child safe from the effects of substance abuse.

Alcohol addicted mothers and fetus have treatment programs as well ranging from the twelve step program to medications. Woman who are pregnant are most likely in need of an inpatient treatment program or detox program, due to the sever withdrawal symptoms attached with detoxing from alcohol abuse. Withdrawal symptoms in pregnant woman can be as serious as seizures, and psychiatric instances.

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Most treatment programs for woman with who are pregnant are combined with medications such as Barbiturates, and Benzodiazepeims. Librium and other forms of Benzodiazepemis are limited because of the potential side effects to the fetus or unborn child. Infants who are delivered with fetal alcohol syndrome needs to be closely monitored upon delivery by a heath professional. Health professionals should be watching for signs and symptoms of delirium, irritability, tremors, fever, and sweating. Heath professionals should also monitor an infants and mothers heart rate and perform a stress test on the infant to ensure that the child is not in distress. It is suggested that mothers who are treated for alcohol abuse while pregnant continue to attend a treatment program after giving birth. Therapy and counseling are suggested and the twelve step program should be ongoing.

In conclusion all legal and illegal drugs can have adverse effects on a mother and a fetus or unborn child. Counseling and parental involvement is necessary to help ensure that we raise children who are free from emotional restraints that lead them to drug use and abuse. It is also important to be active as parents and have an open line of communication to ensure that the signs and symptoms of drug and alcohol use are identified in the early stages so we can save our children. All drugs and alcohol in all consumption amounts are detrimental to both mother and child, and there is a wide and diverse amount of treatment programs and medications to help become and remain drug free.

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References: Drugs, Brains, and Behavior: The Science of Addiction 2010 http://www.drugabuse.gov/publications/science-addiction

Organization of Teratology Information Services, (2009) http://otispregnancy.org/

National Survey on Drug Use and Health, 2009 www.icpsr.umich.edu/icpsrweb/SAMHDA/studies/29621

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service * National Institutes of Health Prepared: April 2001 Fetal Exposure and the Brain-A Commentary by NIAAA Director Enoch Gordis, M.D. Parke, R. D. & Gauvain, M. (2009). Child psychology: A contemporary viewpoint (7th ed.). Boston: McGraw-Hill.

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Robertson J, Polifka JE, Avner M, Chambers C, Delevan G, Koren G, Lavigne SV, Martinez LP, Miller RK, Carey JC. 2005. A survey of pregnant women using isotretinoin. Birth Defects Res A Clin Mol Teratol, (OTIS)

Substance Abuse and Mental Health Administration. Results from the 2006 National Survey on Drug Use and Health: National Findings. Office of Applied Studies, NSDUH Series H-32, DHHS, Publication No. SMA 07-4293, Rockville, MD, 2007.

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