Addiction and Arrested Prenatal Growth
he use of recreational drugs leading to drug addiction is a serious medical and social issue at present. Nicotine in cigarette as a harmful drug was the first to receive attention followed by alcohol. Then came other recreational drugs like marijuana, opiates, cocaine and methamphetamine. The government today ensures that a cigarette pack or a bottle of alcohol comes with a warning, but there is no specific warning about the harm it can cause an unborn baby when taken by a pregnant mother.
One must be aware that almost all commonly used recreational drugs can cross the placenta and reach the foetal circulation thereby directly affecting it. Additionally, when these drugs get into the blood stream it constricts the blood vessels in the placental circulation, reducing blood flow to the foetus causing abnormalities and growth restriction.
Today, alcohol is the most commonly abused drug. According to a CDC report, about 44 per cent women are chronic alcohol consumers. The risk of miscarriage doubles when alcohol is consumed during pregnancy. Neurobehavioral effects of foetal alcohol exposure are well described. Foetal alcohol syndrome is the most described and serious consequence of maternal alcohol consumption and is a preventable problem. In this syndrome the baby has reduced growth before or after birth, facial defects, a small head and mental retardation with abnormal behavioural development.
Mothers taking alcohol during their pregnancy have high incidence of preterm birth, babies with low APGAR scores needing enhanced neonatal ICU care. Nicotine is the second most abused substance especially ¡n the form of cigarettes and maternal smoking is one of the important preventable causes of prenatal morbidity and mortality. Both human epidemiological and clinical research indicates that exposure to tobacco smoke to the foetus in the utero is harmful.
Uterine and placental blood supply is compromised and this can cause spontaneous abortion and low birth weight. Sudden infant death syndrome and behavioural issues in the child are also seen as an effect of smoking during pregnancy. Birth defects of heart, brain and face like cleft lip and palate are also more common among babies of mothers who smoke. At birth these neonates appear drowsy and as they grow they have attention deficit disorders and learning disabilities. For these reasons besides her own health, women should be informed about the risk of smoking on the foetus and advised to quit smoking during pregnancy.
Marijuana is the most widely abused illicit substance. Quite popular in adolescents, it is estimated that 50 per cent of teenagers have used marijuana at some point in their life and approximately 9 -10 per cent are addicted. Pregnant mothers who consume marijuana or synthetic cannabinoids have various problems like abnormal embryo development and implantation failure, tubal pregnancy, abnormal placentation causing spontaneous abortion and preterm birth.
The use of morphine (opioid) by pregnant women has an impact on the neurodevelopment of the offspring. These mothers have a preterm birth with poor growth of the newborn and increased length of hospital stay for the baby in the hospital and after delivery.
(MDMA) or 3, 4-methylenedioxymethamphetamine (MDMA) popularly known as ecstasy is also a common illicit recreational drug taken by young adults. Although there is not much research available on humans, clinical trials in animals show that prenatal exposure to this drug can cause tremors in neonates and these children can have long term learning disabilities.
The knowledge of the effects of maternal use of synthetic cannabinoids during human pregnancy is limited. By extrapolating from some studies done on mice we have found that it can affect multiple sites and stages of pregnancy. Beginning with pre-implantation, embryo development, embryo transport in the fallopian tube, implantation, placentation and even parturition thus severely corn promising the pregnancy outcome.
When mothers take illegal recreational drugs, apart from the direct harm there can also be indirect harm to the foetus like poor nutrition, exposure to violence and mental ill-health. Dealing with this social issue is important and can be done by creating awareness in adolescent girls and young mothers. The harm done to the future generation is immense when pregnant mothers consume these drugs and it should be stopped with education and awareness.