Substance Abuse During Pregnancy: The Littlest Victims By Jessica Gutierrez Summer 2014 Tech Apps in Health Sciences as taught by Dr. Morris

Substance Abuse Defined World Health Organization: the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs Merriam-Webster: excessive use of a drug (such as alcohol, narcotics or cocaine) MedicineNet: the excessive use of a substance, especially alcohol or drug

The true victims of drug addicted mothers are the infants.

Health begins in the womb Prenatal nutrition is essential to the neonate. The placental provides nourishment to the baby while in the womb. Drugs taken by a pregnant woman reach the fetus primarily by crossing the placenta, the same route taken by oxygen and nutrients, which are needed for the fetus's growth and development. Drugs that a pregnant woman takes during pregnancy can affect the fetus in several ways: They can act directly on the fetus, causing damage, abnormal development (leading to birth defects), or death. They can alter the function of the placenta, usually by causing blood vessels to narrow (constrict) and thus reducing the supply of oxygen and nutrients to the fetus from the mother. Sometimes the result is a baby that is underweight and underdeveloped. They can cause the muscles of the uterus to contract forcefully, indirectly injuring the fetus by reducing its blood supply or triggering preterm labor and delivery. They can also affect the fetus indirectly. For example, drugs that lower the mother's blood pressure may reduce blood flow to the placenta and thus reduce the supply of oxygen and nutrients to the fetus. Merck, 2015

Drug abuse during pregnancy is a very real problem The latest statistics state that as much as 5% of pregnant women abuse drugs and/or alcohol during their pregnancy. The number of babies born to drug-addicted mothers has more than doubled in the last decade.

Prescription drugs are a big part of the problem Taking prescription drugs improperly or to excess is no safer than taking illegal street drugs such as heroin or cocaine.

Life After Birth: •Babies born addicted to drugs (including prescription drugs) have a constant, high-pitched cry, experience light and sound sensitivity, and suffer from a low threshold for agitation. •Other symptoms include rashes, vomiting, and diarrhea. •These same babies are prone to experiencing seizures. •Addicted newborns can require elongated hospital stays can be weeks or even months longer than babies not suffering from addiction.

Dependency in the newborn Regular drug use can produce dependence in the newborn, and the baby may go through withdrawal upon birth. Most research in this area has focused on the effects of opioid misuse which includes prescription pain relievers or heroin. Updated data has shown that use of alcohol, barbiturates, benzodiazepines, and caffeine during pregnancy may also cause the infant to show withdrawal symptoms at birth (Hudak et al., 2012). T

Neonatal Abstinence Syndrome Infants born to substance abusing mothers, whether prescription or illegal drug, are at risk for neonatal abstinence syndrome (NAS).  With NAS, the infant undergoes withdrawal from the drug the mother has been using. Opioid medications, such as Oxycodone, Vicodin, and Percocet, trigger some of the most difficult withdrawal symptoms. A recent study explains that as many as 90% of babies born to mothers addicted to opioids will go through withdrawal.

There are more and more cases of NAS than ever before. 1` “Nationally, the rate of neonatal abstinence syndrome involving mothers' use of opiates - which includes heroin as well as prescription narcotics like codeine and Vicodin - surged from 2.8 cases for every 1,000 births in 2009 to 7.3 cases for every 1,000 births in 2013, the study found.” There are more and more cases of NAS than ever before. Fox News Health, 2016

Substance abuse in pregnancy has real consequences: Research proves that abuse of tobacco, alcohol, or illicit drugs or abuse of prescription drugs by pregnant women can have severe health consequences for infants. This is due to the fact that substances pass easily through the placenta, so substances that a pregnant woman takes also reach the baby (Neonatal abstinence syndrome, 2014).

Stillbirth due to substance abuse Recent research shows that smoking tobacco or marijuana, taking prescription pain relievers, or using illegal drugs during pregnancy is associated with double or even triple the risk of stillbirth (Tobacco, drug use in pregnancy, 2013). Risks of Stillbirth from Substance Use in Pregnancy Tobacco use—1.8 to 2.8 times greater risk of stillbirth, with the highest risk found among the heaviest smokers Marijuana use—2.3 times greater risk of stillbirth Evidence of any stimulant, marijuana, or prescription pain reliever use—2.2 times greater risk of stillbirth Passive exposure to tobacco—2.1 times greater risk of stillbirth (Source: Tobacco, drug use in pregnancy, 2013)

Withdrawal may be temporary but there are lifelong issues Too much alcohol while pregnant may lead to fetal alcohol syndrome. Small amounts of alcohol may have an effect on brain development. Smoking during pregnancy can slow fetal growth and brain development as well. Consumption of dangerous drugs is not safe for the unborn baby. Studies have shown that consumption of illegal drugs or improperly used prescription drugs can result in miscarriage, low birth weight, premature labor, placental abruption and even fetal death. Later in life these infants may experience learning disabilities and are far more likely to struggle with addictions than their peers not born to drug-addicted mothers.

Treatment for drug addicted mothers is essential Drug addiction requires professional intervention. Drug and alcohol abuse change the way a person thinks so it is nearly impossible for a pregnant woman to change her addiction without help –no matter how much she loves her baby.

REFERENCES Centers for Disease Control and Prevention (CDC). The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.   Hudak ML, Tan RC, The Committee on Drugs, The Committee on Fetus and Newborn. Clinical report: neonatal drug withdrawal. Pediatrics. 2012;129(2):e540-e560. Medications and Breastfeeding. HealthyChildren.org. American Academy of Pediatrics. www.healthychildren.org/English/ages-stages/baby/breastfeeding/Pages/Medications-and-Breastfeeding.aspx Medications and Pregnancy. Centers for Disease Control and Prevention. www.cdc.gov/pregnancy/meds/index.html. Tobacco Use and Pregnancy. Centers for Disease Control and Prevention. www.cdc.gov/Reproductivehealth/TobaccoUsePregnancy/index.htm.