How does postnatal use of drugs affect the child

Know the Long Term Effects of Taking Drugs During Pregnancy

Once you take the at-home pregnancy test and realize that your life is about to change, you may have several questions about what is best for the health of you and your baby.

Although your friends and family will likely all have an opinion about what it means to be healthy during pregnancy, avoiding substances like alcohol, nicotine, marijuana, and illicit drugs from the beginning can make the biggest impact on your baby’s future.

The Developing Brain

At birth, the human brain weights approximately 800g, which is more than half of the weight of an adult brain. During embryonic development, the neural tube creates cells that go on to form neurons, the building blocks of the central nervous system (brain and spinal cord). At just 10 weeks after conception, all of the major structures of the brain and spinal cord are recognizable.

During pregnancy the brain is growing very rapidly through processes that involve cell growth, planned cell death and connections between cells. Due to this rapid development, any interference with normal brain development can have a significant impact on physical growth, behavior and cognition, including intelligence and language skills. 

Brain development occurs by cell growth and pruning, a process by which unused cells are shed (or, planned cell death). Brain development also occurs by connection between cells, which creates the development of neural pathways called myelination. Myelination occurs as the baby or child learns, has experiences and bonds with loved ones. 

After birth, brain weight continues to increase to about 1200g at 6 years old, eventually reaching adult weight of 1500g. Brain size due to the number of neurons created accounts for some portion of intelligence. A growing body of research is also linking intelligence to major neural pathways (connections) that are strong and efficient.

Alcohol, Substance Use & Other Risk Factors

The precise nature of fetal growth means that any interference on the size or effectiveness of the brain can have permanent consequences to the child. That is why pregnant women have so many recommendations around food, supplements and medications, and are instructed to abstain from alcohol, nicotine and illicit drug use. 

“The largest body of literature we have currently is around alcohol use during pregnancy and how it affects a child’s growth, neurocognitive development and social-emotional functioning,” said Lindsey Felix, PhD, with Samaritan Neuropsychology.

She reports that a growing body of literature is showing that using cocaine, marijuana and opiates has long term negative consequences, though this is harder to study since gathering reliable information about illicit drug use during pregnancy is challenging.

“Measuring the precise effects of a substance used during pregnancy on a child is difficult since children who are exposed to one substance are often exposed to multiple substances,” said Felix.

Further, she notes that women who use substances during pregnancy often have other risk factors including low socioeconomic status, poor living conditions, poor prenatal care, and their own cognitive, emotional or behavioral problems. These all contribute to neurocognitive and psychological outcomes in their children.

Marijuana & CBD

In Oregon, access to marijuana for recreational use makes it easier than ever for women to use without thinking about the affect it may be having on an unborn baby.

Products containing the cannabis compound CBD from the hemp plant, a cousin of the marijuana plant, are also readily available in stores and online. CBD does not give the “high” feeling associated with marijuana. Additionally, since CBD is a sold as a supplement and is unregulated, there is no way of knowing how much you are actually getting in a dose or if the product has been contaminated with other substances.

“Although there is not yet extensive research on CBD, the effects of marijuana use on a developing fetus are well documented,” said Felix. “Children with a history of prenatal marijuana exposure are at-risk for problems with attentional regulation, visual spatial abilities, and disruptive behavior. ” 

Marijuana and CBD, she concludes, should be avoided during pregnancy. 

Long Term Effects For Children

The severity of consequences for the child can depend on how much the mother uses and at what time during pregnancy. Each substance reacts differently in the mother’s body and can affect the baby in different ways, but outcomes run the gamut of affecting intelligence, attention, higher-level executive functions like problem-solving, and language, as well as academic achievement, emotional functioning, behavior regulation, and the child’s own future drug use.

According to Felix, exposure to tobacco/nicotine during pregnancy has been linked to later behavior problems, including ADHD. Marijuana exposure in utero can affect attention, visual perceptual abilities, and behavior problems, including delinquent behavior. Prenatal alcohol exposure is linked to poor physical growth, lower intelligence, attention problems, and academic underachievement. Cocaine exposure during pregnancy has been associated with lower intelligence, and impairments in attention, language, and executive functions, as well as emotional and behavioral problems. Opioid use during pregnancy has been linked to problems with attention, memory, and behavior (including hyperactivity). 

Effective Early Intervention Strategies

As a baby grows physically, intellectually, and socially, a delay in any area may signal a problem. The factors that help determine success start at conception, according to Felix. It is important that pregnant women avoid use of alcohol, illicit drugs, and tobacco/nicotine in order to provide their baby with optimal growing conditions. 

After a child is born, it is important that they are provided with love, a secure connection with their caregivers, and a home free of violence, illicit drugs, and nicotine/tobacco. This sort of loving environment can help mitigate negative effects of prenatal substance exposure.   

Early Intervention Services like speech therapy or physical therapy can address any delays a child may be demonstrating. For school-aged children who are having difficulty with schoolwork or paying attention in class, taking advantage of academic accommodations or special education services at school can be a big benefit, says Felix.

An evaluation by a school specialist or a mental health professional can help develop a plan for learning and behavior at school and home. Felix notes that some combination of classroom tools used by the teacher and parenting tools used at home are the most beneficial. A child’s plan may also include medication.

“For any child, a nurturing home life is going to have as big of an impact on positive development as a genetic predisposition,” said Felix. “Parents who are also tuned in to when their kids need extra help at school are giving their kids the best chance possible to succeed.”

Do you wonder if your child is progressing as they should? Learn more about getting an evaluation at Samaritan Neuropsychology.

Get help with a substance use disorder or tobacco addiction.

Substance Use While Pregnant and Breastfeeding

Research Report

Research shows that use of tobacco, alcohol, or illicit drugs or misuse of prescription drugs by pregnant women can have severe health consequences for infants. This is because many substances pass easily through the placenta, so substances that a pregnant woman takes also reach the fetus. ⁹¹ 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.⁹² Estimates suggest that about 5 percent of pregnant women use one or more addictive substances.⁹³

Regular use of some drugs can cause neonatal abstinence syndrome (NAS), in which the baby goes through withdrawal upon birth. Most research in this area has focused on the effects of opioids (prescription pain relievers or heroin). However, data has shown that use of alcohol, barbiturates, benzodiazepines, and caffeine during pregnancy may also cause the infant to show withdrawal symptoms at birth.⁹⁴ The type and severity of an infant's withdrawal symptoms depend on the drug(s) used, how long and how often the birth mother used, how her body breaks the drug down, and whether the infant was born full term or prematurely.⁹⁵

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

Symptoms of drug withdrawal in a newborn can develop immediately or up to 14 days after birth and can include⁹⁴:

• blotchy skin coloring
• diarrhea
• excessive or high-pitched crying
• abnormal sucking reflex
• fever
• hyperactive reflexes
• increased muscle tone
• irritability
• poor feeding
• rapid breathing
• seizures
• sleep problems
• slow weight gain
• stuffy nose and sneezing
• sweating
• trembling
• vomiting

Effects of using some drugs could be long-term and possibly fatal to the baby:⁹⁵

• birth defects
• low birth weight
• premature birth
• small head circumference
• sudden infant death syndrome (SIDS)

Risks of Sudden Infant Death (SIDS)

Children born to mothers who both drank and smoked beyond the first trimester of pregnancy have a twelvefold increased risk for sudden infant death syndrome (SIDS) compared to those unexposed or only exposed in the first trimester of pregnancy. New information from the NIH Safe Passage Study calls for stronger public health messaging regarding the dangers of drinking and smoking during pregnancy.

Illegal Drugs

Marijuana (Cannabis)

More research needs to be done on how marijuana use during pregnancy could impact the health and development of infants, given changing policies about access to marijuana, significant increases in the number of pregnant women seeking substance use disorder treatment for marijuana use, and confounding effects of polysubstance use.⁹⁶  A 2017 opinion posted by the American College of Obstetrics and Gynecology (ACOG) suggests that cannabis effects on fetal growth (e.g., low birth weight and length) may be more pronounced in women who consume marijuana frequently, especially in the first and second trimesters. ACOG recommends that pregnant women or women contemplating pregnancy should be encouraged to discontinue use of marijuana for medicinal purposes in favor of an alternative therapy for which there are better pregnancy-specific safety data. ¹⁹⁰

A recent study suggests that cannabis use more than doubled among pregnant women in the United States from 2010-1017. ¹⁹¹  Cannabis use was more common during the first trimester than during the second and third. Between 2002-2003 and 2016-2017, past-month cannabis use increased from 3.4% to 7.0% among pregnant women overall and from 5.7% to 12.1% during the first trimester. The study included information from 467,100 women aged 12-44 who participated in the National Survey on Drug Use and Health (NSDUH). Researchers also concluded that past-month clinician-recommended cannabis use was low among pregnant women, and nonmedical use was lower than among nonpregnant women, possibly reflecting the AGOC recommendations.

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Source: Martin et al., 2015

There is no human research connecting marijuana use to the chance of miscarriage,^98,99 although animal studies indicate that the risk for miscarriage increases if marijuana is used early in pregnancy. ¹⁰⁰ Some associations have been found between marijuana use during pregnancy and future developmental and hyperactivity disorders in children.^101–104 There is substantial evidence of a statistical association between marijuana smoking among pregnant women and low birth weight.¹⁰⁵ Researchers theorize that elevated levels of carbon dioxide might restrict fetal growth in women who use marijuana during pregnancy.¹⁰⁶ Evidence is mixed related to premature birth,¹⁰⁷ although some evidence suggests long-term use may elevate these risks.¹⁰⁸ Given the potential of marijuana to negatively impact the developing brain, the American College of Obstetricians and Gynecologists recommends that obstetrician-gynecologists counsel women against using marijuana while trying to get pregnant, during pregnancy, and while they are breastfeeding.¹⁰⁹

Some women report using marijuana to treat severe nausea associated with their pregnancy;^110,111 however, there is no research confirming that this is a safe practice, and it is generally not recommended. Women considering using medical marijuana while pregnant should not do so without checking with their health care provider. Animal studies have shown that moderate concentrations of THC, when administered to mothers while pregnant or nursing, could have long-lasting effects on the child, including increasing stress responsivity and abnormal patterns of social interactions.¹¹² Animal studies also show learning deficits in prenatally exposed individuals.^113,114

Human research has shown that some babies born to women who used marijuana during their pregnancies display altered responses to visual stimuli, increased trembling, and a high-pitched cry,¹¹⁵ which could indicate problems with neurological development.¹¹⁶ In school, marijuana-exposed children are more likely to show gaps in problem-solving skills, memory,¹¹⁷ and the ability to remain attentive.¹⁰³ More research is needed, however, to disentangle marijuana-specific effects from those of other environmental factors that could be associated with a mother's marijuana use, such as an impoverished home environment or the mother's use of other drugs. ¹¹⁸ Prenatal marijuana exposure is also associated with an increased likelihood of a person using marijuana as a young adult, even when other factors that influence drug use are considered.¹¹⁹ More information on marijuana use during pregnancy in NIDA's Marijuana Research Report. More research is needed, but for now, the Food and Drug Administration recommends that pregnant women should not use any vaping product, regardless of the substance.

Despite various surveys, the precise number of women who use marijuana while pregnant is unclear. One study found that women were about twice as likely to screen positive for marijuana use via a drug test than they state in self-reported measures. This suggests that self-reported rates of marijuana use in pregnant females is not an accurate measure of marijuana use and may be an underestimation.⁹⁷

Very little is known about marijuana use and breastfeeding. One study suggests that moderate amounts of THC find their way into breast milk when a nursing mother uses marijuana. ¹²⁰ Some evidence shows that exposure to THC through breast milk in the first month of life could result in decreased motor development at 1 year of age.¹²¹ There have been no studies to determine if exposure to THC during nursing is linked to effects later in the child's life. With regular use, THC can accumulate in human breast milk to high concentrations.¹²⁰ Because a baby's brain is still forming, THC consumed in breast milk could affect brain development. Given all these uncertainties, nursing mothers are discouraged from using marijuana.^109,122 New mothers using medical marijuana should be vigilant about coordinating care between the doctor recommending their marijuana use and the pediatrician caring for their baby.

Stimulants (Cocaine and Methamphetamine)

It is not completely known how a pregnant woman's cocaine use affects her child, since cocaine-using women are more likely to also use other drugs such as alcohol, to have poor nutrition, or to not seek prenatal care. All of these factors can affect a developing fetus, making it difficult to isolate the effects of cocaine.¹²³

Research does show, however, that pregnant women who use cocaine are at higher risk for maternal migraines and seizures, premature membrane rupture, and placental abruption (separation of the placental lining from the uterus).⁹³ Pregnancy is accompanied by normal cardiovascular changes, and cocaine use exacerbates these changes—sometimes leading to serious problems with high blood pressure (hypertensive crisis), spontaneous miscarriage, preterm labor, and difficult delivery.¹²³ Babies born to mothers who use cocaine during pregnancy may also have low birth weight and smaller head circumferences, and are shorter in length than babies born to mothers who do not use cocaine. They also show symptoms of irritability, hyperactivity, tremors, high-pitched cry, and excessive sucking at birth.¹²⁴ These symptoms may be due to the effects of cocaine itself, rather than withdrawal, since cocaine and its metabolites are still present in the baby's body up to 5 to 7 days after delivery. ^125,126 Estimates suggest that there are about 750,000 cocaine-exposed pregnancies every year.¹²³

Pregnant women who use methamphetamine have a greater risk of preeclampsia (high blood pressure and possible organ damage),¹²⁷ premature delivery, and placental abruption. Their babies are more likely to be smaller and to have low birth weight.¹²⁸ In a large, longitudinal study of children prenatally exposed to methamphetamine, exposed children had increased emotional reactivity and anxiety/depression, were more withdrawn, had problems with attention, and showed cognitive problems that could lead to poorer academic outcomes.^129,130

MDMA (Ecstasy, Molly)

More research is needed on the effects of MDMA use during pregnancy. What research exists suggests that prenatal MDMA exposure may cause learning, memory,¹³¹ and motor problems in the baby.^132,133

Heroin

Heroin use during pregnancy can result in neonatal abstinence syndrome (NAS) specifically associated with opioid use. NAS occurs when heroin passes through the placenta to the fetus during pregnancy, causing the baby to become dependent on opioids. Symptoms include excessive crying, high-pitched cry, irritability, seizures, and gastrointestinal problems, among others.¹³⁴

Medications

Prescription and Over-the-Counter (OTC) Drugs

Pregnancy can be a confusing time for women facing many choices about legal drugs, like tobacco and alcohol, as well as prescription and over-the-counter (OTC) drugs that may affect the developing fetus. These are difficult issues for researchers to study because scientists cannot give potentially dangerous drugs to pregnant women. Here are some of the known facts about popular medications and pregnancy:

There are more than 6 million pregnancies in the United States every year,¹³⁵ and about 9 out of 10 pregnant women take medication.¹³⁶ The U.S. Food and Drug Administration issued rules on drug labeling to provide clearer instructions for pregnant and nursing women, including a summary of the risks of use during pregnancy and breastfeeding, a discussion of the data supporting the summary, and other information to help prescribers make safe decisions. ¹³⁷

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See CDC Treating for Two webpage

Even so, we know little about the effects of taking most medications during pregnancy. Fewer than 10% of prescriptions have enough information to determine fetal risks.¹³⁸ This is because pregnant women are often not included in studies to determine safety of new medications before they come on the market.¹³⁸ One study shows that use of short-acting prescription opioids such as oxycodone during pregnancy, especially when combined with tobacco and/or certain antidepressant medications, is associated with an increased likelihood of NAS in the infant.¹³⁹

Although some prescription and OTC medications are safe to take during pregnancy, a pregnant woman should tell her doctor about all prescription and over-the-counter medications, and herbal or dietary supplements she is taking or planning to take. This will allow her doctor to weigh the risks and benefits of a medication during pregnancy. In some cases, the doctor may recommend the continued use of specific medications, even though they could have some impact on the fetus. Suddenly stopping the use of a medication may be more risky for both the mother and fetus than continuing to use the medication while under a doctor's care.¹⁴⁰ This could also include medications to treat substance use disorders—something that is discussed in further detail in the "Sex and Gender Differences in Substance Use Disorder Treatment."

Some prescription and OTC medications are generally compatible with breastfeeding. Others, such as some anti-anxiety and antidepressant medications, have unknown effects,¹⁴¹ so mothers who are using these medications should consult with their doctor before breastfeeding. Nursing mothers should contact their infant's health care provider if their infants show any of these reactions to the breast milk: diarrhea, excessive crying, vomiting, skin rashes, loss of appetite, or sleepiness. ¹⁴²

Other Substances

Alcohol

Alcohol use while pregnant can result in Fetal Alcohol Spectrum Disorders (FASD), a general term that includes Fetal Alcohol Syndrome, partial Fetal Alcohol Syndrome, alcohol-related disorders of brain development, and alcohol-related birth defects. These effects can last throughout life, causing difficulties with motor coordination, emotional control, schoolwork, socialization, and holding a job. More information can be found on the NIAAA Fetal Alcohol Exposure webpage.

Fetal alcohol exposure occurs when a woman drinks while pregnant. Alcohol can disrupt fetal development at any stage during a pregnancy—including at the earliest stages before a woman even knows she is pregnant.

There is currently little research into how a nursing mother's alcohol use might affect her breastfed baby. What science suggests is that, contrary to folklore, alcohol does not increase a nursing mother's milk production, and it may disrupt the breastfed child's sleep cycle. ¹⁴³ The American Academy of Pediatrics recommends that alcohol drinking should be minimized during the months a woman nurses and daily intake limited to no more than 2 ounces of liquor, 8 ounces of wine, or two average beers for a 130-pound woman. In this case, nursing should take place at least 2 hours after drinking to allow the alcohol to be reduced or eliminated from the mother's body and milk. This will minimize the amount of alcohol passed to the baby.¹⁴⁴

Nicotine (Tobacco Products and e-Cigarettes)

Almost 10 percent of pregnant women in the United States have smoked cigarettes in the past month.¹³ Carbon monoxide and nicotine from tobacco smoke may interfere with the oxygen supply to the fetus. Nicotine also readily crosses the placenta, and concentrations of this drug in the blood of the fetus can be as much as 15 percent higher than in the mother.¹⁴⁵ Smoking during pregnancy increases the risk for certain birth defects, premature birth, miscarriage, and low birth weight and is estimated to have caused more than 1,000 infant deaths each year. ¹⁴⁶ Newborns of smoking mothers also show signs of stress and drug withdrawal consistent with what has been reported in infants exposed to other drugs. In some cases, smoking during pregnancy may be associated with sudden infant death syndrome (SIDS), as well as learning and behavioral problems and an increased risk of obesity in children. In addition, smoking more than one pack a day during pregnancy nearly doubles the risk that the affected child will become addicted to tobacco if that child starts smoking.¹⁴⁷ Even a mother's secondhand exposure to cigarette smoke can cause problems; such exposure is associated with premature birth and low birth weight, for example.¹⁴⁸

Research provides strong support that nicotine is a gateway drug, making the brain more sensitive to the effects of other drugs such as cocaine.¹⁴⁹ This shows that pregnant women who use nicotine may be affecting their fetus's brain in ways they may not anticipate. Additionally, e-cigarettes (or e-vaporizers) frequently contain nicotine. Therefore, those products may also pose a risk to the fetus's health. More research is needed, but for now, The Food and Drug Administration recommends that pregnant women should not use any vaping product, regardless of the substance.

Similar to pregnant women, nursing mothers are also advised against using tobacco. New mothers who smoke should be aware that nicotine is passed through breast milk,¹⁵⁰ so tobacco use can impact the infant's brain and body development—even if the mother never smokes near the baby. There is also evidence that the milk of mothers who smoke smells and may taste like cigarettes. It is unclear whether this will make it more likely that exposed children may find tobacco flavors/smells more appealing later in life.¹⁵¹

Secondhand Smoke

Newborns exposed to secondhand smoke are at greater risk for SIDS, respiratory illnesses (asthma, respiratory infections, and bronchitis), ear infections,⁸⁸ cavities,¹⁵² and increased medical visits and hospitalizations. ¹⁵³ If a woman smokes and is planning a pregnancy, the ideal time to seek smoking cessation help is before she becomes pregnant.

April 2020

Pregnancy and drug use

The role of a social worker in this situation is to support the expectant mother psychologically, provide all the information about the possibility of organizing observation and treatment during pregnancy and childbirth, and facilitate the establishment of effective and comfortable communication between the client and the medical staff.

Although the effect of drugs on a woman's body has not been studied enough, all researchers agree that drug use during pregnancy can cause multiple pathologies and delay the development of the child.

As a rule, women addicted to drugs use alcohol and tobacco in parallel, which causes significant harm to the body of a pregnant woman and a child. Pregnancy always takes place against the background of a change in immunity, and if additional effects of toxic substances are added to this, this leads to an exacerbation of chronic processes in the body, the appearance of anemia, the addition of infections, incl. viral, placental lesions, threatened miscarriage, intrauterine growth retardation, malformations of its internal organs.

However! Abrupt discontinuation of opioid drugs may result in miscarriage or premature birth. The best option in this situation is the transition to substitution maintenance therapy (RRT).

RRT is the global standard of care for opioid dependence in pregnant women. Methadone is generally considered the drug of choice for the treatment of pregnant women based on years of experience with its use. There is no need to fear that methadone will adversely affect the health of the child. There is no evidence that stable doses are associated with additional risks to fetal development. However, the use of methadone also has a number of studied negative aspects. A child can be born in a state of the so-called neonatal withdrawal syndrome. It is characterized by increased excitability of the central nervous system, disorders of the gastrointestinal tract, cardiovascular and respiratory systems of newborns. The most common manifestations are: tremor, sleep disturbance, irritable and shrill cry, increased muscle tone, convulsions, decreased appetite, compulsive sucking, vomiting, diarrhea, poor weight gain, sweating, fever, palpitations, nasal congestion. If the mother believes that the child has withdrawal symptoms, it is necessary to tell the doctor about it. Withdrawal symptoms can be relieved under medical supervision in a few days without any long-term effects. Between feedings, you need to give the child as much rest as possible and not take him out into bright light. Under no circumstances should you try to relieve your child of withdrawal symptoms or give him methadone - this can be dangerous for his life!

If a woman taking methadone wants to breastfeed and has no specific contraindications, such as some infectious diseases and illicit drug use, her doctor should support her decision. Breastfeeding is good for babies and mothers, and breastfeeding is not contraindicated while taking methadone. Small amounts of methadone can be found in milk, but there is no clear estimate of how long after the start of treatment it gets there. Small amounts of methadone in milk may prevent or reduce withdrawal symptoms in a newborn. It is possible that similar recommendations could be made for breastfeeding while on buprenorphine, but here they are based on a shorter follow-up period and fewer cases studied.

Women who use , stimulants should, if possible, stop taking drugs under the supervision of a doctor or, in extreme cases, refuse to inject them (for example, switch to oral use).