The week of May 14 is Alcohol and Drug-Related Birth Defects Awareness Week. According to the National Council on Alcoholism and Drug Dependence:
About 20% of pregnant women smoke cigarettes, 12% drink alcohol and 6% use an illicit drug at least once during pregnancy. These numbers are very alarming. If only people knew the dangers of their decisions, perhaps we would be looking at something more acceptable in those numbers.
So what are some of the dangers posed by these substances to a developing fetus?
Effects of Tobacco Use
According to the Centers for Disease Control and Prevention, the fetus gets less oxygen when the mother smokes. Smoking during pregnancy is a risk factor for low birth weight, preterm birth, placenta problems, miscarriage, and sudden infant death syndrome (SIDS).
Effects of Alcohol Use
I have written about the effects of alcohol use during pregnancy before — in fact, it was the subject for the first article I wrote for this blog.
Alcohol easily passes through the placenta, so when a pregnant woman drinks, so does her fetus. According to the National Institutes of Health:
Research shows that there is no safe level of alcohol use during pregnancy; even a very small amount can have negative effects on the developing fetus. For this reason, health care providers recommend that women avoid drinking alcohol and eating foods or taking medications that may contain alcohol, such as certain cough syrups, if there is a chance they might be pregnant.
The effects of drinking during pregnancy depend on the amount and type of alcohol consumed and the developmental stage of the fetus, with the first and second trimesters leading to more serious impairment. Alcohol can cause a range of problems that can include preterm birth, small size and low growth rate, facial deformities, and brain damage that can cause learning and behavioral disorders, attention difficulties, hyperactivity, and developmental disabilities. It almost always includes poor judgment, poor impulse control, and an inability to understand cause and effect, and therefore the consequences of their behavior. Fetal alcohol spectrum disorders (FASD) are a leading cause of intellectual disabilities, but most people suffering from FASD have normal intelligence.
Effects of Cocaine Use
According to the National Institutes of Health:
It is difficult to estimate the full extent of the consequences of maternal drug use and to determine the specific hazard of a particular drug to the unborn child. This is because multiple factors — such as the amount and number of all drugs used, including nicotine or alcohol; extent of prenatal care; exposure to violence in the environment; socioeconomic conditions; maternal nutrition; other health conditions; and exposure to sexually transmitted diseases — can all interact to influence maternal and child outcomes.
This can be demonstrated by the panic about “crack babies” in the 1980s. The initial reports proved to be “grossly exaggerated” and long-term impairment is hard to assess. However, cocaine use is associated with learning and behavioral problems in children. More research is needed.
Effects of Methamphetamine
As with cocaine, the effects of methamphetamine use during pregnancy are hard to isolate from social and economic stresses and the use of other drugs and alcohol as well.
The effects of methamphetamine use on pregnancy and the infant have been less well-studied than those of opiates, alcohol, and cocaine. In addition, women who use methamphetamine frequently use tobacco, alcohol, and other drugs, which may confound the birth outcomes. Because of unrestricted manufacturing processes and chemical additives used by dealers to expand drug volume, a potential risk of illicit drug use is teratogenicity. Case reports and retrospective analyses have suggested that maternal methamphetamine use may be associated with a possible increase of defects of the fetal central nervous system, cardiovascular system, gastrointestinal system, as well as oral cleft and limb defects.
Association is not the same as causation, but though research may not be able to separate methamphetamine use from other possible causes of birth defects, it makes sense to consider it a contributing factor.
Effects of Opioid Use
The use of opioids, both legally prescribed and illegal, is associated with miscarriage and preterm birth as well as serious birth defects, including spina bifida, hydrocephalus, and hypoplastic left heart syndrome.
Effects of Prescription Drugs
How many times has a medication prescribed by your doctor contained a warning not to take it if pregnant or trying to conceive? Your baby takes in everything you take in when you’re pregnant, and that is true for over-the-counter as well as prescription drugs, so it’s important to talk to your doctor or pharmacist before taking anything.
Perhaps the most famous case of a prescription medication causing serious birth defects is thalidomide, a tranquilizer that led to thousands of babies born with limbs only partially developed or missing altogether. The drug was developed in Europe, where it was marketed as a safe alternative to barbiturates. It was also found to help pregnant women with morning sickness. One woman’s insistence kept thalidomide from being approved in the United States:
In July of 1962, president John F. Kennedy and the American press began praising their heroine, FDA inspector Frances Kelsey, who prevented the drug’s approval within the United States despite pressure from the pharmaceutical company and FDA supervisors. Kelsey felt the application for thalidomide contained incomplete and insufficient data on its safety and effectiveness. Among her concerns was the lack of data indicating whether the drug could cross the placenta, which provides nourishment to a developing fetus.
There were some American women who got the drug overseas, including Sherri Finkbine, whose quest for a therapeutic abortion after learning about the birth defects was unsuccessful in this country, and who finally got her abortion in Sweden.
Then there was the case of diethylstilbestrol (DES), a synthetic estrogen that was prescribed for pregnant women to avoid miscarriages and preterm births, even after research showed it prevented neither. It was found to cause a rare vaginal cancer in many girls and young women whose mothers took the drug while pregnant.
Now the pain medication Lyrica, used to ease nerve pain, has been linked to an increased risk of birth defects if taken by pregnant women.
Some women have to take medications for health problems (including addiction) where the untreated disease is worse for mother and child than the medication. In such cases, dosages must be monitored and may need to change at different stages of the pregnancy.
Where We Are Now
When we talk about drug- and alcohol-related birth defects, however, we usually are concerned about women who are addicted to alcohol, prescription opioids, or street drugs. Unfortunately, treatment for addiction is not easily accessible; programs are limited and have waiting lists, and patients might be required to have a particular kind of insurance and meet other conditions. Even fewer programs are equipped to treat pregnant women. The current administration has made severe cuts to federal funding for research in areas such as alcoholism, mental health, behavioral and social science, clinical research, fetal alcohol syndrome, mental illness, substance abuse prevention, underage drinking, women’s health, youth violence, and violence against women.
There are also steep budget cuts proposed to Medicaid, insurance subsidies under the Affordable Care Act, and public health programs:
In terms of the opioid epidemic, the administration proposed more than $27 billion toward drug control policy, including increasing funding for treatment by 2% over the fiscal 2017 continuing resolution level. However, the budget of the Substance Abuse and Mental Health Services Administration is slated to be cut by $400 million next year, including $116 million from SAMHSA’s Community Mental Health Services Block Grant program and $73 million less for substance abuse prevention efforts.
In other words, humanitarian treatment options are being cut from their already insufficient levels, and more emphasis is being put on punishment. This is already a serious problem, as women addicts often delay or forgo prenatal care for fear of being arrested or having the child taken away, and this can only get worse with these changes. Effects like preterm birth and low birth weight are probably also due to the lack of adequate prenatal care and the poor nutrition common among addicts.
If you are pregnant or planning to get pregnant and are using drugs or alcohol, there is treatment available here in Arizona and across the nation to help you get sober. The SAMHSA helpline is a 24-hour, 365-day government resource to help find mental health and substance abuse treatment at 1-800-662-HELP (4357).
I agree. Too much emphasis it put on punishment and not enough on actually helping people. When children and expectant mothers are involved I feel this is even more important.
Hey Port, I just have gone through your article on Alcohol and Drug-Related Birth Defects. Great job! You have given so many pieces of information. Keep it up.