Pregnancy and substance abuse

Summary

The fetal consequences of drug abuse during pregnancy remain underestimated. Obstetrical complications of cigarette smoking include growth retardation, spontaneous abortion and sudden infant death syndrome; alcohol abuse leads to nutritional deficiencies and fetal alcohol syndrome. Heroin and cocaine consumption result in medical, nutritional and social neglect; cocaine and amphetamine cause hypertension, abruptio placentae; all three drugs of abuse cause preterm labor, with neonates being small for gestational age. Intravenous abuse also increases the risk of contracting infectious disease. The recommended treatment standard is to maintain pregnant, opioid-dependent women on synthetic opioids such as methadone, but newer substances like slow-release morphine and buprenorphine may also be beneficial. Treatment should be interdisciplinary and consider the high prevalence of substance dependent partners. Programmes should be initiated to identify women at risk and provide early treatment to improve the outcome for mother and child. Care must be provided in a supportive, proactive and non-judgemental fashion.