This
is a summary of a 2005 scholarly article examining multiple research reports
regarding prenatal alcohol and drug exposure. It was really helpful to us in
deciding what situations we are comfortable with, when the time comes.
“Families choosing to adopt domestically or internationally are
faced with the possibility of prenatal substance exposure for their child.
Alcohol use, drug use, and exposure to environmental agents by pregnant women
can be harmful to the developing fetus, with many known short- and long-term
effects on organ development, somatic growth, and neurodevelopment. As more
families turn to medical providers for consultation before adoption, the
challenge of accurately identifying risk factors for poor medical or cognitive
outcomes becomes paramount.
Prenatal
substance exposure is just one of the important factors in this risk assessment,
but it is one that parents frequently have questions about before and after the
adoption of their child”.
Alcohol
“Children
born to women who drink heavily on a regular basis in the first trimester of
pregnancy have the greatest risk of central nervous system damage. The first month of pregnancy is
particularly crucial for development of the central nervous system and the midportion of the face.
Unfortunately, this early in pregnancy, many women do not realize that they are
pregnant and continue their usual pattern of alcohol ingestion”.
“Although
there is no convincing evidence to date of a ‘‘safe’’ threshold of prenatal
alcohol consumption, one major dysmorphology textbook argues that low birth
weight and ‘‘mild’’ disability can be seen at an exposure of roughly 2
alcoholic drinks per day (lower in recent studies). When 4 to 6 drinks are
consumed, additional clinical features become evident. Most of the children who
are believed to have the full expression of Fetal Alcohol Syndrome are born to women consuming 8
to 10 drinks or more per drinking occasion, on a regular if not daily basis,
for at least the first trimester. It is estimated that the risk of a ‘‘serious
problem” in the offspring of chronically alcoholic women ranges from 30% to 50%.
The greatest risk is that of mental deficiency as well as a host of learning and
behavioral disabilities”.
“Manifestations of central nervous system dysfunction may include mental retardation or
borderline IQ scores, neuromotor deficits, attentional issues and hyperactivity,
and impaired social and adaptive abilities”.
Opiates
“There
is no known congenital malformation associated with prenatal opiate exposure. There
have been harmful fetal effects described with heroin and methadone use,
however, and infants born to addicted women can suffer withdrawal in the
newborn period”.
Effects
on baby include low birth weight, increased risk of preterm delivery (less so
with methadone compared to heroin), withdrawal symptoms (eg, hyperirritability,
tremors, convulsions), gastrointestinal distress, respiratory distress, and
autonomic disturbances (more severe with methadone because it has a longer half
life).
“Recent studies… suggest mild memory and perceptual difficulties
in older children [exposed to opiates], but overall test scores are still
within the normal range”.
Tobacco
“Prenatal tobacco exposure has consistently been
associated with poor fetal growth and is the single most important cause of low
birth weight in developed countries. Even environmental smoke exposure has been
implicated in low birth weight, fetal death, and preterm delivery. Finally, a
growing body of evidence is implicating smoking during pregnancy in a range of
adverse behavioral and cognitive outcomes”.
“Nicotine readily crosses the placenta and distributes
freely to the central nervous system, having direct and indirect effects on
neural development. Intrauterine hypoxia, mediated by carbon monoxide and reduced
uterine blood flow, is a major mechanism of the growth impairment linked to
prenatal tobacco exposure”.
“Tobacco smoking during pregnancy has been associated
with placenta previa, placental abruption, premature rupture of membranes,
preterm birth, intrauterine growth restriction, and sudden infant death
syndrome (SIDS)”.
“Infants
born to mothers who smoke tobacco display higher rates of impaired neurobehavior,
with reduced habituation, lower arousal, hypertonicity and tremors, sucking
difficulties, worse autonomic regulation, and altered cries”.
Marijuana
“Marijuana use during pregnancy may have a modest effect on
prenatal growth, but the results are inconsistent from study to study…These
effects, if any, are not associated with later growth deficiency, although a few
studies have suggested an impact on height as well as persistent negative
effects on head circumference in the offspring of heavy marijuana users. This review
found no consistent link between prenatal marijuana exposure and other adverse
pregnancy outcomes or congenital malformations”.
“Although prenatal tobacco exposure is
associated with deficits in IQ, impulse control, and other fundamental aspects
of performance, prenatal marijuana exposure does not impair IQ or basic
visuoperception but influences the application of these skills in
problem-solving situations requiring visual integration, analysis, and
sustained attention. Marijuana is argued to have an impact on higher level
executive function and performance in a ‘‘top-down’’ fashion, in contrast to
tobacco’s ‘‘bottom-up’’ effects”.
Cocaine
“The
use of cocaine in pregnancy has been associated with a number of obstetric
complications, such as stillbirth, placental abruption, premature rupture of
membranes, fetal distress, and preterm delivery”.
“Prenatal
cocaine abuse may cause specific neurobehavioral and learning problems,
although it is not associated with global cognitive deficits. Infant neurobehavioral abnormalities like irritability or excitability, sleep difficulties, and
state regulation difficulty as well as
transient neurologic abnormalities like tremor, hypertonia, and extensor
posturing have been reported. Heavy prenatal cocaine
use has been linked to poor memory and information processing in infancy. At 3
years of age, increased fussiness, difficult temperament, and behavior problems
were described.”
5/27/13- Current news article: http://chroniclesofanadoption.blogspot.com/2013/05/crack-baby-scare-overblown.html
5/27/13- Current news article: http://chroniclesofanadoption.blogspot.com/2013/05/crack-baby-scare-overblown.html
Meth
“Although the impact of methamphetamine use during human
pregnancy is currently unknown, animal studies have demonstrated neurotoxic effects of amphetamines and remodeling of
synaptic morphology in response to prenatal methamphetamine exposure. One study
did describe a smaller putamen, globus pallidus, and hippocampus in
methamphetamine-exposed children”.
“Women using methamphetamine during pregnancy may have an
increased rate of premature delivery and placental abruption. Methamphetamine
use during pregnancy is linked to fetal growth restriction and, occasionally,
withdrawal symptoms requiring pharmacologic intervention at birth. Clefting, cardiac
anomalies, and fetal growth reduction have been described in infants exposed to
amphetamines during pregnancy”.
“The scant research describing the outcomes of methamphetamine-exposed
children describes possible links with aggressive behavior, peer problems, and hyperactivity.
A small recent study found that methamphetamine-exposed children scored lower
on measures of visual motor integration, attention,verbal memory, and long-term
spatial memory. In rats, even low doses of prenatal methamphetamine exposure
can alter learning and memory in adulthood”.
Other things to remember
“This
review, and most of the research literature, has examined each of these alcohol
and drug exposures one by one. In reality, polysubstance exposure is perhaps
more common; however, to date, we have little understanding of how these and
other prenatal exposures interact with each other to affect the developing fetus”.
“For
children of adoption, it is sobering to consider how these substance exposures,
in combination with other social and biologic risks, may make affected children
more vulnerable to the adverse effects of malnutrition, neglect, abuse,
multiple placements, or institutionalization. At a minimum, it seems less likely
that early neurobehavioral problems can be repaired in such environments. Conversely,
adopted children are typically received into loving and nurturing homes with
motivated and resourceful parents. This is a remarkable intervention in and of
itself, affording children with multiple vulnerabilities the opportunity for catch-up
growth and development, formation of stable and secure attachments, early
diagnosis of primary disabilities, appropriate services, and prevention of secondary
disabilities. The lifelong impact of this caregiving trajectory on the long-term
effects of prenatal alcohol and drug exposures remains to be seen”.
Following a compilation of research regarding other substances not addressed in the above article:
Benzos
“There are many possible risks to the fetus whenever
anxiolytic medications are prescribed to pregnant women. The onset of
teratogenic effects may be immediate or delayed. Possible effects include
abortion, malformation, intrauterine growth retardation, functional deficits,
carcinogenesis, and mutagenesis. The risk of malformation is greatest when the
fetus is exposed between two and eight weeks after conception. If the drugs are
administered at or near term, they may cause fetal dependence and eventual withdrawal
symptoms.”
One study found benzo-exposed low birthweight babies caught
up at “an early stage”. Gross motor development was behind from 6-10 months but
was nearly normal at age 18 months.
Babies exposed to benzos during pregnancy are at risk for low
birthweight, breathing difficulties, floppy muscles, unstable body temperature,
alteration in heart rate, and withdrawal syndrome (irritability, convulsions,
etc).
“Some early studies in animals and humans suggested a slight increase in
the risk for cleft lip and/or cleft palate if a benzodiazepine was taken during
the first trimester. Since these early reports, there have been studies and
reviews that have not supported an association between benzodiazepines and
cleft lip or palate or birth defects in general. It is generally felt that exposure
to a benzodiazepine does not significantly increase the risk for birth defects”.
Antidepressants
“Tricyclic antidepressants (TCA) are generally considered
safe for use during pregnancy (Gilstrap & Little, 1998, Lee et al., 2000).
The birth incidence of congenital malformations is not increased nor does there
seem to be any alteration of brain anatomy based on human studies. Considering cognitive
and behavioural assessments there seem to be no negative effects of prenatal
TCA administration.”
Example: amitriptyline
“SRIs are… prescribed and indicated for use in moderate to
severe depression during pregnancy (Lee et al., 2000). Several studies have found
no increased risk of congenital malformations when using SSRIs during the first
trimester (Koren, 2001; Kulin et al., 1998; Nulman et al., 2002). With respect
to cognitive development, Nulman et al. (2002)With respect to cognitive
development, Nulman et al carried out a prospective controlled study using SSRI
exposure throughout pregnancy. They found no increase in delay of cognitive or
language development in pre-school or early school aged children. Similarly,
Simon et al. (2002) found no increased risk of developmental delay or
congenital malformations after SSRI exposure. However, a recent study by Casper
et al. (2003) showed a different trend after SSRI exposure. In a
well-controlled study, the children of depressed mothers exposed to SSRI or
unexposed depressed mothers were followed up to age of 40 months. They found
that children prenatally exposed to SSRIs scored lower on the psychomotor indexes
of the Bayley Scales of Infant Development test and lower on the motor quality
factor of the Bayley Behavioral Rating Scale. The authors suggest that subtle
motor developmental delays may be one of the side effects of prenatal SSRI
exposure.”
Example: Celexa, Lexapro, Prozac,
Paxil, Zoloft
