Perinatal and Neonatal Issues of Substance Abuse

doi:10.1016/S0031-3955(16)38946-5

Pediatric Clinics of North America

Volume 42, Issue 2, April 1995, Pages 261-281

https://doi.org/10.1016/S0031-3955(16)38946-5 Get rights and content

Six substances that commonly are abused in pregnancy and that affect the fetus and newborn infant are reviewed, including marijuana, cocaine, amphetamines, opiates, alcohol, and cigarettes. Specifically, the effects of each individual drug are delineated separately. Teratogenicity and toxicity are emphasized. Prevalence, diagnosis, and therapy are also reviewed.

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Cited by (80)

Substance Abuse in Pregnancy
2022, Maternal Cardiac Care: A Guide to Managing Pregnant Women with Heart Disease
Substance abuse is a pervasive problem in our society, and it does not spare pregnant women. Anyone caring for pregnant patients should be aware of the effects that various drugs of abuse have on a pregnant women and their fetuses. In particular, many of these drugs have significant effects on the cardiovascular system, which may impact pregnant women with cardiac disease more than most. This chapter covers the effects of the main substances of abuse, including tobacco, alcohol, opioids, cocaine, amphetamines, and marijuana. The anesthetic considerations for each of these substances is also discussed
Maternal crack cocaine use in rats leads to depressive- and anxiety-like behavior, memory impairment, and increased seizure susceptibility in the offspring
2021, European Neuropsychopharmacology
Citation Excerpt :
Due to crack cocaine users' high-risk pregnancies, the number of newborns, exposed to crack during gestation, has reached alarming levels (Aghamohammadi and Zafari, 2016). The combustion metabolites of crack cocaine cross the placental barrier and cause prolonged effects on embryos and fetuses (Bell and Lau, 1995). During the gestational period, the crack cocaine acts on the maternal and fetal central nervous system (CNS), hindering the reuptake of dopamine, noradrenaline, and serotonin by presynaptic terminals, increasing the effects on effector organs (Kessler and Pechansky, 2008).
Crack users suffer the effects of cocaine present in the drug and the action of other active compounds from its pyrolysis. An emergent fact is an increase in the number of pregnant crack cocaine users. Studies suggest that crack cocaine and its metabolites cross the placenta, promoting premature birth, fever, irritability, sweating, and seizures in the early months of life. In children, the effects of crack cocaine have been associated with cognitive deficits, difficulty in verbalization, aggressiveness, and depression, besides enhancing the susceptibility to epileptic seizures, including status epilepticus (SE) in adulthood. Therefore, we investigated the effect of maternal exposure to smoke crack cocaine on several behavioral parameters in the offspring during adulthood. A series of behavioral tests and intrahippocampal pilocarpine (H-PILO) microinjection at sub-convulsive and convulsive doses in a rat model demonstrated that exposure to crack cocaine during the embryonic period leads to anxiogenic-like behavior and long-term memory impairment in both genders and promotes depressive-like behavior in the female. Besides, crack cocaine offspring exposed to a sub-convulsive H-PILO dose showed higher susceptibility to SE, increased seizure frequency, and neurodegeneration, while animals that received a convulsive dose of H-PILO displayed no alteration in SE severity. Taken together, our data suggest that crack cocaine exposure during the gestational period leads to an increased predilection for anxiety and depression, long-term memory deficits, and reduction in the threshold for developing epileptic seizures associated with neuronal death, which predispose crack cocaine babies to develop neuropsychological disorders.
Chemical evidence of prehistoric passive tobacco consumption by a human perinate (early Formative Period, South-Central Andes)
2018, Journal of Archaeological Science
Citation Excerpt :
Extrapolation from this line to the cotinine concentration found in the perinate suggests a consumption by the mother of the equivalent to more than 70 cigarettes per day. This high level of tobacco consumption by the perinate's mother might have led to a misscarriage since tobacco consumption by pregnant women is strongly associated to spontaneous abortions and perinatal deaths (Aliyu et al., 2007; Bell and Lau, 1995; Cui et al., 2016; DiFranza and Lew, 1995). Ethnographic accounts reveal that during rituals South American shamans may consume huge quantities of tobacco.
Consumption of psychoactive substances is a long-standing tradition among indigenous peoples of the Americas. Archaeologically, consumption of tobacco has been shown through analysis of archaeological smoking pipe residues, mummy hair and dental calculus. Analysis of the hair of a perinate recovered from a rock shelter in Northern Chile and dated ca. 2400 yrs BP showed the presence of nicotine and its main metabolic product, cotinine. Quantitative segmental hair analysis showed that nicotine was taken up from the mother via the placenta and not through breast milk and that the death of the perinate occurred soon before or at the time of delivery. The analysis also indicated that the mother consumed high quantities of tobacco, suggesting she was a “tobacco shamaness” who might have experienced a miscarriage, since tobacco consumption by pregnant women is strongly associated to spontaneous abortions and perinatal death. Thus, at the dawn of pastoralism and agriculture in the highlands of the Atacama Desert, female individuals were already intensively consuming this psychoactive plant, transmitting its signals, and perhaps its lethal effects, to a child during gestation. This is the first evidence of simultaneous presence of nicotine and cotinine in pre-Hispanic bioanthropological remains from the Americas, thus constituting unequivocal direct evidence of tobacco consumption, and it refers to the currently earliest and youngest passive tobacco consumer in the Americas.
Anesthesia in drug addiction
2011, Revista Espanola de Anestesiologia y Reanimacion
The growing social problem of drug abuse has increased the likelihood that anesthesiologists will find acute or chronic drug users among patients requiring anesthesia for elective or emergency surgery. We must therefore be aware of the effects drugs have on the organism and their possible pharmacokinetic and pharmacodynamic interactions with anesthetic agents in order to prevent complications during surgery and postoperative recovery. Such knowledge is required for the management of abstinence syndrome or overdose, which pose the greatest potential dangers for the hospitalized drug addict.
El consumo de drogas es un problema creciente en la sociedad actual. Las probabilidades de encontrar pacientes bajo efecto agudo o crónico de estas sustancias, que requieran tratamiento quirúrgico y por lo tanto anestésico de manera electiva o de urgencia, son cada vez mayores. Esto hace necesario conocer los efectos que estas sustancias ejercen sobre el organismo, así como las posibles interacciones farmacocinéticas y farmacodinámicas con los distintos fármacos utilizados en la anestesia, evitando complicaciones tanto en el quirófano, como en el periodo postoperatorio. Este conocimiento es necesario para el anestesiólogo a fin de manejar el síndrome de abstinencia o la sobredosis, que son los mayores peligros potenciales para el paciente drogodependiente durante su estancia en el hospital.
If nicotine is a developmental neurotoxicant in animal studies, dare we recommend nicotine replacement therapy in pregnant women and adolescents?
2008, Neurotoxicology and Teratology
Citation Excerpt :
Superimposed on active maternal smoking, fetal exposures occur via environmental tobacco smoke (ETS), which involves approximately 35% of all pregnancies [93] and contributes significantly to adverse outcomes [7,48,64,157,163,195]. The cost of tobacco-related developmental damage includes immediate perinatal events, such as spontaneous abortions, intrauterine growth retardation and perinatal deaths, and Sudden Infant Death Syndrome, but the consequences extend much further, encompassing subsequent learning disabilities, cognitive dysfunction, behavioral problems, attention deficit hyperactivity disorder, psychiatric disorders, conduct disorders, criminal behaviors and school and career failure [18,25,40,42,43,49,78,97,129–131,152,162,167,238,239]. It is obvious that a successful approach to smoking cessation for pregnant women would have a major impact on public health.
Tobacco use in pregnancy is a leading cause of perinatal morbidity and contributes in major ways to attention deficit hyperactivity disorder, conduct disorders and learning disabilities that emerge in childhood and adolescence. Over the past two decades, animal models of prenatal nicotine exposure have demonstrated that nicotine is a neurobehavioral teratogen that disrupts brain development by preempting the natural, neurotrophic roles of acetylcholine. Through its actions on nicotinic cholinergic receptors, nicotine elicits abnormalities of neural cell proliferation and differentiation, promotes apoptosis and produces deficits in the number of neural cells and in synaptic function. The effects eventually compromise multiple neurotransmitter systems because of the widespread regulatory role of cholinergic neurotransmission. Importantly, the long-term alterations include effects on reward systems that reinforce the subsequent susceptibility to nicotine addiction in later life. These considerations strongly question the appropriateness of nicotine replacement therapy (NRT) for smoking cessation in pregnant women, especially as the pharmacokinetics of the transdermal patch may actually enhance fetal nicotine exposure. Further, because brain maturation continues into adolescence, the period when smoking typically commences, adolescence is also a vulnerable period in which nicotine can change the trajectory of neurodevelopment. There are also serious questions as to whether NRT is actually effective as an aid to smoking cessation in pregnant women and adolescents. This review considers the ramifications of the basic science findings of nicotine's effects on brain development for NRT in these populations.
Substance use before or during pregnancy and the risk of child mortality, perinatal morbidities and congenital anomalies
2023, Epidemiology and Psychiatric Sciences

View all citing articles on Scopus

: Address reprint requests to: Gary L. Bell, MD, Division of Neonatology, T. C. Thompson Children’s Hospital, 910 Blackford Street, Chattanooga, TN 37403

View full text

Perinatal and Neonatal Issues of Substance Abuse

Lancet

Drug Alcohol Depend

Am J Obstet Gynercol

J Pediatrics

J Pediatr

Am J Obstet Gynecol

Neurotoxicol Teratol

J Pediatr

J Pediatr

J Pediatr

J Pediatrics

Am J Obstet Gynecol

J Pediatr

Neurotoxicol Teratol

J Pediatrics

J Pediatr

J Pediatr

J Pediatr

J Pediatr

Neurotoxicol Teratol

Neurotoxicol Teratol

Neurotoxicol Teratol

J Pediatr

Am J Obstet Gynecol

J Pediatr

The Lancet July

Am J Obstet Gynecol

Am J Clin Nutr

J Pediatr

J Pediatr

Am J Obstet Gynecol

Am J Obstet Gynecol

Neurotoxicol Teratol

The Lancet

J Pediatr

The Lancet July

J Pediatr

Smoking during pregnancy: a review of effects on growth and development of offspring

Hum Biol

Possible teratogenic effect of cigarette smoking

Nature

Maternal narcotic abuse and the newborn

Arch Dis Child

Cigarette, alcohol, and coffee consumption and spontaneous abortion

Am J Public Health

Children of alcoholic mothers

Pediatrician

Analysis of facial shape in children gestationally exposed to marijuana, alcohol, and/or cocaine

Pediatrics

The effects of moderate alcohol consumption during pregnancy on fetal growth and morphogenesis

J Pediatr

Lack of abnormalities in a newborn exposed to amphetamine during gestation

Am J Dis Child

Evaluation of auditory brain-stem response in full-term infants of cocaine-abusing mothers

Am J Dis Child

The moro reaction: A scoring system for neonatal narcotic withdrawal

Developmental Medicine & Child Neurology

Clinical and laboratory observations: Perinatal cerebral infarction and maternal cocaine use

J Pediatrics

Maternal cocaine use and genitourinary tract malformations

Teratology

Cocaine/polydrug use in pregnancy: Two-year follow-up

Pediatrics