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Substance abuse always takes a toll on an addict's health. When the person abusing drugs is pregnant, it brings a new person — the fetus — into that risky fold. What effects can various drugs have if used during pregnancy?

Women make up a minority of drug users — four in 10 people with substance use disorders are estimated to be female. Most female drug addicts are, however, in their reproductive years. When those women become pregnant, they may do everything in their power to get off the drugs immediately, or they may not. About six percent of expectant mothers abuse illegal drugs. More — 16 and 8.5 percent respectively — smoke cigarettes or drink alcohol. 

In the US alone, around 380,000 babies are born to drug-addicted mothers each year, and research indicates that the situation isn't much better in other developed countries. 

What happens when a pregnant woman is also a drug addict? How can illegal drugs affect her and her baby? This will, of course, vary greatly depending on the substance used, so let's dive right in. 

How can marijuana use affect pregnancy?

Often seen as a fairly benign drug, some pregnant women may even form the impression that marijuana — now used for medicinal reasons — could have some positive effects. They'd be wrong. Given the fact that research indicates that more and more women are now using weed while pregnant, it's important to be aware of the risks. (The same risks apply if you were hoping to use marijuana to reduce morning sickness; you don't have to have a marijuana use disorder to be putting your baby at risk by using cannabis.)

Smoking cannabis, or using weed in some other form, during pregnancy has been associated with a wide range of negative health outcomes, increasing the risk of:

  • Premature labor and birth.
  • A low birth-weight baby.
  • Poorer brain development in children.
  • Attention and behavior problems later in life for the baby.
  • Needing to be admitted to the NICU.
  • Still birth — to the tune of 2.3 times. 

The potential consequences of opioid use in pregnancy

Opioids include heroin, but also numerous prescription drugs like fentanyl, oxycodone, hydrocodone, and morphine. Used during pregnancy, they can lead to extremely serious consequences, including:

  • Neonatal abstinence syndrome, wherein the baby goes into withdrawal after birth. This serious condition affects anywhere between 45 and 94 percent of babies born to opioid-addicted mothers. While it can be treated, neonatal abstinence syndrome itself constitutes a medical emergency and can even become fatal.
  • Low birth weight in babies. 
  • Respiratory problems in babies. 
  • Growth delays later in the baby's life. 
  • Microcephaly, a small brain. 
  • Sudden infant death syndrome. 
  • Bleeding during the third trimester of pregnancy. 

Opioid use during pregnancy poses a very serious threat to the health of a fetus and the baby that later results. It is important for pregnant women who are addicted to any kind of opioids to be open about this with their healthcare providers, so a medical plan can be put in place to manage withdrawal in the safest way possible and prenatal care can be stepped up a few notches. 

What can using cocaine during pregnancy do to a baby?

Cocaine abuse during pregnancy has been associated with numerous negative outcomes:

  • Waters that break early, requiring induction or c-section, leading to premature birth.
  • Placental abruption, during which the placenta separates from the uterus before a baby is born. This is extremely dangerous. 
  • Preeclampsia, a another dangerous condition characterized by extremely high blood pressure combined with protein in the urine.
  • Again, small babies and premature babies. 
  • For mothers, migraines and seizures.

It is, however, not yet clear how the abuse of cocaine and other stimulants during pregnancy may affect babies in the long term. 

Let's not forget about the 'legal drugs': Alcohol and tobacco in pregnancy

You may be able to buy alcohol and cigarettes legally, but that doesn't mean using them during pregnancy is any less harmful than the abuse of illegal substances. 

There is no safe drinking limit during pregnancy — that is, no amount of alcohol has been proven to be safe for a developing fetus. Heavy drinking has been associated with outcomes ranging from behavioral and cognitive problems and fetal alcohol syndrome all the way to miscarriage and stillbirth. 

Tobacco is another killer. It's well-known that babies born to smokers are more likely to be smaller than expected for their gestational age, but smoking during pregnancy can also lead to ectopic pregnancy (outside the uterus — nearly always unviable), behavioral problems in children, placental abruption, and ultimately stillbirth. Smoking while pregnant more than doubles the risk that a baby will be born dead. 

What should you take away from all of this?

Substance abuse always poses the risk of adverse health outcomes. Substance abuse during pregnancy exposes another person — the fetus — to those risks. The exact nature of possible complications varies greatly from one substance to the next, as we have seen, and the full spectrum of potential outcomes isn't always known. The risks of MDMA use during pregnancy still need to be studied further, for instance, and many more illegal drugs exist than we covered here. Barbiturates and benzodiazepines are, to name two, also known to have the potential to cause withdrawal in newborns. 

Regardless of the substance a woman is addicted to:

  • It would be an understatement to say that seeking help for the addiction before getting pregnant is ideal. This is especially true for substances that induce physical withdrawal syndromes, such as opioids, which can be difficult to manage. 
  • If you are pregnant and a substance addict, or someone you care about falls into this category, it is crucial to receive proper prenatal care. The woman's healthcare team should be aware of the substance use so risks can better be managed. 
  • Treatment for substance abuse in expectant mothers is available, and focuses on behavioral therapies. 

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