Pregnancy: the Effects of Alcohol and Substance Abuse Essay

Abstract This paper examined the effects of alcohol and substance abuse on fetal development in expecting mothers. The critical periods of fetal development during pregnancy are reviewed and discussed in order to determine the effects alcohol and substance can cause during certain stages. In order to gain a more efficient understanding of the effects different substances can have on fetal development the following substances were studied: (1) alcohol, (2) cocaine, (3) opioids, (4) nicotine (smoking), and (5) cannabis sativa (marijuana). Each substance (previously listed) examined was provided with supporting evidenced of past research. Developmental (i.e. physical and mental) impairments were found to be common amongst the general population of newborn infants and children exposed to alcohol and drug substances in utero. Use of alcohol and drug substances during pregnancy not only put expecting mothers own health at risk, but their fetuses as well. Providing expecting mothers with proper treatment for alcohol and substance use has proven to be an effective method in reducing the risk of impairing their fetus’s development (i.e. physical, and mental) during pregnancy and later into childhood. It is essential to provide general awareness to the public about the affects that alcohol and substance abuse can have on fetal development and help pregnant women seek proper care. Pregnancy: The Effects of Alcohol and Substance Abuse on Fetal Development Today alcohol and substance abuse is continuing to increase across the general population, particularly among expecting mothers (Cohen &Inaba, 2007). Many infants being born today suffer from severe physical, mental, and behavioral deformities and impairments due to alcohol and substance exposure in utero (Cohen & Inaba, 2007). Research has been continuously conducted in order to examine the effects different substances can have on a developing fetuses growth (i.e. physical, mental, and behavioral) in utero and after birth. The majority of their findings indicate a strong correlation between the time, type and amount of substances mothers use during their pregnancy and the effects it has on their fetuses (Cohen & Inaba, 2007). The purpose of this paper is to address these issues through several different concepts: (a) first, what are the critical levels of development in utero?, (b) an in depth review on substances associated with fetal impairments (i.e. alcohol, cocaine, opioids, nicotine, and cannabis sativa (marijuana)), supported by scientific evidence and possible treatment, and (d) identifying substance abuse in expecting mothers and reducing harm to the fetus. Critical Periods of Fetal Development The first critical period of fetal development is known as the germ cell period. This begins when a sperm and egg unite and their genetic information is fused together (Office of Children’s Health Protection, 2003). During this period exposure to any form of toxicant substances (i.e. alcohol and drug substances) can potentially harm the germ cells development. This can have a direct impact on not only the mother’s fertility, but also her future child’s health (Office of Children’s Health Protection, 2003). After the germ cells have developed past what is known as a single-cell zygote, they are now identified as a fetus (meaning they are capable of living outside of the mothers womb) and have reached the embryonic and fetal period of development (Office of Children’s Health Protection, 2003). The fetus grows increasingly fast during this period, because it is consider more vulnerable to environmental and substance exposures than during other stages o f development (Office of Children’s Health Protection, 2003). This is due to the fact that major organs are beginning to form, grow and develop, which will continue throughout the remainder of the pregnancy and infancy (Office of Children’s Health Protection, 2003). Disruption of development (i.e. environmental toxins and substances) during this period can cause major defects in the structure of developing organs (i.e. brain cellular structure, lungs, heart, kidney, and etc.), and other important structures (i.e. bones and muscles). This may result in the death of the fetus or cause severe physical malformations (i.e. congenital abnormalities) or mental impairments (i.e. disorders) (Office of Children’s Health Protection, 2003). As the stages of prenatal development progress, exposure to environmental toxins and substances can result in the fetus developing an array of defects and deficiencies that can continue after birth and up through adulthood (i.e. physical, mental, and behavioral) (Office of Children’s Health Protection, 2003). It is clear that expecting mothers need to be conscious of what they expose their fetuses to in utero so they develop properly. It is imperative that expecting mothers avoid the use of any alcohol or other drug substances during their pregnancy. Each period of development for a fetus is critical and exposure to alcohol and substances can significantly reduce their chance of being born and living a healthy life (Office of Children’s Health Protection, 2003). The Effects of Different Substances on Fetal Development Expecting mothers need to be cautious of what they expose their growing fetus to throughout the entire pregnancy. Disruption of proper fetal development can cause severe deformities in the fetus physically, mentally, and behaviorally (Cohen & Inaba, 2007). Expecting mothers ingest alcohol and drug substances leave their fetus susceptible to severe developmental impairments (Cohen & Inaba, 2007). The following areas will be covered in this section: (1) fetal exposure to alcohol, (2) fetal exposure to cocaine, (3) fetal exposure to opioids, (4) fetal exposure to nicotine, and (5) fetal exposure to cannabis sativa (marijuana). Fetal Exposure to Alcohol When expecting mothers consume alcohol they are immediately putting their fetus’s health at risk. Essentially they are leaving their fetus susceptible to not only structural deformities, but also a variety of fetal alcohol spectrum disorders (FASD) (Feldman, pg.76, 2011). Out of all of the FASDs, fetal alcohol syndrome (FAS) is the most common. Statistics indicate that over â€Å"0.33-2.9 cases per 1,000 births have FAS† (Cohen & Inaba, 2007). FAS typically results in the fetus developing the following problems: (1) severe abnormalities in physical, neurological and behavioral functioning and development, (2) severely reduced weight and cranium size, (3) deformities of the face and other body parts (otherwise known as dysmorphia), and (4) are at higher risk for Sudden Infant Death Syndrome (SIDS) (Feldman, pg.76, 2011). In essence exposure to alcohol can significantly affect a fetus internal and external body structure, can cause neurological and behavioral abnormalitie s, and even physical deformities. Research Kenneth Jones (1986) supports this assumption through his studies on FAS. Jones (1986) findings suggest that FAS effects the development of the fetus’s brain and facial/bodily structures during utero and after birth. Typically children will be diagnosed with moderate to severe mental retardation due to structural deformities in their the brain (i.e. microcephaly, short palpebral fissures, and etc.) or they will be identified as having severe facial dysmorphia (i.e. long smooth philtrum, thin vermilion of the upper lip, joint anomalies, altered palmar crease pattern, and etc.) (Jones, 1986). Jones (1986) concluded that over 40% of infants who are born are born to alcoholic mothers, whom are then diagnosed with FAS. However, it is possible for doctors to reduce the chances of children developing FAS and other FASDs through preventive forms of treatment. The majority of times children are more susceptible to developing FASD due to the doctors inability to clearly identify the expecting mothers level of drinking (Bakhireva & Savage, 2011). If physicians are given the capability to identify expecting mothers regular drinking patterns they can provide her with alternative methods to drinking and reduce the risk of her child develop an FASD (Bakhireva & Savage, 2011). Bakhireva & Savage (2011) found that in identifying expecting mothers drinking levels, physicians would be able to detect the fetus’s risk for developing FASD and other neurobehavioral disorders later in life and prevent it. Bakhireva & Savage (2011) findings suggest that there are biomarkers that are more sensitive to alcohol metabolism, which are capable of detecting the alcohol in tissue types for longer periods of time since the mother last drank. This will then assist physicians in diagnosing fetal alcohol exposure and possible damage to the fetus, which will then help them discern what preventive measures need to be taken. Developing new methods of detection and prevention of FASD is one of the most effective ways to help children avoid severe d evelopmental impairments. Expecting mothers also need to be informed of the damages that alcohol exposure can cause and seek the necessary care. Fetal Exposure to Cocaine Today over 558,000 expecting mothers abuse cocaine (Cohen & Inaba, 2007). The National Survey on Drug Use and Health (NSDUH)(2005) cited by Cohen & Inaba (2007) determined that there was a â€Å"4% rate of cocaine use among women in their first trimester, 3% among those in their second trimester, and 2% among those in their third trimester†. Because of this expecting mothers need to become aware of how cocaine can affect their developing fetus. Typically the stimulants in cocaine affect the fetus’s heart, which leads to blood vessel to constriction. This causes unhealthy elevations of blood pressure in both the mother and fetus (Cohen & Inaba, 2011). For the fetus there life is put at great risk. This is because the mother’s body will stop the flow of any blood, nutrients, or oxygen from reaching the fetus and can cause retarted fetal development or even a stroke within the fetus’s brain (Cohen & Inaba, 2007). This type of constriction can also increase th e chances of the mother having a spontaneous abortion (due to the separation of the placenta from the uterine wall) or a premature delivery (in some cases (typically the third trimester) cocaine can induce labor) (Cohen & Inaba, 2007). Even when an infant makes it through delivery the majority of them suffer from severe withdrawal symptoms. Signs of withdrawal typically consist of: (1) extreme agitation and irritability, (2) hyperactive movement and high respiratory rates, (3) seizures and tremors, and (4) uncontrollable sweating and crying (Cohen & Inaba, 2007). Although physical deformities are common amongst the majority of substances infants are exposed do during utero, cocaine has been found to cause the most damage neurologically. Typically children exposed to cocaine show an increase in â€Å"neurobehavioral disorganization, irritability, and poor language development† (Cohen & Inaba, 2007). In fact researchers Brown, Bakeman, Coles, Sexson, & Demi (1998) studied the effects of cocaine and alcohol exposure during utero on mother’s newborn infant’s and how it affected their birth weight, length, ponderal index, and irritability levels. Researchers found that exposed infants showed an increase in fetal growth deficits, infant orientation, and irritability and a decrease in respiratory rate and proper motor development (only affected by cocaine exposure) (Brown, Bakeman, Coles, Sexson, & Demi, 1998). Cocaine exposure clearly has a severe effect on fetal development. Therefore it is essential that preventive techniques be discussed and reviewed for expecting mothers who are using. Just like alcohol use, there are methods to testing expecting mothers for cocaine use. The most commonly used methods are urine toxicology and serum toxicology, which helps detect â€Å"metabolite benzoylecgonine† (substance found in cocaine) from 72 hours to two weeks after the mother has used (Bhuvaneswar, 2008). In the majority of states today it is mandatory for expecting mothers to be routinely screened for drug use during prenatal doctor visits. In some states a positive test before delivery results in the arrest and incarceration of the expecting mother (Bhuvaneswar, 2008). Most health care providers, however, have argued that women should be given proper drug counseling, confidential screening, and referral for treatment and case management rather than criminal penalties (Bhuvaneswar, 2008). That way expecting mothers can receive the necessary treatment to help make sure the fetus is not harmed anymore than it already has. Essentially when it comes to cocaine use, expecting mothers, and what preventive measures to take, proper screening and treatment are most effective in making sure a fetus develops properly and is born healthy. Fetal Exposure to Opioids Opioids are the most common substance used by expecting mothers. Heroin and methadone are the two most abused. It is assumed that each year there are over 7000 opiate-exposed babies being born (Bhuvaneswar, 2008). Typically expecting mothers will continue to use opioids throughout their pregnancy. When expecting mothers use opioids it usually takes less than one hour for the substance to reach the placental barrier. After only 6 hours it is common for not only the mother to experience withdrawal symptoms, but her fetus as well (Bhuvaneswar, 2008). As the mother goes through withdrawal the substance epinephrine may increase in the amniotic sacks fluid, which could cause severe damage to the growing fetus (Bhuvaneswar, 2008). Continued use of opioids throughout a pregnancy usually results in the following: (1) fetal growth retardation, (2) premature abruption of the placenta (which leads to premature delivery, spontaneous abortion, miscarriage, or stillbirth), (3) neurobehavioral abnor malities (i.e. abnormal sleep patterns, behavioral problems, poor motor skills, learning disorders, mental retardation, and others), and (4) greater risk for Sudden Infant Death Syndrome (SIDS) (Cohen & Inaba, 2007). In some cases opioid use can cause the infant to experience Neonatal Abstinence Syndrome (NAS) (severe withdrawal after delivery). It can last from 48-72 hours to days, weeks, or even months. It all depends on how much the mother exposed her infant to during utero (Cohen & Inaba, 2007). Symptoms of NAS are much more intense than an infant who may be withdrawing from nicotine or marijuana. When an infant is experiencing NAS they will exhibit the following characterisitcs: (1) extreme hyperactivity, agitation and irritability, (2) high-pitched crying, sweating and tremors, (3) intense muscle spasms, (4) restlessness, (5) increased respiration, (6) vomiting, and diarrhea, and (7) severe seizures, which may lead to death (Cohen & Inaba, 2007). If an infant successfully makes is through withdrawal they are capable of being cleaned of any opioid substance that they were exposed to during utero. Just as there are preventive measures for expecting mothers using alcohol or cocaine, there are preventive measures for mothers who use opiates. Today there are several clinical options for management of opiate use during pregnancy: (1) methadone maintenance, (2) the use of buprenorphine and naltrexone, and (3) opioid detoxification (usually done during the mothers second trimester) (Bhuvaneswar, 2008). Although not all risks to the fetus are eliminated with these types of treatment, the use of methadone, buprenorphine and naltrexone does help reduce the amount of spontaneous abortions and transmission of infections that opiate use usually causes (Bhuvaneswar, 2008). The main purpose of these methods is to essentially stop the mother from using altogether and reduce the chances of NAS when the child is born. If the expecting mother is able to detox and stop opiate use the chances of her child being born healthy is greater. Fetal Exposure to Nicotine There are over 2,000 different compounds that can be identified in one cigarette. Regardless of the many unhealthy substances contained in one cigarette, more than 17% of expecting mothers still smoke throughout their pregnancy (Cohen & Inaba, 2007). Cigarettes contain both nicotine and carbon dioxide. Which are two known compounds capable of crossing over the placental barrier during pregnancy and reducing the fetuses supply of oxygen (Cohen & Inaba, 2007). However, restriction of oxygen to the fetus is only one concern. The expecting mother is also increasing her chances of having a premature delivery, miscarriage, or even a stillbirth. Nevertheless, premature births are the most common occurrences among expecting mothers who smoke (Cohen & Inaba, 2007). Infants who are born prematurely are abnormally small â€Å"on average they weigh, 7 ounces less, are 1.4 centimeters shorter, and have a smaller head circumference compared with babies of nonsmoking and non-drug-abusing mothersâ €  (Cohen & Inaba, 2007). Although less common than exposure to other drug substances, smoking can cause a variety of defects. The most typical are as follows: (1) congenital abnormalities (heart malformation, cleft lip/palate), (2) brain damage and nerve damage, (3) depressed immune system, (4) poor cognitive abilities (i.e. learning disabilities), and (5) increase chance of Sudden Infant Death Syndrome (SIDS) (Cohen & Inaba, 2007). Typically though cognitive abilities are most likely to be impaired. In fact researcher Karen Law (2003) studied the effects nicotine exposure can have on a fetuses neurobehavioral development after birth. Law (2003) found that the infants who were exposed to nicotine during utero were more excitable and hypertonic and showed higher stress levels and abstinence signs when born. Shea & Steiners (2008) research on the effects of prenatal exposure to nicotine found the same results as Law (2003). Shea and Steiners (2008) findings indicated that the nicotine from cigarettes directly affects the fetus’s placental vasculature. This can lead to cognitive and learning deficits in childhood and adolescents, increased risk of hypoxia induced brain damage, and an increased chance of perinatal mortality or even sudden infant death syndrome (SIDS) (Shea & Steiner, 2008). Law (2003) and Shea and Steiner (2008) suggest that pregnant women need to avoid smoking during pregnancy in order to prevent serious impairments in neurodevelopment of their fetus. To the majority of expecting mothers exposing their fetuses to nicotine seems much less irresponsible than if they were to expose them to a substance like cocaine or heroine. However, research shows that smoking can and will affect expecting mothers children. May be not to the same extent as cocaine or heroine, but to a point where your child will still be incapable of proper development. Fetal Exposure to Cannabis Sativa (marijuana) It is said that over 17% of expecting mothers smoke marijuana (Cohen & Inaba, 2007). Some mothers condone their use of marijuana throughout their pregnancy, because it is said to help reduce pain when labor occurs. Many people would suggest that the majority of studies today imply that the use of marijuana during pregnancy causes only minimal side effects to the overall health of a fetus. Therefore, it is acceptable for mothers to use when pregnant. This is not true. Jutras-Aswad, DiNieri, Harkany, & Hurd, (2009) studied the use of marijuana during pregnancy and the affects it can have on the fetus during utero and after birth. Researchers did this by examining the endocannabinoid (eCB) system and the effects it has on children’s behavior and mental health. Research indicated that eCB has a direct effect on the fetuses’ central nervous systems (CNS) patterning by influencing migration, survival, and differentiation of committed neurons. Researchers discovered that eCB affects the neuronal systems that control mood, cognition, reward, and goal directed behavior. This then effects the fetus’s brain development, which leaves them vulnerable to severe behavioral problems and neuropsychiatric disorders more so than others after birth. After reviewing this research it obvious that marijuana can have a direct impact on the fetuses brain development (Jutras-Aswad, DiNieri, Harkany, & Hurd, 2009). Although the affects may not be apparent during a mother’s pregnancy, they are clearly identified later in infancy and childhood. In fact previous research conducted by Richardson, Day, and Goldschmidt (1995) studied the effects of marijuana use during pregnancy. Children who had been exposed to marijuana during utero were assessed repeatedly during the neonatal period until the age of six. Results indicated that prenatal marijuana exposure became apparent around ages four through six. There was an increase in childre n’s behavioral problems (i.e. affected their goal directed behavior, planning, organized search, and impulse control) and a decrease in their performance on visual perceptual tasks, language comprehension, sustained attention, and memory (Cohen & Inaba, 2007). These findings support the theory that marijuana use during pregnancy can have an effect on children’s neurological development (Cohen & Inaba, 2007). So like many other drugs, it is strongly recommended that expecting mothers avoid the use of marijuana. Identifying & Providing Treatment for Substance Abuse in Expecting Mothers After reviewing the effects of alcohol and other drug substances on fetal development it is evident that expecting mothers need to abstain from substance use throughout their pregnancies. Rassool & Villar-Luis (2006) further support this assumption through their review on the effects that substance abuse can have on fetal development. Researchers identified several drug substances (i.e. alcohol, cocaine, opioids, nicotine, and cannabis) and found direct causes each substance has on expecting mother’s fetuses after birth. Researchers discovered the following primary concerns for each substance: (1) alcohol use can lead to fetal alcohol syndrome an d possible miscarriage of the fetus, (2) cocaine, opioids, and nicotine can cause perinatal complications and unwanted abortions, and (3) cannabis sativa (marijuana) can cause perinatal complications (miscarriage), intrauterine growth restrictions, abruption placentae, pre-term deliveries, and neurobehavioral abnormalities. After reviewing each substance and potential damage it can cause the Rassool & Villar-Luis (2006) suggest that different measures of prevention should be taken by expecting mothers to reduce the risk of harming their fetus. There are forms of prevention and treatment to help expecting mothers reduce the risk of harming their fetus’s development. The most efficient way to help expecting mothers find treatment is through using the necessary screening techniques in which physicians can identify alcohol or substance abuse (Cohen & Inaba, 2007). By doing so physicians can provide proper intervention, treatment, and preventive services to substance abusing mothers (Cohen & Inaba, 2007). Typically expecting mothers who use drugs during pregnancy are classified as â€Å"AODs† (i.e. â€Å"pregnant women who use alcohol and other drugs†). The most commonly used instrument to identify AODs was developed by Dr. Ira Chasnoff (Cohen & Inaba, 2007). It is known as the 4Ps Plus Instrument, which consists of four basic questions that essentially help identify AODs (Cohen & Inaba,2007). The questions are listed below: 1.) Did either of your parents ever have a problem with alcohol or drugs? 2.) Does your partner have problem with alcohol or drugs? 3.) Have you ever drunk beer, wine, or liquor? 4.) In the month before you knew you were pregnant, how many cigarettes did you smoke? In the month before you knew you were pregnant, how much beer, wine, or liquor did you drink? Once women with AOD are identified they can properly be treated in order to protect the mother and the growing fetus. Treatment may not seem effective once the expecting mother has already exposed her fetus to alcohol or other substances, but that is not true. Although the fetus is still at risk for some developmental damage it is still possible to stop any more from occurring if the mother stops using. Researchers Mayet, Morgan, MaCormack, & Strang (2008) have support for this assumption through their assessment of mothers who exposed their children to substances during utero and then proceeded to attended perinatal addiction treatment throughout the remainder of their pregnancy. Researchers administered a cross-sectional audit of health-care records in order to compare the outcomes of women in 2002â€⠀œ2005 with data from 1989–1991 and the local (i.e. non-substance abusing women) maternity population in 2004–2005. Research found that less newborns required treatment for neonatal abstinence syndrome (NAS) in 2002–2005 compared to 1989–1991. However, there were higher rates of miscarriages, low birth weights, and premature infants, compared to the local maternity population between 2004–2004. Findings suggest that perinatal addictions treatment can be extremely beneficial to mothers abusing substances. It lowers the risk of the mother harming her fetus by reducing the amount of drug substances she exposes her fetus to. It also suggests that addiction treatments are becoming more evolved and are better servicing people compared to 1989-1991. In helping women become abstinent from substance use during their pregnancy it will help both them and their child live a healthier life during and after birth. Conclusion In conclusion, it is clear that alcohol and substance use is an increasing problem for the population of expecting mothers. As discussed in the paper the majority of expecting mothers are exposing their fetuses to the followings substances: (1) alcohol, (2) cocaine, (3) opioids, (4) cigarettes (nicotine), and (5) cannabis sativa (marijuana). Expecting mothers are unaware that they are putting their growing fetus at risk for severe developmental deformities and impairments (i.e. physical, mental, and behavioral) due to such exposure in utero and after birth. Not only that, but mothers are increasing their chances of premature deliveries, miscarriages, spontaneous abortions, and stillbirths. Even if their child makes it through delivery the majority of them experience severe Neonatal Abstinence Syndrome (NAS), Sudden Infant Death Syndrome (SIDS), or are born with disorders like fetal alcohol syndrome (FAS) (Cohen & Inaba, 2007). However, there are preventive measures that can be taken to avoid substance-abusing mothers risking their fetus’s developmental health. If physicians are able to identify expecting mothers substance use they will be able to give them proper a treatment and care. This will help reduce the chances of the mother impairing her fetus’s development any further (Cohen & Inaba, 2007). Mothers will also be able to get â€Å"clean† and raise their child in a healthy environment. Although it may seem impossible, there are ways to help expecting mothers properly nourish their child back to health even when it comes to substance abuse. References Bakhireva, L. N., & Savage, D. D. (2011). Focus on: Biomarkers of fetal alcohol exposure and fetal alcohol effects. Alcohol Research & Health, 34(1), 56-63. Bhuvaneswar, Chaya (2008). Cocaine & opioid use during pregnancy: Prevalence & Management. Prime Care Companion J. Clinical Psychiatry. 10(1): 59–65. Brown, J. V., Bakeman, R., Coles, C. D., Sexson, W. R., & Demi, A. S. (1998). Maternal drug use during pregnancy: Are preterm and full-term infants affected differently?. Developmental Psychology, 34(3), 540-554. doi:10.1037/0012-1649.34.3.540 Cohen, W.E., & Inaba, D.S. (2007). Uppers, downers, all arounders (6th ed.). Medford, OR: CNS publications, Inc. Feldman, R. S. (2011). Development across the life span (6th ed.). Upper Saddle River, NJ: Pearson/Prentice Hall. ISBN:0558937071. Jones, K.L. (1986). Fetal alcohol syndrome. Department of Pediatrics; 8:122-126. Jutras-Aswad, D., DiNieri, J. A., Harkany, T., & Hurd, Y. L. (2009). Neurobiological consequences of maternal canna bis on human fetal development and its neuropsychiatric outcome. European Archives Of Psychiatry And Clinical Neuroscience, 259(7), 395-412. doi:10.1007/s00406-009-0027-z Law, K.L. (2003). Smoking during pregnancy and newborn neurobehavior. Pediatrics Vol. 111: 1318-1323. Mayet, S., Groshkova, T., Morgan, L., MacCormack, T., & Strang, J. (2008). Drugs and pregnancy—Outcomes of women engaged with a specialist perinatal outreach addictions service. Drug And Alcohol Review, 27(5), 497-503. doi:10.1080/09595230802245261 Rassool, G., & Villar-Luà ­s, M. M. (2006). Reproductive risks of alcohol and illicit drugs: An overview. Journal Of Addictions Nursing, 17(4), 211-213. doi:10.1080/10884600600995242 Shea, A. K., & Steiner, M. (2008). Cigarette smoking during pregnancy. Nicotine & Tobacco Research, 10(2), 267-278. doi:10.1080/14622200701825908 The Office of Children’s Health Protection (2003).Critical periods in development. ICF Consulting, Inc.