Risk Factors

Alcohol

• Alcohol is teratogenic
• An occasional drink during pregnancy carries no known risk
• Fetal alcohol syndrome (FAS) may occur with chronic exposure to alcohol in the later stages of pregnancy. Features  may include :
  • Growth retardation
  • Central nervous disfunction :
    • Microcephaly
    • Mental retardation
    • Abnormal neurobehaviour (hyperactivity disorder)
• Facial anomalies :
  • Small palpebral  fissures
  • Indistinct / Absent philtrum
  • Epichantic folds
  • Flattened nasal bridge
  • Short length of nose
  • Thin upper lip
  • Low set, unparallel ears
  • Retarded midfacial development

Tobacco

• The leading preventable cause of low birth weight
• Smoking is associated with decreased birth weight and increased prematurity
• There is a positive association between sudden infant death syndrome and smoking
• Use of nicotine patch is controversial

Marijuana

• No evidence of significant teratogenesis in humans
• Metabolites detected in urine of users for days to weeks
• Commonly used by multiple substance abusers; thus. Its presence in urine may identify patients at high risk for being current users of substances as well

Cocaine

• Pregnancy does not increase one’s suspectibility to cocaine’s toxin effects
• Complication of pregnancy :
  • Spontaneous abortion and fetal death in utero
  • Preterm labor and delivery
  • Meconium stained amniotic fluid
  • Teratogenic effects of cocaine :
    • Growth retardation
    • Microcephaly
    • Neurobehavioral abnormalities ; impairment in orientation and motor function

Opiates

Heroin

• Three to sevenfold increase in incidence of stillbirth, fetal growth retardation, prematurity, and neonatal mortalitiy
• Signs of infant withdrawal occur 24 to 72 hours after birth
• Treatment with methadone improves pregnancy outcome

Newborn infants born to narcotic addicts are at risk for severe, potentially fatal narcotic withdrawal syndrome, characterized by :

• High pitched cry
• Poor feeding
• Hypertonicity or tremors
• Irritability
• Sneezing
• Sweating
• Vomiting
• Seizures

Hallucinogens

• No evidence that lysergic acid diethylamide or other hallucinogens cause chromosal damage or other deleterious effects on human pregnancy
• There have been no studies on the potential long term effects on neonatal neurodevelopment

Amphetamines

Crystal methamphetamine, a potent iv stimulant has been associated with :

Decreased fetal head circumference

• Placental abruption
• Intrauterine growth retardation
• Fetal death in utero