Addiction Treatment Blog

It is as natural to die as to be born; and to a little infant, perhaps, the one is as painful as the other.

Sir Francis Bacon, 1561-1626, Essays, ‘Of Death’.

Drug Abuse in Pregnancy

It is particularly difficult to study drug abuse in human pregnancy. There are a number of reasons for this.

• Recruitment. Suitable women may be difficult to identify because they may feel guilty about their drug taking, be afraid to tell healthcare staff about illegal drug use and be frightened of reproaches from relatives should this come to light.
• Confounding. The lifestyle of many women who abuse drugs may already predispose them to an adverse pregnancy outcome, e.g. living conditions, general health, reproductive health, nutritional status and socioeconomic group. Separating environmental and personal confounders is particularly difficult when trying to follow-up drug-exposed infants after birth.
• Multi-drug use. It is almost impossible to study any single drug of abuse in complete isolation because multi-drug use is common. Tobacco and alcohol alone are frequently consumed by those who abuse street drugs, and these are known to have adverse effects upon the foetus.
• Identification. Many drug abusers do not know exactly what they are taking, either in terms of identity (due to adulteration) or in terms of dose (due to impurity and dilution).
• Collecting data. Usually studies rely on maternal recall of the extent and nature of drug use during pregnancy and this may not be reliable.
• Changing use. The pattern of use may change during the pregnancy. Mothers may increase or decrease dose or frequency.

Apart from the pharmacological effects that are directly to specific to the developing foetus, drugs of abuse can affect the foetus in other ways. Those who inject drugs during pregnancy are at increased risk of becoming infected with HIV if they share injecting equipment. This can be passed on to the foetus. Any serious drug-related maternal illness may threaten the health of mother or foetus during pregnancy, e.g. seizures due to cocaine, hyperpyrexia due to ecstasy, liver damage due to alcohol, septicaemia due to non-sterile injection and accidents due to intoxication with any drug.

Perhaps the most difficult area of all study is the effect of in utero drug exposure upon later childhood development. Subtle drug-induced neurological damage to the developing foetus which may not be noticeable at birth, could result in physical, emotional, psychiatric or behavioural problems which might only be apparent later in life when the association with maternal drug abuse can no longer be made. Once out of the womb, there are a large number of potentially confounding variables which can interfere with study in this area.

Clearly it is preferable if women who abuse drugs can stop taking them before conception. However, in reality this does not occur because pregnancies are unplanned, women do not understand the risks of continued abuse or because mothers are physically dependent and cannot stop without support. In these situations it can be helpful to inform mothers of the potential risks to their babies. This chapter aims to provide this information in a reasonably succint way.

Drug Abuse in Breast-feeding Women

All drugs passes into human milk to some extent and, ideally of course, drugs of abuse should not be taken whilst breast-feeding. Unfortunately, for most drugs of abuse there is very little information available on the extent of drug passage into milk and the effects upon the infant. Most of the data comes from case histories in medical literature and, as with most biological and pharmacological processes, there is a potentially large inter-patient variation in the kinetics of drugs lacting women. The small number of reports may therefore be unrepresentative. Three basic factors which affect the extent of penetration into human milk are the following.

1. Drugs that are highly protein bound in plasma tend to cross into milk in much smaller amounts than those which are not bound so extensively.
2. Fat-soluble drugs can concentrate into the lipid phase of milk (although this phase is a small proportion of the total volume).
3. Weak bases tend to concentrate in milk because it is slightly acidic relative to plasma.

Most of the drugs of abuse considered here are largely metabolised in the liver. Liver metabolism can be markedly deficient in babies, especially if they are premature. This may allow accumulation. Babies are also more sensitive than adults to most drugs that act on the central nervous system (CNS) and, again, prematures are especially sensitive to this effect. However, when deciding whether it is wise for a nursing mother taking drugs to breast feed, it is important to consider other factors besides milk penetration by the drug. One could take the view of the American Academy of Pediatrics that nursing mothers should not ingest any drugs of abuse whilst breast feeding because drugs could be hazardous to the infant and to the physical and emotional health of the mother. This is obviously the ideal situation but it is unrealistic because in practice some women are dependent upon drugs or will simply want to take them regardless, and will have to decide whether to breast feed or not. It is vital that each case is assessed individually. Breast feeding has a variety of important benefits to the baby, including increased mother-infant bonding, increased immunity to infection (and perhaps other diseases) and balanced nutritional intake. A decision not to breast feed should be made with due consideration for these factors and should be made with due consideration for these factors and should also take into account that the alternative to breast-feeding (bottle feeding) is a more time-consuming option which requires attention to sterility and careful preparation. In addition bottle feeding can be costly. Some mothers may not be able to cope with bottle feeding for a variety of reasons and in certain circumstances it may be preferable to encourage breast-feeding despite the baby being exposed to a street drug in the mother’s milk, i.e. it may be the ‘least worst option’.

Certain measures can be taken to limit the baby’s exposure to drugs if a nursing mother does take drugs of abuse and breast feed, It is obviously helpful if the mother can reduce the dose of drug taken. The mother should also try and take the drug immediately after feeding and avoid feeding while intoxicated, so that the baby is not exposed to the highest maternal level of drug. If possible the drug should be taken at night after the last feed and nursing avoided thereafter until the next morning. In some situations the mother may be able to express and save breast milk during a time of the day when drug exposure is low and administer this later when infant exposure to drug would be higher if milk was given directly from the breast.

In most cases there are no data on the long-term effects upon the infant of exposure to drugs of abuse in human milk. Since drugs of abuse all act upon the CNS to some extent, it is possible that there could be adverse effects upon mental development, behaviour or psychiatric health but this is a very under-researched area. It might be anticipated that regular taking of drugs of abuse might impair parenting skills but this has also not be studied.

The details below are a summary of the clinical data that have been published.

Alcohol

Pregnancy

Continued heavy drinking is most likely to affect the foetus, and the worst effects are seen in alcoholics but the effects of alcohol in pregnancy are probably dose-dependent. In terms of damage to the foetus, it is particularly difficult to separate the contribution made directly by high levels of ethanol from other aspects of the alcoholic’s lifestyle. For example, alcoholics often have a very poor diet and are more likely to smoke. Despite this it is generally believed that alcohol is teratogenic. Foetal alcohol syndrome (FAS) has been identified in babies born to alcoholics and those who regularly drink heavily, although many of these women are delivered of apparently healthy babies. FAS has the following characteristics:

• intra-uterine growth retardation (including reduced weight at birth and decreased head circumference);
• characteristic facial changes;
• neurological defects (especially reduced mental ability and brain anomalies);
• congenital abnormalities (especially heart damage, limb malformations, genitourinary defects).

In addition, FAS is associated with delayed mental development, retardation, low IQ and various behavioural problems later in life. Reduced growth rate and small size can also continue into childhoodd, although facial changes may diminish with time. The FAS has been associated with ‘heavy drinking’ but the precise definition of this in terms of the quantity of alcohol required is unclear. FAS probably represents the worst end of a spectrum of dose-related damage that alcohol can cause to the foetus. Babies born to women who drink smaller amounts of ethanol than a chronic alcoholic can still show evidence of harm such as minor anormalies, growth deficiency and behavioural problems.

Moderate to heavy alcohol use in pregnancy is also associated with an increased risk of prematurity, miscarriage, stillbirth and spontaneous abortion. Some neonates appear to be delivered with CNS depression due to alcohol and experience  withdrawal reactions. Symptoms include tremors, irritability, apnoea, restlessness, hypertonia and agitation. These usually appear within a few hours of birth and resolve within a few days. There is a greater risk of perinatal amongst babies born to alcoholics.

There is no particular evidence that a single occasional drink is associated with an adverse effect upon pregnancy outcome but a ’safe’ level of drinking in pregnancy has not been established. It is also not clear whether alcohol can cause damage at any stage of pregnancy or whether there are periods of lesser risk. As a result it would be best to avoid all alcohol during pregnancy until studies are available which can accurately estimate the risk to the foetus of low intake.

Breast-feeding

Alcohol passes into breast milk, although acetaldehyde, the major pharmacologically active metabolite, does not. Very large maternal doses caused a reversible ‘Cushing’s syndrome‘ like effect in one breast-fed infant and ‘drunkenness’ in another baby. However, these are isolated reports. A more ubiquitous property of alcohol is its ability to inhibit milk injection in a dose-dependent way by blocking the release of oxytocin from the pituitary in response to suckling. A high intake of alcohol can inhibit milk flow completely. When breast feeding occurs immediately after consuming an alcoholic drink, the infant is found to consume only about three-quarters of the amount of milk, which it would do otherwise. The precise reasons for this are unclear but it may be that alcohol imparts a disagreeable taste to the milk.

One study has shown that regular alcohol intake can adversely affect motor development at one year. One drink a day had only slight effects, occasional drinking had no effect. The impairment was more marked if more than six drinks a day were taken during nursing. No adverse mental effects were reported.

Notwithstanding these effects, it is generally considered acceptable to consume small amounts of alcohol while breast-feeding. However, it is easy to avoid breast feeding for one or two hours after a single alcoholic drink – thus reducing infant exposure – and this should be recommended.

Amphetamines

Pregnancy

Amphetamine is not thought to cause congenital abnormalities. Studies of cohorts of women taking the drug do not reveal an increased risk. When the participants in such studies are summated, the published cohort studies to date include about 300 women. However, one case-control study (where a link is sought retrospectively between babies with a given anomaly) suggested that amphetamine could be contributory factor to the development of congenital heart disease. But case control studies are subject to a variety of confounders and are less reliable than cohort studies. A larger case-control study (219 patients) and a prospective study of 50 patients failed to establish a link with congenital heart disease.

Amphetamine is known to cause maternal anorexia (which can result in relative malnutrition), hypertension and reduced blood flow to the placenta. Intrauterine growth retardation and foetal hypoxia are possible adverse effects upon the neonate as a result of these actions. Amphetamine abuse is probably associated with low birth weight, prematurity and increased perinatal mortality. However, these effects have been inadequately studied. Some studies suggest that maternal amphetamine abuse near term is associated with neonatal drowsiness and even withdrawal symptoms but information on this is scant. The limited studies of childhood development suggest little difference between amphetamine exposed infants and the general population at one year of age.

There is no information at all on the actions of ecstasy in human pregnancy. At the present time one can only assume that the effects would be similar to those of amphetamine.

Breast-feeding

There is only one detailed case report in the literature of amphetamine administration to a breast-feeding mother. Milk from a woman receiving 20 mg of dexamphetamine daily for therapeutic reasons was analysed. The drug was found to be much more concentrated in milk than in plasma. Despite this, no adverse effects were reported in the baby who was periodically assessed for 2 years. Similarly, a review of 103 infants receiving milk from mothers who took amphetamines (various forms) and doses revealed no acute side effects in the recipients. Theoratically, amphetamines might be anticipated to cause stimulation (irritability, poor sleep pattern) or sedation (poor feeding) in infants. On the whole, children tend to be sedated by amphetamines rather than stimulated.

Although the effects upon lactation have not been studied specifically, high doses of amphetamine do suppress prolactin secretion in patients with hyperprolactinaemia. If this effect were to occur in lacting women the drug might reduce milk production. There is no information at all on any of the amphetamine derivatives such as ecstasy and methamphetamine in lactation.

Anabolic Steroids

Pregnancy

There is no information on anabolic steroid abuse in pregnancy. When the therapeutic drugs testosterone or danazol are used inadvertently in human pregnancy each can be associated with virilisation of the genitalia of female foetuses. These drugs are related to anabolic steroids but therapeutically are used in much smaller amounts than the anabolic steroids used by abusers. No adverse effects have been described in male foetuses.

Breast-feeding

Anabolic steroid use in breast-feeding does not appear to have been studied. However, the androgenic properties of this group of steroids are known to reduce breast size when taken chronically and in this situation impaired milk production would seem likely. Anabolic steroids are lipid-soluble so milk penetration should be anticipated. These drugs might cause virilisation of girls exposed to them via breast milk.

Benzodiazepines

Pregnancy

Most studied suggest that benzodiazepines (BZDs) are not likely to cause congenital malformations. Other studies suggesting a teratogenic effect have not demonstrated a consistent pattern of abnormalities. Very limited data suggest a link to dysmorphism but if this is an effect of BZDs it must be rare (a specific link to cleft palate has also been suggested but not proven).

During prolonged maternal administration, BZDs may accumulate in the foetus at a greater concentration than in the mother. After birth the drug may remain in the newborn for a long time due to the immaturity of the neonatal liver resulting in sedation, lethargy, reduced muscle tone, hypothermia and poor feeding. These effects can be most noticeable when a dose of BZD is given close to birth and have been referred to as the ‘floppy infant syndrome’. Withdrawal reactions can occur if BZD exposure in utero was chronic and are very similar to those described for neonatal opioid withdrawal.

Chronic BZD use during pregnancy has been associated with low birth weight in one small study.

Breast-feeding

Although all the BZDs are excreted into breast milk to some degree, small doses for a short period are probably acceptable in breast-feeding mothers. However, the very large doses used by those who abuse them at street level could have a detrimental effect on the baby who is breast fed, by causing sedation. The BZDs are cleared hepatically and so would be expected to accumulate in babies due to their immature metabolism. Consequently, the worst effects of sedation might not be seen for several days after starting regular administration of maternal BZDs. The effects of this sedation are unknown so it would be better for regular high-dose BZD abusers to avoid breast-feeding. Those taking BZDs for therapeutic reasons should be encouraged to take a short course only, and the baby monitored for sedation.

Caffeine

Pregnancy

Studies involving several thousand women have shown that caffeine is unlikely to cause congenital anomalies at normal intake. There is less information on very high caffeine consumption. Human studies suggest that high doses might be associated with spontaneous abortion or reduced birth weight but this has not been proven. Work involving monkeys has reported an increased incidence of miscarriages and still-births at high dose. Reversible cardiac arrhythmias have been described in the human foetus and newborn after exposure to very high caffeine doses. In 1998, eight newborns with apparent caffeine withdrawal symptoms were described. Their mothers had consumed large amounts of caffeine. Symptoms included jitteriness and vomiting.

Breast-feeding

Caffeine is commonly taken by breast-feeding women and there are no apparent adverse effects upon the nursing infant at normal levels of intake. Caffeine is used therapeutically at a dose of up to 10 mg/kg/day (of base) to treat neonatal apnoea. This is considerably higher dose than could be achieved by drinking caffeinated beverages and it is not associated with significant side effects.

Cannabis

Pregnancy

Cannabis is commonly abused in pregnancy. Some studies have shown that it increases the likelihood of premature delivery, especially in heavy users but not all studies have confirmed this. Most suggest that this is not likely to be a significant effect when demographic factors are taken into account. It has been suggested that cannabis can decrease in utero growth leading to small birth weight babies. However, again, the majority of studies do not support this.

There are case reports and small studies in the medical literature suggesting that cannabis might have a teratogenic effect but the diverse array of adverse foetal effects mitigates against a drug-related effect. In addition, in many of these studies potentially confounding variables were not excluded. If cannabis does cause foetal malformations then the effect must be rare and occur only at high doses because most studies do not reveal a teratogenic effect.

A study in 1989 suggested that foetal exposure to cannabis was associated with an increased risk for developing childhood leukaemia. Ten out of 204 exposed cases had leukaemia, compared to one of 203 controls. The leukaemia developed at a younger age than normal in the cannabis group (at about 38 months). This study requires confirmation.

The effects of in utero cannabis exposure upon infant behaviour has not been studied adequately. So far results suggest that newborns that were exposed to cannabis in the womb may show increased startle responses, tremor and visual response to abnormalities but the significance of these are unknown. Follow-up of these babies at one year showed no differences compared to controls. Other studies in older children have given equivocal results.

Breast-feeding

Delta-9-tetrahydrocannabinol (THC) passes into breast milk when smoked or when given orally for therapeutic reasons (dronabinol) and may even be concentrated in it. Despite this, two detailed case reports provided no evidence of acute adverse reactions in the infant. However, given the nature of cannabis and its actions in in humans, which are more subtle than many of the other illicit substances, any effects in babies would probably be difficult to identify. As with tobacco (see below), the baby may be exposed to the drug via passive inhalation of smoke as well as via milk, so parents should avoid smoking in the same room as babies. The long-term effects of cannabis upon infants have not been studied adequately. One study of 27 babies exposed to cannabis via breast milk revealed no mental or physical differences between exposed babies and controls at one year of age. By contrast, another study showed a deficient motor development at one year in cannabis-exposed infants.

In animals cannabis may reduce lactation by suppressing prolactin secretion. A similar effect upon prolactin has been observed in non-breast feeding women but this has not been studied in lactating women.

Cocaine

Pregnancy

Cocaine has potent vasoconstricting and hypertensive properties and these may be important in the aetiology of many of the adverse effects noted in pregnancy. Cocaine can restrict blood flow to the uterus, cause noted in pregnancy. Cocaine can restrict blood flow to the uterus, cause foetal hypoxia and trigger uterine contractions. Foetal CNS infarction and other brain anomalies have also been reported and may be related to cocaine-induced brain haemorrhage or ischaemia. Persistent neonatal arterial hypertension is also known.

Cocaine has been associated with an increased incidence of spontaneous abortion, stillbirth, prematurity and abruptio placentae, which is often linked to foetal death.

Decreased neonatal weight and size, including decreased head circumference, are associated with in utero exposure to cocaine, perhaps due to reduced oxygen supply to the foetus. Limited evidence suggests that these babies can make good this decreased weight and size in early infancy.

It has been claimed that cocaine can cause a wide variety of congenital defects but these effects have either been reported from small studies or are described as defects for which there is only a small increased risk in larger studies. It is very difficult to ascertain which of these are true drug-related effects. Gut, genitourinary, skull and heart defects are most commonly described and many are attributed to cocaine’s effects upon foetal circulation. On the whole cocaine probably has some teratogenic effects but it is not a highly teratogenic substance.

Babies may be irritable at birth and exhibit symptoms such as: tremor, hypertension, abnormal reflexes, tachypnoea, autonomic instability, vomiting, diarrhoea, seizures and poor feeding. Foetuses exposed to cocaine are at increased risk of perinatal death and some studies also reveal an association with sudden infant death syndrome (SIDS) but not all studies have confirmed this link.

Cocaine may be associated with developmental delay and mental retardation in infants born to cocaine-abusing women but this has not been studied adequately enough at present to allow definite conclusions to be made.

Breast-feeding

Cocaine intoxication has been reported in one infant receiving milk from a woman who had taken cocaine, The baby experienced tachycardia, tachypnoea, hypertension, irritability and tremor. The infant’s urine contained cocaine and metabolites, Young babies are relatively deficient in the plasma esterase enzymes needed to metabolise cocaine.

Although only one case report is available, the fact that it describes in adverse effect suggests that cocaine should not be used during breast-feeding.

LSD

Pregnancy

Of the commonly abused illicit substances, LSD has been studied the least in human pregnancy. There are several case reports in the medical literature which ascribe various congenital anomalies to LSD administration but there is no consistent pattern to these, rendering an association unlikely. All of the human studies are small. The evidence from these does not support a link between maternal LSD use and foetal malformations or other adverse pregnancy outcome but these data are limited. Research into the long-term effects of in utero exposure to LSD has not been conducted.

Breast-feeding

The use of LSD during lactation has never been reported in the medical literature. Consequently, use in breast-feeding should be avoided because the effects upon the infant are completely unknown. LSD is a very potent psychoactive compound in small doses.

Opioids

Pregnancy

Opioids are perhaps second only to cocaine as the most extensively studied drugs of abuse in human pregnancy. Although not all authorities are in agreement over the precise effects of taking opioids in pregnancy, the information presented here is that which most agree upon.

The daily administration of heroin or methadone during pregnancy is associated with increased rated of prematurity, low birth weight and small neonatal size. Reduced head circumference has particularly been noted. There is also an increased perinatal mortality. Several studies have suggested that there is an increased risk of SIDS amongst babies exposed to opioids in utero. The incidence could be as high as 4 per cent. Opioids are not thought to cause congenital abnormalities.

Preschool children who were exposed to opioids in the womb may exhibit a range of problems which have been attributed to drug exposure. The smaller head size noted at birth in some individuals may be persistent. Children may also show reduced growth and increased abnormal behaviour compared to their peers. Behavioural problems observed include hyperactivity, increased aggression and decreased inhibitions.

It has been argued that all of the effects discussed so far, except reduced newborn weight and size, are due more to the mother’s or parent’s lifestyle (living conditions, general health, diet, personality) than to the direct effects of opioids. Although this may be true, in practice it is extraordinarily difficult to separate environmental effects from pharmacological ones. One recent small study has suggested that moving opioid-exposed children away from their parents at an early age, to foster or adoptive parents, may eliminate preschool behavioural differences.

Withdrawal reactions are common in neonates exposed to opioids throughout the third trimester. The majority are affected to some degree. Some authors feel that symptoms are worse in babies born to women receiving methadone than in those taking heroin. The typical symptoms are similar to those experienced in adults undergoing withdrawal.

Withdrawal symptoms may be present at birth but, if not, onset usually occurs within 24 to 48 hours for babies born of heroin-dependent mothers and within two to seven days for babies exposed to methadone. Sometimes the peak intensity of symptoms can be delayed by as much as 10 to 14 days. The acute symptoms may persist for several weeks but usually these abate within three weeks for those exposed to heroin; the time course of methadone’s effects is much more variable. Subacute symptoms such as sleeping problems, irritability and poor feeding may last for up to six months in some cases. It is generally believed, although not conclusively proven, that the intensity of neonatal withdrawal symptoms is related to maternal opioid dose. If possible, therefore, opioid intake should be gradually reduced during pregnancy. Babies born to mothers taking 20 mg of methadone per day or less seem to fare better than those exposed to greater doses.

Withdrawal symptoms after in utero exposure to opioids

• Hypertonia, hyperreflexia, tremor
• Hyperactivity, irritability, poor sleeping pattern, decreased sleep
• Diarrhoea
• Tachypnoea, rhinorrhoea, yawning, hiccups, sneezing, apnoea
• Poor feeding, weight loss or failure to gain weight
• Feer
• High-pitched cry
• Lacrimation

Seizures can occur but these are often a later complication. They are probably more common in methadone exposed babies and occur typically at about 10 days after birth.

Breast-feeding

The effects of heroin abuse in breast-feeding have not been investigated in recent times. Morphine does pass into breast milk in small amounts and the results of single dose studies suggest that when given for therapeutic effect, small doses are probably not a significant problem in breast feeding. The morphine in breast milk would be subject to baby’s first-pass liver metabolism which, although not studied in this age group, is quite extensive in adults. However, the effects on the breast-fed baby of maternal chronic administration of large doses of opioids is not known.

The American Academy of Pediatrics (AAP) states that tremors, restlessness, vomiting and poor feeding have occurred in infants receiving opioids in breast milk but these could be the result of withdrawal from in utero exposure. Some have been advocated that mothers taken opioids should breast feed in order to prevent neonatal withdrawal from in utero exposure to opioids but this is a rather ‘hit and miss’ approach. Neonates are notoriously sensitive to opioids and metabolise them very slowly, so accumulation is possible. Methadone, which has a long half-life in adults, could be particularly liable to accumulate in babies but the concentration in milk seems to be less than that in maternal plasma. The AAP considers that methadone administration during nursing is not likely to be harmful to the infant if the mother takes no more than 20 mg per day. This is a rather unhelpful limit because very few patients take such a small maintenance dose.

In adults, certain opioids have a very limited bioavailability when given orally and so absorption of these from breast milk in the infant’s gut may similarly be limited. Such drugs include buprenorphine and fentanyl. It it were possible to stabilise nursing mothers on maintenance doses of buprenorphine rather than methadone this may be preferrable.

Opioids are given therapeutically to babies from time to time in very small doses and apart from causing CNS depression and constipation, they do not appear to be intrinsically harmful. In overdose excessive sedation and respiratory depression can occur. In practical terms, one would wish to monitor any baby signs of sedation if a woman taking moderate to large doses of opioids wished to breast feed. Furthermore, one should be aware that when breast feeding stops the baby could experience withdrawal symptoms.

Tobacco

Pregnancy

Tobacco smoking is associated with reduced oxygen supply and blood flow to the foetus. The following adverse effects are linked to smoking in pregnancy: spontaneous abortion, low birth weight, premature birth and increased perinatal mortality (including SIDS). All of these effects are more likely in women who are heavy smokers. The incidence is markedly reduced in women who cease smoking before the end of the first trimester. Although still rare, smoking increases the risk of congenital limb reduction defects; other than this it has been difficult to associate smoking is convincingly with teratogenic effects. However, tobacco smoking is associated with a twofold increase in risk of ectopic pregnancy.

Abnormal behaviour and impairment of intellectual development may persist into childhood but these effects are generally mild and the environmental contributions to them cannot be separated from the direct effect of tobacco smoking. The effects of reduced growth are usually overcome in early infancy.

Breast-feeding

The AAP states that shock, vomiting, diarrhoea, tachycardia, restlessness and insomnia have been reported in babies when tobacco was smoked by the mother during nursing, although this is probably based on one case report. Nicotine can be concentrated in milk and has been reported to cause infantile colic. The baby is exposed to nicotine partly via breast milk and partly via passive inhalation of smoke while the mother or others smoke near to the infant. Passive smoking is associated with increased respiratory tract infections. Nicotine can also lower prolactin levels so nursing mothers may find that they stop feeding sooner than non-smokers.

Mothers should not smoke just before feeding to reduce infant exposure to peak milk levels of nicotine; they should also avoid smoking near the baby and should try and reduce consumption if possible.

Volatile Substance Abuse

Pregnancy

Volatile substances can cause hypoxia so theoretically they could reduce oxygen supply to the foetal brain; however this has not been studied. Five cases of maternal renal tubular acidosis this has not been studied. Five cases of maternal renal tubular acidosis during pregnancy have been described in known heavy abusers of toluene; in three of the newborns delivered to these women there was growth retardation and in two of these hyperchloraemic acidosis.

Various studies of occupational exposure to solvents have been performed. These have reported differing results depending upon the solvent involved and the extent of exposure. Taken as a whole they do not support a strong link between occupational exposure to solvents and adverse pregnancy outcome. Some studies claim an increased risk of congenital defects but there is no consistent pattern to the anomalies claimed and many studies show no association. Similarly, some studies have shown no association. Similarly, some studies have shown an increased risk of spontaneous abortion but others have not.

In 1996, a team of researchers in Canada suggested that volatile substance abuse can be associated with a neonatal withdrawal syndrome which may respond to treatment with phenobarbitone. The syndrome was identified and treated in 32 babies born over a four-year period. The syndrome was characterised by a high pitched cry, lack of sleep, tremor, hypotonia, poor feeding and a hyperactive Moro reflex. Treatment was typically initiated about 24 hours after birth and lasted for approximately six days.

The authors stated that the aroma of solvents in mother or baby may be a marker for this syndrome.

Breast-feeding

Volatile substance abuse in lactating women has not been studied but the very short half-lives of most volatile substances suggest that breast feeding should not cause problems for the infant unless it occurs whilst the mother is actually intoxicated.

Are You Pregnant or Breast-feeding and Abusing Drugs?

If you are using any of the drugs of abuse mentioned in this article, you should seek help immediately for both your and your baby’s health. Call Europe’s finest addiction treatment rehab clinic, The Causeway Retreat, now on 0207 100 7260. The Causeway Retreat is based on a private island where you and your baby can have a wonderful time in this beautiful island while you are getting your treatment from our addiction treatment experts. You can visit our gallery to see the photos of this beautiful island, or fill the form below to have the latest version of our brochure delivered to your e-mail address.