March 04, 2013
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AAP reviews effects of prenatal substance abuse on fetus

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Prenatal substance abuse continues to be a problem and poses important health risks to the developing fetus, according to results of a technical report recently published in Pediatrics.

The National Survey on Drug Use and Health is an annual survey providing national and state level information on the use of alcohol, tobacco and illicit drugs in a sample of more than 67,000 noninstitutionalized people aged older than 12 years. Data are combined into 2-year epochs and include reported drug use for pregnant women aged 15 to 44 years.

Illegal drug use among pregnant women remained relatively stable from 2007 to 2008 (5.1%) to 2009 to 2010 (4.4%).

Researchers found that illicit drug use was highest among the youngest pregnant women, 16.2% for 15- to 17-year-olds, compared with 7.4% among 18- to 25-year-olds and 1.9% among 26- to 44-year-olds.

Alcohol remains the most widely studied prenatal drug of abuse, and evidence is strong for fetal growth problems, congenital anomalies and abnormal infant neurobehavior.

Researchers found that with prenatal marijuana exposure, there are no significant effects for fetal growth, congenital anomalies or withdrawal. However, researchers said long-term studies reveal effects on behaviors, cognition and achievement, but not on language or growth.

Researchers found that the most significant effect of prenatal opiate use is neonatal abstinence syndrome. There also were documented effects on fetal growth, but not long-term growth, and infant neurobehavior and long-term effects on behavior.

Prenatal cocaine use has a negative effect on fetal growth and slight effects on infant neurobehavior, according to researchers. There is little evidence to support a connection with congenital anomalies or withdrawal. Researchers also said there are long-term effects on behavior and subtle effects on language. There is little evidence to support and effect on overall cognition, but some studies have documented effects on specific areas of executive function.

Researchers said effects of prenatal methamphetamine exposure studies are still in the beginning stages. However, early studies have shown an effect on fetal growth and infant neurobehavior, but no association with congenital anomalies and no data regarding infant withdrawal or any long-term effects.

Researchers add that the primary care pediatrician’s role in addressing prenatal substance exposure includes prevention, identification of exposure, recognition of medical issues for the exposed infant, protection of the infant and follow-up of the exposed infant.

Disclosure: The researchers report no relevant financial disclosures.