Alcohol and illicit drugs are toxic to the placenta and developing fetus and can cause congenital syndromes and withdrawal symptoms. Prescription drugs also may have adverse effects on the fetus ( # Some Drugs With Adverse Effects During Pregnancy). Fetal alcohol syndrome and the effects of cigarette smoking on the fetus are discussed elsewhere.
A fetus that has been exposed to drugs in utero (termed fetuses exposed to noxious substances [FENS]) can become dependent on the drug during gestation. Although some toxic substances used by the mother are not illegal, many are. In any case, the home situation should be evaluated to determine whether the infant will be safely cared for after discharge. Understanding local jurisdictions and laws is important because many countries and localities have mandatory reporting guidelines. With the supportive help of relatives, friends, and visiting nurses, the mother may be able to care for her infant. If not, foster home care or an alternative care plan may be best.
Amphetamines
Prenatal exposure to amphetamines
Barbiturates
Prolonged maternal abuse of barbiturates
Cocaine
inhibits reuptake of the neurotransmitters norepinephrine and epinephrineplacental abruption and spontaneous abortion, perhaps caused by reduced maternal blood flow to the placental vascular bed; abruption may also lead to intrauterine fetal death or to neurologic damage if the infant survives.
Neonates born to addicted mothers have low birth weight, reduced body length and head circumference, and lower Apgar scoreslimb amputations, genitourinary malformations, including prune-belly syndrome
Marijuana
Marijuana does not consistently increase risk of congenital malformations, fetal growth restriction, or postnatal neurobehavioral abnormalities. However, women who use marijuana during pregnancy often also use alcohol, cigarettes, or both, which can cause fetal problems.
Opioids
Opioid exposure in utero can cause withdrawal on delivery. The neonate of a woman who used opioids chronically during pregnancy should be observed for withdrawal symptoms (narcotic abstinence syndrome [NAS]). NAS usually occurs within 72 hours after delivery, although many neonatal units observe infants for 4 or 5 days to be sure there are no significant signs of withdrawal.
Characteristic signs of withdrawal include
Irritability
Jitteriness
Hypertonicity
Vomiting and/or diarrhea
Sweating
Seizures
Hyperventilation that causes respiratory alkalosis
Prenatal benzodiazepine exposure may cause similar effects.
There are many scoring systems to help quantify the severity of withdrawal (see The Opioid Exposed Newborn: Assessment and Pharmacologic Management). Mild withdrawal symptoms are treated by a few days of swaddling and soothing care to alleviate the physical overarousal and by giving frequent feedings to reduce restlessness. With patience, some problems resolve in no more than a week.
The Eat, Sleep, Console (ESC) approach for NAS assessment (1, 2
see Table: One Drug Regimen for Neonatal Opioid Withdrawal).
One Drug Regimen for Neonatal Opioid Withdrawal
Drug | Starting Dose | Incremental Increase | Taper |
|---|---|---|---|
0.04 mg/kg orally every 3–4 hours | 0.04 mg/kg/dose | 10–20% every 2–3 days | |
0.05–0.1 mg/kg orally every 6 hours | 0.05 mg/kg/dose | 10–20% every week | |
Adapted from Hudak ML, Tan RC, The Committee on Drugs, The Committee on Fetus and Newborn: Neonatal drug withdrawal. Pediatrics 129:E540–E560, 2012. doi: 10.1542/peds.2011-3212 | |||
The incidence of SIDS is greater among infants born to women addicted to opioids but still is < 10/1000 infants, so routine use of home cardiorespiratory monitors is not recommended for these infants.
Opioids references
1. Grisham LM, Stephen MM, Coykendall MR, et al: Eat, sleep, console approach: A family-centered model for the treatment of neonatal abstinence syndrome. Adv Neonatal Care 19(2):138–144, 2019. doi: 10.1097/ANC.0000000000000581
2. Dodds D, Koch K, Buitrago-Mogollon T, Horstmann S: Successful implementation of the eat sleep console model of care for infants with NAS in a community hospital. Hosp Pediatr 9(8):632–638, 2019. doi: 10.1542/hpeds.2019-0086
More Information
The following is an English-language resource that may be useful. Please note that THE MANUAL is not responsible for the content of this resource.
The Opioid Exposed Newborn: Assessment and Pharmacologic Management: Scoring systems to help quantify the severity of withdrawal
