33. Alcohol
When you drink, so does your baby—the
more you drink, the more your baby “drinks.” Alcohol use by a pregnant
woman carries considerable risk to her and her developing baby. The
fetus is especially vulnerable to the effects of alcohol in early
pregnancy.
Drinking during pregnancy has been
associated with behavior problems in a child. The more alcohol a woman
drinks, the more problems a child may experience. Drinking as little as
two drinks a day has been associated with fetal-alcohol effects.
Chronic use of alcohol during pregnancy can lead to fetal-alcohol
syndrome (FAS); see the discussion below.
Your developing baby may be harmed by an
alcohol level that has little apparent effect on you. A fetus cannot
metabolize alcohol as quickly as an adult, so alcohol remains in its
system much longer. Moderate use of alcohol has been linked to a
greater risk of miscarriage. Studies show spina bifida is up to 60
times more common in babies exposed to alcohol before birth than in
babies who were not exposed.
Before pregnancy, Wendy drank socially,
but she hadn’t missed alcohol during her pregnancy. She felt that by
abstaining from alcohol, she was doing something good for her baby. At
a party, she was offered a glass of wine. The pregnancy was going well,
and she hadn’t had any problems; what would be the harm? She wasn’t
sure, so she decided to stay with fruit juice. At her next prenatal
visit, she wanted to know how much alcohol she could drink safely. I
supported Wendy in her decision not to drink at all during her
pregnancy. I told her that research has not identified a “safe” amount
of alcohol to consume during pregnancy. The more we learn, the more it
appears that even a little alcohol might be harmful.
The word is spreading about alcohol use
in pregnancy, but one study found many pregnant women in North America
ignore the advice. In that study, four times as
many women said they drank alcohol during pregnancy than those who had
been interviewed in an earlier study. Don’t put your baby at risk! Pass
up all alcohol during your pregnancy.
You may wonder about recipes that call
for alcohol. It’s OK to eat food that contains alcohol if it has been
baked or simmered for at least 1 hour. Cooking for that length of time cooks out almost all of the alcohol content.
Some women wonder if nonalcoholic wine
and beer are safe to drink during pregnancy. Even though they are
labeled “no alcohol,” these beverages contain some
alcohol—about 0.5%. Because we don’t know what alcohol-intake level is
safe for the fetus, it’s a good idea to avoid these beverages.
If you drink during pregnancy, it may
affect sperm production in a male child born from that pregnancy.
Researchers have noted an association between alcoholic intake of the
mother and sperm concentration in her adult son.
Taking drugs with alcohol increases the
risk of damage to the fetus. Drugs that cause the greatest concern
include analgesics, antidepressants and anticonvulsants.
Some researchers believe heavy alcohol
consumption by a baby’s father before or at the time of conception may
produce FAS in the baby. Alcohol consumption by the father has also
been linked to intrauterine-growth restriction.
Be very careful about substances you use
that may contain alcohol. Over-the-counter cough medicines and cold
remedies often contain alcohol—as much as 25% of the preparation!
Fetal-Alcohol Syndrome and Fetal-Alcohol Exposure
Fetal-alcohol syndrome (FAS) is a
collection of problems that affect children born to alcoholic women.
Mild abnormalities have been associated with as little as two drinks a
day (1 ounce of alcohol)—this is called fetal-alcohol exposure (FAE).
FAS occurs in 1 or 2 of every 1000
births. It is characterized by growth restriction before and after
birth. Heart and limb defects and unusual facial characteristics, such
as a short, upturned nose, a flat upper jawbone and “different” eyes,
have also been seen in FAS children. These children may have behavioral
problems, impaired speech and impaired gross-motor functions. FAS ranks
with neural-tube defects and Down syndrome as a major cause of mental
retardation in babies.
We advise women that any amount of alcohol is too much. It’s best to avoid alcohol completely while you’re pregnant!
33. Abuse of Other Substances
When we discuss substance abuse,
we refer to use of drugs prohibited by law, but we also include use of
legal medications, such as benzodiazepine or barbiturates. These
substances may also have harmful effects during pregnancy, regardless
of whether they are used for legitimate or illicit reasons.
Drug use can greatly affect your
pregnancy. A woman who uses or abuses drugs may have more pregnancy
complications because of her lifestyle. Women who use certain
substances commonly display nutritional deficiencies; anemia and
fetal-growth restriction are other risks. A pregnant woman who uses
drugs may increase her risk of pre-eclampsia.
Marijuana
Marijuana contains tetrahydrocannabinol
(THC), which crosses the placenta and enters the baby’s system.
Exposure can cause attention-deficit disorders, memory problems and
impaired decision-making ability in children; these problems can appear
in a child between 3 and 12 years of age.
Central-Nervous-System Drugs
When used during pregnancy,
central-nervous-system stimulants, such as amphetamines, are associated
with an increase in cardiovascular defects in babies. These babies
frequently show signs of withdrawal, poor feeding, seizures and other
problems.
Tranquilizing agents include
benzodiazepines (Valium and Librium) and other agents; they have been
associated with an increase in birth defects. Heavy use in pregnancy is
also associated with infant withdrawal after birth.
Narcotics and Mind-Altering Drugs
Habitual use of morphine, Demerol,
heroin and codeine can lead to physical dependence in the user. A
pregnant woman who uses narcotics is subject to pre-eclampsia, preterm
labor, fetal-growth problems and narcotic withdrawal in the baby
following birth. The incidence of sudden-infant-death syndrome (SIDS)
is 10 times higher among babies born to mothers who used narcotics during pregnancy than babies whose mothers did not.
Intravenous drug use is frequently
accompanied by health problems, such as AIDS, hepatitis and
endocarditis. Any of these problems is extremely serious during
pregnancy.
Hallucinogens, such as LSD, mescaline,
hashish and peyote, are still used by many people. Phencyclidine (PCP,
angel dust) falls into this group. PCP is believed to cause abnormal development in human babies, although this has not been definitively proved.
Cocaine and Crack
Cocaine use can definitely complicate a
pregnancy. Often a user consumes the drug over a period of time, such
as several days. During this time, the user may eat or drink very
little, with serious consequences for a developing fetus.
Continued use of cocaine or its stronger
form, crack, can affect maternal nutrition and temperature control,
which can harm the fetus. Cocaine use has been linked with many
pregnancy problems. A woman who uses cocaine during the first 13 weeks
of pregnancy faces an increased risk of miscarriage. Cocaine can damage
the developing baby as early as 3 days after conception!
Infants born to mothers who use cocaine
during pregnancy often have mental deficiencies. Sudden-infant-death
syndrome (SIDS) is also more common among these babies. Many babies are
stillborn.
One of the most difficult discussions
I’ve had was with Sally. When she came to see me for her yearly exam
and Pap smear, she was upset and discouraged. Adam, her 10-year-old
pride and joy, was now in fifth grade. He was having trouble in school
and had been diagnosed with attention-deficit disorder. Her pregnancy
had seemed to go OK 10 years ago. She hadn’t been able to talk about it
then, but she said she had continued using cocaine through the first
part of her pregnancy. She was now contemplating another pregnancy.
Sally realized that although there was nothing she could do now to
change her pregnancy with Adam, she would do things differently with
this baby.
