Information on Drug Abuse During Pregnancy

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Drug Abuse During Pregnancy

As a result of widespread public-health announcements, most people are aware that smoking cigarettes, drinking excessive amounts of alcohol, and using illicit drugs are risky and destructive, especially during pregnancy. Yet it's often to believe that "this could happen to me"—that we might actually suffer the effects we hear about. Furthermore, even if one is convinced of the dangers These substances, gaining freedom from their grip can be a real uphill battle. If need any additional reasons to separate yourself from cigarettes, alcohol, or tzal drugs, or some extra resolve to remain free of these unhealthy habits, con- carefully the following facts:

Cigarette smoking.
This is a form of legalized drug addiction that is harmful to the those around the smoker, and especially the baby growing inside the smoker. Thousands of chemicals in cigarette smoke flow directly from the mother's lungs into her bloodstream and then directly into the baby. Nicotine specifically causes constriction of blood vessels in both the placenta and the -Dabv. thus reducing the baby's supply of vital blood and oxygen. Carbon monoxide in smoke binds tightly to red blood cells and displaces oxygen. The 77frail effect is a recurrent choking of the baby's oxygen supply, resulting in filler (by an average of half a pound) and shorter babies. Unfortunately, these infants (whom doctors refer to as "small-for-dates") are more likely than theirnormal counterparts to have a variety of medical problems after birth.

The smoker's baby is more likely to be born prematurely or to be stillborn.The tragedy of sudden infant death syndrome (SIDS) occurs twice as frequentlywhen the child's mother has smoked throughout pregnancy, and the risk in-creases drastically if there is continuing exposure to secondhand smoke afterbirth. According to a study published by researchers at the University ofCalifornia, infants exposed to smoke from ten or fewer cigarettes per day arcmore than twice as likely to die of SIDS than babies in smoke-free environments.When the exposure involves more than twenty cigarettes per day, the risk soarsto more than twenty times that of infants not exposed.

Exposure to cigarette smoke after birth is linked to colds, ear infections, andasthma. And the child who sees Mom and Dad smoke is also much more likely topick up the habit than are his peers who live in homes where there are no smokers.

Let's not forget smoking's effect on the mother. Aside from the long-termrisks of chronic lung disease, heart disease, ulcers, and diseased blood vessels, sheis more likely to have unexpected vaginal bleeding during her pregnancy.

The only good news about smoking is that quitting early in pregnancy reducesthe baby's risk of problems to the level of a child horn to a nonsmoker. For manywomen, the emotional impact of a threat to the baby is powerful enough to over-ride the compulsion to light up, and a pregnancy usually lasts long enough tohelp temporary abstinence become a smoke-free life.

But cigarettes are so powerfully addictive that additional support may benecessary to kick the habit. If you are a smoker, it's never too late—or too early—to stop. A successful decision to quit usually requires:

• A well-defined list of reasons that have some emotional power. ("I don't want to starve my baby of oxygen" or "I want to live long enough to seemy kids grow up.") Since resistance to quitting often hinges on anemotional attachment to cigarettes, your reasons for giving up smokingshould likewise motivate you on an emotional level.

• A specified quitting date that is announced to family, friends, and coworkers. Some gentle peer pressure can be a powerful motivator.

• Participation in a stop-smoking class. These are available in most communities through nearby hospitals or local chapters of national organizations (American Lung Association, American Heart Association,American Cancer Society).

• A firm declaration that your home, car, and workplace are smoke-free zones. Nobody, but nobody—spouse, in-laws, guests, visiting heads ofstate—lights up in your airspace.

• If you are not yet pregnant, you may wish to consider using nicotinepatches or chewing gum to assist you through the withdrawal process.These are now available on both a prescription and nonprescription (orover-the-counter) basis. If you have any questions or concerns abouttheir proper use, you may want to discuss them with your physician. Youshould not smoke while using nicotine patches or gum, and you cannotuse them during pregnancy.

Alcoholic beverages. Daily consumption of alcohol during pregnancy, with orwithout binge drinking, may lead to a complex of problems in the baby knownas fetal alcohol syndrome. Babies with this disorder may have a variety of ab-normalities of the head, face, heart, joints, and limbs. In addition, the central ner-vous system can be affected, causing mental retardation, hyperactivity, andbehavioral problems. The damage appears to be directly related to the amount ofalcohol consumed, especially during the early months of pregnancy.

A woman who enjoys an occasional drink may wonder how much alcohol might be safe during pregnancy. Some studies suggest that even two drinks aweek may lead to a mild withdrawal syndrome in the newborn, with increased ir-ritability and stomach disturbances. The simplest and safest course is to abstainfrom alcohol altogether during pregnancy. You would be wise to abstain or con-sume no more than two alcoholic drinks per week if you are not yet pregnant butmight become so in the near future. If drinking is not an ingrained habit, this should not be difficult. But if you find it hard to stay away from alcohol or con-trol how much you drink at any given time, total avoidance is even more impor-tant. It is likely that you will need outside help to do so, whether in a groupsetting such as a church support group or Alcoholics Anonymous, or individually with a professional counselor.

Illegal drugs. The use of illegal drugs continues to be a fearsome epidemic in our culture. The popular term recreational drug use is a contradiction because theword recreation implies an activity that has a positive, restoring, re-creating effecton mind and body. These substances, however, have just the opposite effect,draining away the resources, health, and, ultimately, life from their users. Whenthe user is a pregnant woman, two lives (at least) are being damaged.

Regular marijuana users may deliver prematurely and even at term are morelikely to have smaller babies. Cocaine use during pregnancy can cause not only a miscarriage or premature labor but also the eventual delivery of a small, irritable baby who may have serious, lifelong problems. Aside from any difficulties that might arise from premature delivery, cocaine itself can damage the infant's central nervous system, urinary tract, and limbs by constricting their blood sup-ply. Increased irritability during the newborn period, developmental delays, and difficulty with learning and interacting with others may also be attributable tococaine use by the mother. (Frequently other substances such as alcohol and to-bacco have been used as well, complicating the question of identifying specific consequences of cocaine.)

A mother's use of narcotics such as heroin or methadone throughout her preg-nancy may subject the baby to a difficult withdrawal after birth. Symptoms, which usually begin during the first day or two after birth, can include increased irritabil-ity, tremors, a high-pitched cry constant hunger, sweating, and sneezing. In severe cases, seizures, vomiting, diarrhea, and difficulty with breathing can occur.Furthermore, if these drugs are taken intravenously (that is, injected into the veins),there is an additional risk of acquiring HIV, which eventually causes AIDS. This willnot only shorten the mother's life drastically, but could infect her baby as well.

As serious as all these health concerns are, they do not encompass the vast waste of resources and the chaotic lifestyle that so often accompany the use of il-legal drugs. Chronic drug abuse patients are usually unable to deal consistently with the daily demands of child care. Food preparation, safety in the home, and basic healthpractices are likely to he compromised. Run-ins with the law and difficulty maintaining steady employment arc not uncommon. Healthy relationships with friendsand family members may be in short supply. The disturbances and distractions of chronic drug use seriously compromise a parent's ability to bring up healthy chil-dren. Whether or not you arc pregnant, the time to stop using any of these toxic substances is no and seeking help to do so should be an immediate priority.

Caffeine. This stimulant abounds in everyday beverages such as coffee, tea, and soft drinks, as well as some headache remedies and pain relievers. A daily intake of up to 200 mg (the amount in one or two five-ounce cups of coffee) is widely considered safe during pregnancy. Larger amounts (over 500 mg per day) will keep both you and your baby awake, and his or her increased activity levels before birth may lead to a lower birth weight. If you consume coffee by the potful or so-das by the six-pack, you should begin cutting back to the 200 mg limit (see table)before you become pregnant or reduce immediately if you are already expecting.Decreasing the brewing time for coffee or tea will also cut caffeine content.

Prescription and over-the-counter (OTC) drugs. In general, you should try to avoidusing any type of medication that isn't specifically prescribed or approved by Always be sure to inform any physician who treats you that you or might be pregnant, since this could have a significant impact on nzedication(s) areheor she might recommend.

CAFFEINE CONTENT OF FOODS AND BEVERAGES

Food Source	Amount	Caffeine Content
Regular coffee	8 oz	100-500 mg
Instant coffee	8 oz	80-100 mg
Decaf coffee	8 oz	3-5 mg
Tea	8 oz	60-65 mg
* Regular cola	6 oz	36 mg
Diet cola	6 oz	18 mg
Chocolate bar	1 oz	20 mg

* Read labels to determine the presence of caffeine in specific soft drinks,Such as Mountain Dew, Dr. Pepper, etc.

The fact that you can buy a drug off the shelf at the supermarket doesn't neces-sarily mean that it is wise to use it during pregnancy. Pain relievers, cold tablets,laxatives, and other medications, as well as vitamin, herb, and food supplements,may seem harmless merely because they are easily accessible or advertised as"natural!" A number of these are, in fact, quite safe during pregnancy, but youshould consult your physician, who is familiar with your medical history and thedetails of your pregnancy, before using any of them. Common examples of OTCmedications include the following:

Pain relievers. Acetaminophen (Tylenol, Panadol, and various others) isgenerally recognized as safe for both mother and baby during pregnwhenused in the recommended dosage, but it can be toxic to the liver in anancyoverdose.This drug reduces aches, pains, headaches, and fever. Both aspirin and the var-ious brands of the anti-inflammatory drugs ibuprofen (Advil, Motrin, Nuprin,and others), naproxen (Aleve), and ketoprofen (Orudis KT and others) may increase the risk of bleeding in both mother and baby, especially of birth. Anti-inflammatory medications taken late in pregnancy also may inhibt the onset of labor. Furthermore, they can cause a structure in the infant's heart known as the ductus arteriosus to close, resulting in potential circula-tory problems after birth. While such complications are very unusual, you should avoid these medications during pregnancy ( during the finalweeks) unless they are recommended for a specific purposeeciallyby your physician.

Cold tablets. Decongestants, antihistamines, cough syrups, and nasalsprays are sold in a bewildering array of combinations and preparations. All areintended to relieve symptoms, but these drugs rarely have a direct effect on thecourse of an upper-respiratory illness. Some of the ingredients in cold remediesare considered safe during a normal pregnancy, but you should check with yourphysician and pharmacist before using any of them. Rest, fluids, and time willtake care of the vast majority of these infections. However, you should also con-tact your doctor if your runny nose, sore throat, or cough continues for morethan a week; if you are producing thick, discolored drainage from nose or chest;or if you are running a fever over 100°F. If the doctor you speak with is not theone who is caring for your pregnancy, be sure that he or she knows you arepregnant.

Antacids. Many pregnant women develop heartburn and indigestion be-cause of changes in the intestinal tract produced by the growing uterus. Antacidsare generally considered safe during pregnancy when used in recommendeddoses, but they may provoke diarrhea and can interfere with the absorption ofprescription drugs.

Laxatives. Constipation is common during pregnancy, but chemical laxa-tives are not the preferred method of treatment. Lots of fluids and juices, addi-tional fiber in the diet (whether directly from food sources or psyllium-seedsupplements such as Metamucil or Citrucel), and regular exercise are the bestfirst-line remedies. If you are not able to have a bowel movement for a few daysat a time, you should review additional options with your physician.

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