Prenatal exposure to drugs and alcohol

Drugs

Parental drug misuse can have an effect on the development of the foetus and long-term consequences for children. Some effects may be physical, but the most important ones will be on the developing mind and brain of the child. These effects may not be visible, and, in some cases, the impact on the child´s development and behaviour may not manifest for some years.

Although damage to the foetus can occur at any stage of the pregnancy, the first three months are the most vulnerable period for congenital malformations, while brain growth is most rapid late in pregnancy. The effects on the unborn child include: chromosomal abnormalities; structural malformations (e.g. cleft palate); intrauterine growth retardation; functional impairment (e.g. deafness); behavioural abnormalities (e.g. hyperactivity); and learning difficulties.

In addition, a high proportion of newborn babies, especially those whose mother used heroin, will suffer withdrawal symptoms which may last up to several months and which will include tremors, high muscle tone, irritability, diarrhoea, vomiting and abnormal feeding and sleep patterns.

Recreational drugs

Heroin

There is no clear evidence that heroin causes malformations to the foetus, but there is an increase in premature delivery, low birth weight and death around the time of delivery. Forty to eighty per cent of babies will develop a withdrawal syndrome lasting from several days to several months. The children tend to grow normally afterwards, although small head circumference may persist. There is no clear evidence of abnormal brain development in most of the children studied. Although methadone can be substituted for heroin, it may be more beneficial for the mother, and more toxic for the newborn.

Cocaine, crack cocaine (coke, snow)

There is considerable disagreement amongst medical experts as to whether cocaine or crack causes congenital malformations, but small head size, intrauterine growth retardation, prematurity, stillbirths, heart defects, abnormal bone development and neonatal withdrawal syndrome have been noted. Some studies have reported learning disorders and attention deficit at three years of age; however, longer-term follow up is needed to establish the importance of these effects.

Amphetamines

They include methamphetamine, speed and Ecstasy, and are known to cause maternal anorexia, hypertension and reduced blood flow to the placenta. There is no conclusive evidence so far that amphetamines cause congenital malformations, but there is a risk of intrauterine growth retardation and premature delivery. It is thought that withdrawal symptoms may develop. There is no clear evidence that prenatal amphetamine exposure causes long-term effects on growth and development.

Cannabis (marijuana, Indian hemp, hashish)

Cannabis is one of the most commonly used drugs in pregnant women, but little is known about its effects during pregnancy. There is conflicting data about the association of cannabis with congenital malformations and neonatal withdrawal syndrome. One long-term study found that the speech and memory performance among four-yearolds whose mothers had consumed cannabis daily or several times a week during pregnancy was affected significantly

Other drugs

Tranquilisers (Benzodiazepines e.g. diazepam, temazepam, etc.)

Some studies have found evidence of cardiac malformation, facial clefts and multiple malformations in the unborn foetus but others have not confirmed this. Withdrawal symptoms may cause the ´floppy infant syndrome´ (including lethargy, poor muscle tone and sucking problems). There is very little data on the effects on long-term development.

Antidepressants

There is no clear evidence from research published to-date to indicate that there is an increased risk of malformation in babies born to mothers who misuse antidepressants. Some short-term withdrawal symptoms have been reported. The long-term effects of antidepressants of any type are not known.
go to top

Looking forward

Diagnosing babies and young children as affected by parental drug misuse and predicting likely outcomes is very hard to establish. This is partly due to the lack of conclusive research todate, and to the fact that it is nearly impossible to accurately determine the type, amount and timing in pregnancy for each substance used – especially as users often combine different drugs together, sometimes with alcohol.

Substance misuse is also frequently associated with poverty, physical or mental health issues, poor medical care and diet, which makes it even more difficult to clearly establish correlations between cause and effect. The most important thing to remember is that, by providing a stable, loving home for children affected by drugs and offering them good parenting, optimal nutrition, and appropriate stimulation, health care and educational opportunities, you can help them to reach their full potential.

Alcohol

The effects of maternal alcohol consumption on the foetus and then on the child´s development have been the object of research for some time and are generally better known than those of drug exposure. Although studies suggest that higher levels of maternal alcohol consumption correlate with more severe impact on children´s health and development, there is no established ´safe amount´ to drink in pregnancy. The ultimate impact will be a complex interplay between general prenatal health and nutrition, the pattern and amount of alcohol consumed and the timing during the pregnancy, and the genetic and resilience factors in the developing foetus.
go to top

Foetal Alcohol Spectrum Disorder

The term Foetal Alcohol Spectrum Disorder (FASD) is used to describe a wide range of disorders resulting from prenatal exposure to alcohol. They are also known as Foetal Alcohol Syndrome (FAS) or Foetal Alcohol Effects (FAE). The diagnosis of FAS in a child is characterised by:

• abnormalities of growth, including low birth weight and small head circumference
• central nervous system involvement and
• include small, widely-spaced eyes, flat midface, short, upturned nose, thin upper lip.

Children who only have some of the characteristics are categorised as having FAE. The presence or absence of characteristic physical features cannot predict the severity of behavioural and intellectual effects, which may be mild, moderate or severe. Other difficulties which may be associated with FASD include depressed immune function, strabismus, hearing loss, and abnormalities of heart, lungs and teeth.

Most babies with FASD are irritable and have trouble eating and sleeping. They are sensitive to sensory stimulation, which can include distress when being held or cuddled, and may have a strong startle reflex. They may have high or low muscle tone. They will frequently have difficulties forming attachments.

The neurological and behavioural effects are frequently misdiagnosed as Attention Deficit Hyperactivity Disorder, and not always connected to a diagnosis of FASD. Most children will have some developmental delays, and some degree of learning difficulty. Generally the features of FASD will include:

• attention and memory deficits
• hyperactivity
• difficulty learning from behaviours
• inability to understand the consequences of their actions
• difficulty with abstract concepts
• reduced problem-solving skills
• difficulty with social functioning
• difficulties with controlling impulses.

Understanding FASD

It is important to recognise that the above are signs that the brains of these children have been structurally damaged, affecting the way that they process information. Children with FASD often experience low self-esteem, perceiving themselves as stupid, and often feel frustrated, angry and discouraged too. They can be easily distracted, and find following instructions difficult, especially verbal ones. By rewording or repeating instructions, minimising distractions, giving them more time to respond and more attention, being encouraging and consistent, and especially by understanding better the neurological nature of FASD, we can help children overcome these feelings.

FASD cannot be cured, but, with consistency and support, both within their family and at school, and by providing a loving and stable environment, children affected by FASD can be helped to understand and live with their condition and build up their confidence and self esteem.

Originally published in the Be My Parent newspaper in September 2005.

Did you know Be My Parent has a glossary of adoption and fostering related terms?

This article is published with the kind permission of the people involved. You may download it for your own reference but if you wish to use it for any other purpose, please contact Be My Parent for authorisation: Be My Parent, BAAF, Saffron House, 6-10 Kirby Street, London EC1N 8TS. Telephone: 020 7421 2666/5/4.

Last updated: 04 December 07

Back to previous