Drugs in pregnancy

From Wikipedia, the free encyclopedia
  (Redirected from Pharmaceutical drugs in pregnancy)
Jump to navigation Jump to search

Around 5–10% of women of childbearing age abuse alcohol or drugs.[1] This can have serious consequences to the health of both mother and fetus. Many short term side effects, especially physical abnormalities observed upon birth, have been reported and are more commonly known.


Some medications can adversely affect a fetus, but in some cases the benefits outweigh the risks. Diabetes mellitus during pregnancy may need intensive therapy with insulin to prevent complications to mother and baby. Pain management for the mother is an important area where an evaluation of the benefits and risks is needed. NSAIDs such as ibuprofen and naproxen are probably safe for use for a short period of time, 48–72 hours, once the mother has reached the second trimester.[2] If taking aspirin for pain management the mother should not take a dose higher than 100 mg.[2]

Pregnancy categories[edit]

U.S. Code of Federal Regulations requires that certain drugs and biological products must be labelled very specifically with respect to their effects on pregnant populations, including a definition of a "pregnancy category". These rules are enforced by the Food and Drug Administration (FDA).[3][4] The FDA does not regulate labelling for all hazardous and non-hazardous substances and some potentially hazardous substances are not assigned a pregnancy category.[citation needed]

Australia’s categorisations system takes into account the birth defects, the effects around the birth or when the mother gives birth, and problems that will arise later in the child's life caused from the drug taken. The system places them into a category of their severity that the drug could cause to the infant when it crosses the placenta(Australian Government, 2014).[5]


Valproic acid, and its derivatives such as sodium valproate and divalproex sodium, causes cognitive deficit in the child, with an increased dose causing decreased intelligence quotient.[6] On the other hand, evidence is conflicting for carbamazepine regarding any increased risk of congenital physical anomalies or neurodevelopmental disorders by intrauterine exposure.[6] Similarly, children exposed lamotrigine or phenytoin in the womb do not seem to differ in their skills compared to those who were exposed to carbamazepine.[6]

Recreational drugs[edit]


Alcohol passes easily from the mother's bloodstream through the placenta and into the bloodstream of the fetus. Since the fetus is smaller and does not have a fully developed liver, the concentration of alcohol in its bloodstream lasts longer increasing the chances of detrimental side effects.[7] The severity of effects alcohol may have on a developing fetus depends upon the amount and frequency of alcohol consumed as well as the stage of pregnancy. Rates of alcohol consumption can generally be categorized in one of three ways: heavy drinking (more than 48-60g ethanol/day), moderately high drinking (24-48g ethanol/day), and binge drinking (4-5 drinks/90g ethanol at a time).[8] Heavy drinking and binge drinking are closely associated with a higher risk of fetal alcohol spectrum disorders (FASDs). The most severe form of FASD is fetal alcohol syndrome (FAS). This used to be the only diagnosis for fetal disorders due to alcohol consumption but the term was broadened to a "spectrum" due to the variety of abnormalities observed in newborns. This was most likely because of the different amounts of alcohol ingested during pregnancy indicating that there is not a clear, specific dose that determines if a fetus will be affected by alcohol or not. This is why it is very important for pregnant women to abstain from alcohol use altogether. FAS is characterized by slower physical growth, distinct facial abnormalities including smooth philtrum, thin vermilion, and short palpebral fissures, neurological deficits, and/or smaller head circumference. Other problems associated with FASD include delayed or uncoordinated motor skills, hearing or vision problems, learning disabilities, behavior problems, and inappropriate social skills compared to same-age peers. Those affected are more likely to have trouble in school, legal problems, participate in high-risk behaviors, and develop substance use disorders themselves.


Cannabis consumption in pregnancy might be associated with restrictions in growth of the fetus, miscarriage, and cognitive deficits.[9] Cannabis is the most frequently used illicit drug amongst pregnant women.[10] Tetrahydrocannabinol, an active ingredient in cannabis, can both cross the placenta and accumulates in high concentrations in breast milk.


Tobacco is the most commonly used substance amongst pregnant women, at 25%. Similar to cocaine, nicotine is able to cross the placenta and accumulates within fetal tissues. Based on a literature review conducted between 2007 and 2008,[11] children born to women who smoked heavily were more susceptible to behavioral problems such as ADHD, poor impulse control, and aggressive behaviors. A number of studies have shown that tobacco use is a significant factor in miscarriages among pregnant smokers.[12] Tobacco contains carbon monoxide, which has the potential to prevent the fetus from receiving sufficient oxygen. Other health concerns tobacco poses are premature birth, low birth weight, and an increase risk of sudden infant death syndrome (SIDS) of up to three times compared to infants not exposed to tobacco. Smoking and pregnancy, combined, cause twice the risk of premature rupture of membranes, placental abruption and placenta previa. In addition to the fetus, women in general who smoke heavily are less likely to become pregnant.


No specific disorders or conditions have been found to result for people whose mothers used cocaine while pregnant.[13] Studies focusing on children of six years and younger have not shown any direct, long-term effects of PCE on language, growth, or development as measured by test scores.[14] PCE also appears to have little effect on infant growth.[15] However, PCE is associated with premature birth, birth defects, attention deficit hyperactivity disorder, and other conditions. The effects of cocaine on a fetus are thought to be similar to those of tobacco and less severe than those of alcohol.


Opioids include heroin, fentanyl, painkillers such as oxycodone and methadone. Women who abuse opioids during pregnancy are at a higher risk for premature birth and for lower birth weight. There is no consensus on the effects on cognitive abilities.[16]

Opioid abuse is the main cause of neonatal abstinence syndrome, which is where the baby experiences withdrawals from the drug they were exposed to during the pregnancy. Typical symptoms may include tremors, convulsions, twitching, excessive crying, poor feeding or sucking, slow weight gain, breathing problems, fever, diarrhea, and vomiting amongst others.[17]


Prenatal methamphetamine exposure has shown to negatively impact brain development and behavioral functioning. A 2019 study further investigated neurocognitive and neurodevelopmental effects of prenatal methamphetamine exposure. This study had two groups, one containing children who were prenatally exposed to methamphetamine but no other illicit drugs and one containing children who met diagnosis criteria for ADHD but were not prenatally exposed to any illicit substance. Both groups of children completed intelligence measures to compute an IQ. Study results showed that the prenatally exposed children performed lower on the intelligence measures than their non-exposed peers with ADHD. The study results also suggest that prenatal exposure to methamphetamine may negatively impact processing speed as children develop. [18]

Further reading[edit]

  • Briggs, Gerald G.; Freeman, Roger K.; Towers, Craig V.; Forinash, Alicia (2016). Drugs in pregnancy and lactation: a reference guide to fetal and neonatal risk (11th ed.). Lippincott Williams & Wilkins. ISBN 978-1-4963-5037-4.
  • Lowinson, Joyce H.; Ruiz, Pedro; Millman, Robert B.; Langrod, John G., eds. (2005). "Chapter 53. Maternal and neonatal effects of alcohol and drugs by Loretta B. Finnegan and Stephen R. Kandall". Substance abuse: a comprehensive textbook. Lippincott Williams & Wilkins. pp. 805–839.
  • Schaefer, Christof, ed. (2001). Drugs during pregnancy and lactation: handbook of prescription drugs and comparative risk assessment. Elsevier. ISBN 978-0-444-50763-1.
  • Schaefer, Christof; Peters, Paul W.J.; Miller, Richard K., eds. (2011). Drugs during pregnancy and lactation: treatment options and risk assessment (2nd ed.). Elsevier. ISBN 978-0-08-054977-4.


  1. ^ Morse; Gehshan; Hutchins (1997). "Screening for Substance Abuse During Pregnancy" (PDF). National Center for Education in Maternal and Child Health.
  2. ^ a b Kim, Joong; Segal, Neil (2015). Pharmacological Treatment of Musculoskeletal Conditions During Pregnancy and Lactation. Springer International Publishing. pp. 227–242. ISBN 978-3-319-14318-7.
  3. ^ FDA (1 April 2015), CFR – Code of Federal Regulations Title 21, 4, Food and Drug Administration
  4. ^ FDA (3 December 2014), Pregnancy and Lactation Labeling (Drugs) Final Rule, Food and Drug Administration
  5. ^ "Australian categorisation system for prescription medicines in pregnancy". Australian Government. 2014. Retrieved 18 May 2016.
  6. ^ a b c Bromley, Rebecca; Weston, Jennifer; Adab, Naghme; Greenhalgh, Janette; Sanniti, Anna; McKay, Andrew J; Tudur Smith, Catrin; Marson, Anthony G; Bromley, Rebecca (2014). "Treatment for epilepsy in pregnancy: Neurodevelopmental outcomes in the child". Cochrane Database of Systematic Reviews (10): CD010236. doi:10.1002/14651858.CD010236.pub2. PMID 25354543.
  7. ^ "Pregnancy and Alcohol: Safety, Effects & Addiction". American Pregnancy Association. 27 April 2012. Retrieved 21 March 2019.
  8. ^ Ornoy, Asher; Ergaz, Zivanit (February 2010). "Alcohol Abuse in Pregnant Women: Effects on the Fetus and Newborn, Mode of Action and Maternal Treatment". International Journal of Environmental Research and Public Health. 7 (2): 364–379. doi:10.3390/ijerph7020364. ISSN 1661-7827. PMC 2872283. PMID 20616979.
  9. ^ Fonseca BM, Correia-da-Silva G, Almada M, Costa MA, Teixeira NA (2013). "The Endocannabinoid System in the Postimplantation Period: A Role during Decidualization and Placentation". Int J Endocrinol (Review). 2013: 510540. doi:10.1155/2013/510540. PMC 3818851. PMID 24228028.
  10. ^ Agenda, Committee on the Health Effects of Marijuana: An Evidence Review and Research; Practice, Board on Population Health and Public Health; Division, Health and Medicine; National Academies of Sciences, Engineering (12 January 2017). Prenatal, Perinatal, and Neonatal Exposure to Cannabis. National Academies Press (US).
  11. ^ Cornelius, Marie D.; Day, Nancy L. (April 2009). "Developmental consequences of prenatal tobacco exposure". Current Opinion in Neurology. 22 (2): 121–125. doi:10.1097/WCO.0b013e328326f6dc. ISSN 1350-7540. PMC 2745235. PMID 19532034.
  12. ^ CDCTobaccoFree (6 February 2018). "Smoking During Pregnancy". Centers for Disease Control and Prevention. Retrieved 21 March 2019.
  13. ^ Lamy, S; Thibaut, F (February 2010). "Psychoactive substance use during pregnancy: A review". L'Encéphale (in French). 36 (1): 33–38. doi:10.1016/j.encep.2008.12.009. PMID 20159194.
  14. ^ Ackerman, J; Riggins, T; Black, M (2010). "A review of the effects of prenatal cocaine exposure among school-aged children". Pediatrics. 125 (3): 554–65. doi:10.1542/peds.2009-0637. PMC 3150504. PMID 20142293.
  15. ^ Goldberg 2009, p. 228.
  16. ^ Nygaard, Egil; Slinning, Kari; Moe, Vibeke; Walhovd, Kristine B. (17 February 2017). "Cognitive function of youths born to mothers with opioid and poly-substance abuse problems during pregnancy". Child Neuropsychology. 23 (2): 159–187. doi:10.1080/09297049.2015.1092509. hdl:10852/55276. ISSN 0929-7049. PMID 26471942.
  17. ^ https://docs.google.com/document/d/1p0fwjFSlsgWkT643vw04_HNl4NKe9rBIu9vbbOD5uf8/edit#
  18. ^ Brinker, M. J., Cohen, J. G., Sharrette, J. A., & Hall, T. A. (2019). Neurocognitive and neurodevelopmental impact of prenatal methamphetamine exposure: A comparison study of prenatally exposed children with nonexposed ADHD peers. Applied Neuropsychology: Child, 8(2), 132-139. doi:10.1080/21622965.2017.1401479