Drug Abuse and Pregnancy, Research Paper Example

Abstract

Many people automatically assume that it is harmful for pregnant women to take drugs. However, a review of the literature has indicated that this relationship is dependent upon the drug dose and the type of drug taken. When a women is pregnant and taking a drug whether recreationally or for a medical purpose, she should consult a healthcare professional to determine if the drug can have any negative interaction with the developing fetus that has the potential for causing birth defects in the newborn child. In situations where it is medically possible, it is best for the pregnant mother to avoid use of all drugs, whether recreational, over-the-counter, or prescribed, unless the healthcare professional recommends otherwise.

Introduction

While many people are aware of the overall detrimental effects that drug use could have on overall health, many drug users are unaware of the harmful effects of their behavior on their unborn children. Many drugs impact fetal development during pregnancy due to alterations in signal transduction pathways as a result of introducing the foreign chemical structure. These alterations lead to abnormal cell growth and division, which contributes to many phenotypic birth defects. It is therefore essential to educate pregnant women or women considering having a child about which drugs can cause birth defects, what dose of the drug causes these issues, and measures that could be taken to either prevent their use or stop them entirely.

Broadly, a drug is defined as a chemical molecule that is capable of interfering with human biology. It is possible to harness these drugs for positive therapeutic effects, but it is essential to note that they can also confer toxic effects, including addiction (Langer, 1988). When the average person is asked to define what a drug is, they will list chemicals such as marijuana, cocaine, and heroin, without realizing that many of the substances they use on a daily basis are considered drugs and could interfere with their biology. While it is more obvious that illegal drugs can cause harmful effects on pregnancies, more commonplace drugs such as over the counter and prescribed medications, caffeine in beverages, alcohol, and nicotine in cigarettes could just be as deleterious to an unborn child as their illegal counterparts.

Since the term “drug” is so broadly defined, it will be used here to refer to both illegal and illegal drugs, including those used in medications and for relaxation. A literature review will be conducted to identify the relationship between drug use, fetal development, and birth defects for several types of drugs including alcohol, nicotine, caffeine, marijuana, heroin, ibuprofen, and methotrexate, which all have very different chemical structures, biological uses, and effects in the body.

Literature

Alcohol is a legal substance that is typically used for purposes of entertainment. Many studies have been conducted to determine the relationship between alcohol consumption and the presence of birth defects in newborn children, and as a consequence, the National Institute of Health recommends that pregnant mothers refrain from drinking alcohol. One of these studies, entitled “Moderate Alcohol Use During Pregnancy And Decreased Infant Birth Weight”, examines the effects of alcohol consumption when it is consumed only in moderation (Little, 1997). This study provides useful information concerning the relative dosing of alcohol that causes birth defects. In other words, is it only high levels of consumption that leads to aberrant fetal development and therefore birth defects?

To determine whether a relationship existed between infant birth weight and their mother’s drinking habits, birth weight information was collected for 263 infants belonging to a single health insurance plan, and the mother’s alcohol consumption was measured at three time points retrospectively; before pregnancy, in early pregnancy, and in late pregnancy. The study controlled for smoking, which is also believed to contribute to low birth weight, in order to correct for factors that have potential to confound this relationship. As a consequence, smokers were equally represented in the populations of the study that accounted for light and heavy drinkers.

The study determined that the relationship between alcohol consumption and low birth weight is statistically significant whether the mother consumed alcohol during early pregnancy or late pregnancy. In addition, mother’s in the study who ingested at least one ounce of alcohol daily were likely to give birth to a child that was on the average of 91 grams underweight in early pregnancy and 160 grams underweight in late pregnancy. Although it is detrimental to the child’s birth weight to consume alcohol during any stage of pregnancy, consumption during the later phases are more likely to contribute to a greater weight loss.

A second study entitled “Effects of Maternal Alcohol, Nicotine, and Caffeine Use During Pregnancy on Infant Mental and Motor Development at Eight Months” aims to determine the relationship between smoking, drinking coffee, and drinking alcohol on fetal development because these three drugs are typically used together (Streissguth et al., 1980). The authors aimed to determine whether symptomatic reports of increased jitteriness, atypical head orientation and hand-to-mouth activity, decreased alertness, decreased vigorous bodily activity, decreased sucking pressure, low levels of response to stimuli, and poorer state regulation were in fact associated with alcohol intake, and to determine whether smoking and caffeine use could enhance or contribute to these effects in the newborn child. The authors found that even in mothers and children who were considered to be at low risk for birth defects, alcohol consumption, caffeine use, and nicotine use increased the odds of the child being born with defects of the central nervous system.

It is useful to consider the relationship between marijuana use in mothers and the risk of birth defects in newborn children because marijuana is one of the most common used an easily attainable recreational illegal drug. Many researchers believe that marijuana has the ability to impact fetal growth, decrease the length of gestation, and lead to other birth malformations. Despite these claims however, there have not been many studies that have evaluated this relationship. One of the more reliable studies that attempts to evaluate this relationship is entitled “Prenatal marijuana use: epidemiology, methodologic issues, and infant outcome” (Day et al., 1991). This study is unique in that it confirms the fact that the current studies we have about the relationship between marijuana and fetal development are unclear. Many studies that have attempted to determine the relationship between prenatal marijuana use and fetal outcome are ambiguous, and those that aim to determine a relationship between marijuana use and birth weight or abnormal morphology fail to use controls that will allow us to compare the results to some kind of baseline. As a consequence, we cannot be certain whether marijuana use actually has a negative health impact on the fetus.

Like the other drugs studied thus far, researchers are interested in determining whether there is a relationship between heroin use in pregnant mothers and low birth weight and abnormal behavioral effects. An article that efficiently explores this question is entitled “Methadone and heroin during pregnancy: a review of behavioral effects in human and animal offspring” (Hutchings, 1982). The primary behavior issue observed in both mice and humans born to a mother with heroin use is that the newborn appears symptoms of withdrawal from the substance, which includes hyperactivity, disturbed sleep, and increased emotional incontinence. After this initial addiction subsides, the child may experience impaired organizational and perceptual abilities, poor self-adjustment, and heightened activity.

It is also useful for pregnant mothers to be aware of the over-the-counter drugs that may interfere with the proper development of their unborn child since these easy to obtain remedies help solve common problems such as colds and headaches. A study entitled “Use of over-the-counter medications during pregnancy” attempts to elucidate this relationship (Werler, 2004). Researchers found that about 18% of mothers whose children were born with birth defects used ibuprofen regularly during their pregnancy. In contrast, 65% of mothers whose children were born with birth defects used acetaminophen during their pregnancy and 15% used pseudoephedrine. Ultimately, it was shown that some pregnant women who use ibuprofen during their pregnancy do give birth to children with birth defects.

Another important drug to consider is methotrexate because it is commonly used as a cancer therapy and is becoming more widely used as an anti-inflammatory treatment for arthritis. “The effects of methotrexate on pregnancy, fertility, and lactation” explore the literature to determine whether the drug has a harmful effect on fetal development and whether its use leads to birth defects (Lloyd, 1999). This article makes an interesting point that it is the dose of the drug that is used rather than the drug itself that could cause harmful effects on the developing fetus. When the drug is prescribed for the use of cancer patients, it is usually given in a high dose which can lead to traumatic events in fetal development that could eventually give rise to spontaneous abortion. When methotrexate is given to treat arthritis on the other hand, many women who were on the drug prenatally give birth to their child without any complication and no birth defects are obvious.

Discussion/Analysis

The results demonstrated in “Moderate Alcohol Use During Pregnancy And Decreased Infant Birth Weight” are consistent with our current understanding about drinking and pregnancy. Although there weren’t a lot of studies that confirmed this relationship until the 1990’s, when mother’s began to give up alcohol as a result of this belief, researchers found that the prevalence of infant birth defects significantly decreased, which validates this model.

Since this study indicated that at least one ounce of alcohol consumed daily could interfere with the birth weight of a newborn child, it is essential to note how small this quantity. One ounce of alcohol is less than the amount of alcohol usually contained in one shot, which is usually not even enough alcohol to cause someone to become intoxicated. As a consequence, we can observe that the impact of alcohol on our body is very different than the impact of alcohol on the developing fetus and later newborn child. While a grown adult is able to easily handle an ounce of alcohol, the unborn child is much smaller and therefore has a smaller quantity of cell mass. If the alcohol interacts with our cells, this isn’t as detrimental because we are fully formed adults. Yet, when it interacts with fetal cells that are undergoing differentiation, the growth pathways of these cells can become compromised, which leads to lower birth weight, among other potential birth defects.

While this study considers the impact of alcohol on fetal development in mother’s with low to moderate levels of alcohol consumption, it is useful to consider the effects that alcohol consumption could have on a developing child when it is used in high doses. The birth defects that result from mother alcohol consumption during pregnancy are broadly termed as Fetal Alcohol Spectrum Disorders (FASDs). Children suffering from these disorders are more likely to experience abnormal facial features, growth deficiencies, and central nervous system problems. In the worst case scenario, the woman can undergo spontaneous abortion. It is therefore essential to educate pregnant mothers on the harmful effects that drinking could have on their unborn child and that these disorders are completely preventable if they eliminate their intake. Even if a mother is unaware of her pregnancy and drinks during the beginning of it, she should stop when the pregnancy is confirmed; even though it isn’t beneficial for the fetus to be exposed to alcohol at any stage of the pregnancy, the likelihood of birth defects will decrease if the mother changes this behavior.

In “Effects of Maternal Alcohol, Nicotine, and Caffeine Use During Pregnancy on Infant Mental and Motor Development at Eight Months”, the authors uncovered a relationship between alcohol, nicotine, and caffeine use during pregnancy and central nervous system defects in young children. Since this study was conducted in 1980, it was one of the first attempts that can be credited with determining this relationship. The practice of physicians and other health care professionals were heavily impacted by this study and those that follows because regardless of the particular birth defect or relative risk of it occurring, a relationship between smoking during pregnancy and birth defects, drinking alcohol during pregnancy and birth defects, and consuming caffeine during pregnancy and slight cognitive impairment is obvious. Therefore, it is recommended that pregnant women prevent themselves from engaging in these activities at any level. For women who wish to become pregnant, they should consider smoking cessation at least one year before the intended pregnancy to rid their body of the carcinogens and teratogens in addition to withdrawal symptoms in order to protect their unborn child. Furthermore, it is possible that using all three drugs, caffeine, nicotine, and alcohol, have an additive effect on the harm that is induced in the developing fetus. Because all three drugs have very different chemical structures, they are capable of interfering in different aspects of the biology of the developing child. Although one drug targeting one or several pathways could be harmful to the child, several drugs targeting even more pathways will be even more deleterious. As a consequence, pregnant women should avoid ingesting any drug product that could cause harmful effects to themselves or the fetus unless necessary for other health reasons, in order to ensure that both the mother and the child will be protected throughout the course of the pregnancy.

“Prenatal marijuana use: epidemiology, methodologic issues, and infant outcome” calls into question the validity of many of the studies that have been conducted concerning the relationship between marijuana use and birth defects. At this point in time, we are unable to generate results that conclusively demonstrate that there is any relationship. While some studies have turned up with positive results, we must critically evaluate the study to determine whether its methodology is correct to solve the problem that it wishes to and in addition, the study must be externally valid. When small sample sizes or inadequate corrections for confounding factors are used in these kinds of statistical analyses, it is impossible to generate conclusive results. In addition, many of these studies have been found to lack the quality of reproducibility which shows that the relationships likely do not stand. It is therefore necessary for talented researchers who understand the concepts of experimental design, sample size, powered studies, and external and internal validity to conduct studies to evaluate the biological effects of marijuana. However, since many scientists have attempted to find a relationship between this substance and fetal development and failed, we can conclude that there is likely no relationship between the two and that it is not detrimental for pregnant mothers to smoke marijuana.

“Methadone and heroin during pregnancy: a review of behavioral effects in human and animal offspring” clearly demonstrates that there is a negative impact on the development of children whose mothers are heroin or methadone users. While the behavioral impacts are somewhat debatable because they could be caused by another source, it is definite that the child is born with an addiction to the substance that their mother used. Women who use methadone or heroin should consider avoiding pregnancy until they successfully complete a rehabilitation program that completely cures them of their addiction. The rehabilitation process is very difficult for most adults, and it is just as so for newborn children. They experience many of the same symptoms as adults and are in nearly constant pain until they are able to get the drug out of their system.

While “Use of over-the-counter medications during pregnancy” showed that some pregnant mothers who use ibuprofen during their pregnancy give birth to children with birth defects. However, the fact that 18% of these participants took this medication does not necessarily show a relationship. It could be that pregnant women are more likely than non-pregnant women to use ibuprofen due to symptoms related to their pregnancy. While there could be risks potentially associated with the use of over-the-counter medications, studies on the topic have not been able to demonstrate a conclusive result. It is recommended that pregnant mothers who are concerned about over-the-counter medication use and who are experience common issues such as headaches or colds consult their healthcare professionals for advice.

“The effects of methotrexate on pregnancy, fertility, and lactation” presents an interesting challenge to both pregnant women and the healthcare professionals who care for them. Since methotrexate will not cause birth defects in women who receive small doses when they are pregnant, it is ethical to use the drug for the treatment of women with arthritis in this situation. Meanwhile, this dose of methotrexate would not be effective in fighting cancer of pregnant women. As a consequence, many physicians recommend that pregnant women undergo abortions before they receive their cancer treatments, which is the case for a number of these types of drugs. Unfortunately, women who have cancer during pregnancy are usually not diagnosed until after their pregnancy has begun, which leaves them with a very difficult choice to make; receiving the drug will terminate the pregnancy, yet not taking the drug could contribute to their own loss of life.

Conclusion

Many people believe that taking drugs is harmful for pregnant women overall. However, it has been shown that the relationship between drug intake and pregnancy relies on the individual drug that is taken rather than the fact that a drug is taken. Nicotine, alcohol, caffeine, and heroin lead to aberrant fetal development that contributes to birth defects. Meanwhile, ibuprofen and marijuana does not. Furthermore, the dose of the drug is sometimes essential in determining whether or not the normal fetal development will be disrupted; low doses of methotrexate does not harm the unborn child, while high doses can lead to spontaneous termination of pregnancy.

Annotated Bibliography

Day NL, Richardson GA. (1991). Prenatal marijuana use: epidemiology, methodologic issues, and infant outcome.Clinics in Perinatology. Retrieved from http://europepmc.org/abstract/MED/2040119/reload=0;jsessionid=8RYiIwFkViqD6X1s1on4.60

This article claims that we should attempt to understand more about the use of marijuana in women who are pregnant because it is one of the most common illegal substances. It also characterizes the typical pregnant marijuana user as someone who is usually Caucasian, young, and a user of other substances. They report that previous studies that compare prenatal marijuana use and outcome at birth have ambiguous results. In addition, there is likely no relationship between marijuana use and low birth weight, and studies that have attempted to prove a difference in the morphology of the child are inconclusive.

Hutchings DE. (1982). Methadone and heroin during pregnancy: a review of behavioral effects in human and animal offspring.Neurobehavioral Toxicology and Teratology. Retrieved from http://europepmc.org/abstract/MED/7121694

This article examines the impact of both methadone and heroin, which are structurally similar drugs and cause identical effects, although methadone is less addictive. The main impact of the drug on children whose mothers were users during their pregnancy is that they will be born with an addiction to the drug in addition to suffering behavioral symptoms that include impaired organizational and perceptual abilities, poor self-adjustment, and heightened activity.

Langer R. (1988). Drug delivery and targeting. Retrieved from http://europepmc.org/abstract/MED/9579855

This article explains a lot about what drugs are and how scientists and doctors use them to create treatments. It provides a lot of useful information about drug dosing and briefly discusses the structure of certain drugs and their classes. This is useful information for the introduction of the topic because the structure of drugs and their definition plays a major role in how they interact with the human body and developing fetus.

Little, R. (1977).Moderate Alcohol Use During Pregnancy And Decreased Infant Birth Weight. American Journal of Public Health. Retrieved from http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.67.12.1154

This article is among the first epidemiological studies that attempted to determine the relationship between consuming alcohol during pregnancy and the detrimental impacts it could have on the baby. This was a retrospective study that used information collected from a health insurance company and once birth weights of participants were measured, the author estimated levels of alcohol consumption of their mothers. This study is useful because it controls for smoking in the analysis, which could be a confounding factor of the relationship. Ultimately, it is useful for showing that even moderate levels of drinking has the ability to negatively impact an infant’s birth weight. We can therefore conclude that drinking alcohol in any quantity can pose a health risk to an unborn child.

Lloyd ME, Carr M, McElhatton P, Hall GM, Hughes RA. (1999). The effects of methotrexate on pregnancy, fertility, and lactation. Q J Med. Retrieved from http://qjmed.oxfordjournals.org/content/92/10/551.full.pdf+html

Methotrexate is a drug that is commonly used in cancer and can lead to spontaneous abortion of the fetus. However, low doses of the drug used to treat other medical issues such as arthritis does not lead to as much of a negative effect in the developing fetus. Ultimately, the drug can be very toxic to the fetus when used in large doses and have negligible effect when used in small doses.

Streissguth AP, Barr HM, Martin DC, Herman CS. (1980). Effects of Maternal Alcohol, Nicotine, and Caffeine Use During Pregnancy on Infant Mental and Motor Development at Eight Months. Alcoholism: Clinical and Experimental Research. Retrieved from http://www.readcube.com/articles/10.1111%2Fj.1530-0277.1980.tb05630.x

This is an epidemiological study that develops a regression model for risk factors of birth defects that include alcohol, nicotine, and caffeine use of the mother. In order to be sure that these three factors are the cause of birth defects, the authors adjusted the model for age and other biological characteristics that they believed could have been confounding factors. Ultimately, a relationship between alcohol, nicotine, and caffeine use in the pregnant mother was related to issues in the child likely due to the ability of these substances to interfere with fetal development.

Werler MM, Mitchell AA, Hernandez-Diaz S,Honein MA. Use of over-the-counter medications during pregnancy. American Journal of Obstetrics & Gynecology. Retrieved from http://www.ajog.org/article/S0002-9378(05)00346-7/abstract

The authors summarize the use of several over-the-counter drugs in women who eventually give birth to children with birth defects and those who do not. About 18% of women who give birth to children with birth defects used ibuprofen. This result does not necessarily indicate that there is a relationship between ibuprofen use and aberrant fetal development.