Addictions and Recovery

The short answer is “It depends”:

The critical variables are the following:

• The type of drug
• The amount of daily intake
• The timing of intake by the mother, i.e., which trimester of fetal development

Detection of psychoactive drugs

It is possible to detect psychoactive drugs, or their metabolites, in the hair of a newborn or in its meconium, the first fecal excretion of a newborn child. This first excretion is composed mostly of bile, mucus, and epithelial cells.

Would you like to see what meconium looks like?

DON’T BE SHY, SURE YOU WOULD!!

In a 2021 study, Roca et. al. describe clinical features and risk factors associated with prenatal exposure to drugs of abuse. Their sample population included neonates admitted to a
neonatal intensive care unit (NICU) or neonatal intermediate care unit (NIMCU) in a referral hospital between March 2018 and December 2019.

Inclusion criteria for this study

• Cases of suspected prenatal exposure to drugs of abuse due to the presence of social, health-related and epidemiological risk factors (mothers with past or current substance use, absent or insufficient prenatal care, and/or teenage pregnancy).
• Cases of suspected exposure due to clinical manifestations (hypertonia, irritability, inconsolable crying, tremors, strong startle reflex or unexplained intrauterine growth restriction [IUGR]) or the environment of the infant.
• Cases in which prenatal exposure was not suspected due to clinical manifestations or environmental factors, but in which mothers provided informed consent for participation in the study.

On the assumption that a significant number of such neonates will have been exposed to drugs of abuse while in utero, these neonates were tested for cannabinoids, cocaine, opiates, methadone, amphetamines and ecstasy. In addition to analyzing meconium, toxicology tests were performed in samples of infant hair and urine if a meconium sample was not available.

The results they report pertain to 372 (41.6%) of the 895 newborn infants admitted to the NICU and NIMCU in the period under study.

Results

• Exposure to drugs of abuse was detected in 49 (13.2%) cases: in 41 (83.7%) one drug and in 8 (16.3%) more than one;
• In the group with positive results, 41 infants (83.7%) tested positive for only 1 substance: 24 (58.5%) for cannabis, 11 (26.8%) for ETG and 6 (14.6%) for cocaine. Eight infants (16.3%) tested positive for more than 1 substance;
• Somatometry at birth revealed: a) lower length percentile in those exposed to some drug, more than one and cannabis; b) lower weight percentile in those exposed to cannabis and of these compared to those exposed to alcohol;
• In neonates older than 34 pregnancy weeks (PW): a) lower length percentile in those exposed to any substance; b) lower percentile of length and weight in exposed to more than one;
• Some, but not all, neonates born to women who imbibed alcohol showed characteristic facial features associated with Fetal Alcohol Syndrome.

Effects of psychoactive drugs on the developing child

The initial studies on the effects of prenatal exposure to cocaine described catastrophic effects, leading to the term “crack babies”, who were described as “emotionally disrupted, cognitively impaired, less likely to socially interact, and more likely to die from sudden infant death syndrome (SIDS), (Thompson, et. al., 2009).” As a result of these studies, the perception by the public and by policy makers was that the consequences of illegal drugs, such as cocaine, methamphetamine and amphetamine would be far worse than legal drugs such as nicotine and alcohol.

Subsequent studies have shown that the opposite is true: nicotine and alcohol can produce more severe deficits on brain development.

Effects of psychoactive drugs, both illegal and legal, as described in Thompson, et. al., 2009.

Cocaine

The original studies described above, which led to the term “crack babies” and showed severe effects of cocaine were confounded by small sample size, polydrug use, nutritional status of the mother, and other psychosocial problems.

In fact, although longitudinal studies have shown that there are long-term consequences of prenatal cocaine exposure, the behavioral dysfunctions caused by cocaine are mild. Recreational use of cocaine during pregnancy leads to a syndrome resembling attention deficit-hyperactivity disorder, or ADHD. Children exposed prenatally show disturbances in both attention and emotion regulation. Therefore, it is likely that as such children grow up, they will require special needs programs.

Amphetamine/Methamphetamine

Children exposed to methamphetamine or amphetamine during prenatal development show the following characteristics:

• Low birth weight
• Decreased arousal
• Increased stress
• Decreased school achievements
• Movement disturbances

Neurocognitive testing shows that these children score lower on sustained attention, long-term spatial and verbal memory, and visual motor integration.

Nicotine

Prenatal exposure to nicotine smoke, whether the mother actively smokes or she is exposed to second-hand smoke, has multiple potential effects on the fetus, which will continue as the child grows:

• Nicotine smoke is teratogenic, that is, that it can cause developmental malformations;
• It can lead to the following:
  • Stillbirth
  • Low birth weight
  • Increased risk of preterm birth
  • Increased risk of sudden infant death syndrome (SIDS)
  • Increased risk of adolescent substance use
  • Respiratory complications
• There are robust relationships between tobacco smoke exposure and the following:
  • Attention deficit disorder
  • Hyperactivity
  • Antisocial behavior, and
  • Learning disabilities

According to animal studies, nicotine itself has considerable negative neurodevelopmental impact. For that reason, pregnant women are advised NOT to use nicotine patches, because the continued entry of nicotine from these patches through the skin may be worse than the less continuous modality of smoking.

Alcohol

Prenatal exposure to alcohol brings significant negative neurodevelopmental consequences:

• Fetal alcohol syndrome, characterized by growth deficiencies, craniofacial dysmorphologies, and damage to the central nervous system;
• Intellectual disability;
• Deficits in learning;
• Attention and motor development and hyperactivity.

Alcohol will also disrupt the hypothalamic-pituitary-adrenal HPA) axis of both the fetus and the mother. Since this axis is responsible for responses to stress, alterations in maternal HPA functioning could explain some of the long-lasting consequences following prenatal alcohol.

All of these consequences point to the need for intervention and behavior therapy.

Antidepressants (SSRIs)

A higher rate of cardiac abnormalities in the children of women using SSRIs during pregnancy has been reported. Although the mechanism is as yet unknown, altering serotonin function can permanently increase anxiety behaviors and disrupt learning.

Valproate

Valproate is an anti-convulsant and anti-mania drug. Clinical studies pertaining to valproate use have shown a high risk for autism spectrum disorder (ASD), teratogenic (neural tube defects, cranio-facial dysmorphia) and neurotoxic (apoptosis, reduced cell proliferation in multiple brain areas) effects.

P.S.:

Roca, A.; Jarque, P.; Gomila, I.; Marchei, E.; Tittarelli, R.; Angel Elorza, M.; Sanchis, P.; Barcelo, B. (2021). Clinical features and risk factors associated with prenatal exposure to drugs of abuse. (Caracteristicas clinicas y factores de riesgo asociados a la exposicion prenatal a drogas de abuso.) Anales de Pediatria 95:307-320.

Thompson, B.L.; Levitt, P.; Stanwood, G.D. (2009). Prenatal exposure to drugs: effects on brain development and implications for policy and education. Nat. Rev. Neurosci 10(4): 303-312. doi: 10.1038/nrn2598.