Illicit substance use is not uncommon in women of childbearing age. The direct effects of illicit substance use on the mother, pregnancy and the fetus are not well understood, in contrast to the indirect effects of social disadvantage and intercurrent medical and psychiatric illness, which are well documented. We have undertaken a review of the current literature regarding the effects of illicit substance use in pregnancy and include a suggested approach to identification and management of at-risk women.
Substance Abuse and Mental Health Services Administration, Office of Applied Studies. The NSDUH Report: Substance Use Among Women During Pregnancy and Following Childbirth. Rockville, MD, 21 May2009
2.
WallaceC, BurnsL, GilmourS, HutchinsonD. Substance use, psychological distress and violence among pregnant and breastfeeding Australian women. Aust N Z J Public Health2007;31:51–6
3.
Australian Institute of Health and Welfare 2008. 2007 National Drug Strategy Household Survey: First Results. Drug Statistics Series number 20,Cat. no. PHE 98. Canberra: AIHW
4.
WilkinsC, SweetsurP. Trends in population drug use in New Zealand: findings from national household surveying of drug use in 1998, 2001, 2003, and 2006. NZMJ2008;121:61–71 ISSN 1175 8716
5.
HoareJ. Drug Misuse Declared: Findings from the 2008/09 British Crime Survey England and Wales. Home Office Statistical Bulletin, July 2009. ISSN 1358-510X
6.
Substance Abuse and Mental Health Services Administration. Results from the 2008 National Survey on Drug Use and Health: National Findings. Office of Applied Studies, NSDUH Series H-36, HHS Publication No. SMA 09-4434. Rockville, MD, 2009
7.
MooreDG, TurnerJD, ParrottAC, During pregnancy, recreational drug-using women stop taking ecstasy (3,4-methylenedioxy-N-methylamphetamine) and reduce alcohol consumption, but continue to smoke tobacco and cannabis: initial findings from the Development and Infancy Study. J PsychopharmacolOnlineFirst, published on 25 November 2009 as doi: 10.1177/0269881109348165
8.
ThadaniPV, StraussJF, DeySK, National Institute on Drug Abuse Conference report on placental proteins, drug transport, and fetal development. Am J Obstet Gynecol2004;191:1858–62
9.
DeraufC, LaGasseLL, SmithLM, Demographic and psychosocial characteristics of mothers using methamphetamine during pregnancy: preliminary results of the infant development, environment, and lifestyle study (IDEAL). Am J Drug Alcohol Abuse2007;33:281–9
10.
BurnsL, MattickRP, CookeM. The use of record linkage to examine illicit drug use in pregnancy. Addiction2006;101:873–82
11.
LudlowJ, EvansS, HulseG. Obstetric and perinatal outcomes in pregnancies associated with illicit substance abuse. ANZ J Obstet Gynecol2004;44:302–6
12.
JoyaX, PujadasM, FalconM, Gas chromatography–mass spectrometry assay for the simultaneous quantification of drugs of abuse in human placenta at 12th week of gestation. Forensic Sci Int2010;196:38–42
13.
ForresterMB, MerzRD. Risk of selected birth defects with prenatal illicit drug use, Hawaii, 1986–2002. J Toxicol Environ Health, Part A, 2007;70:7–18
14.
BuehlerBA, ConoverB, AndresRL. Teratogenic potential of cocaine. Semin Perinatol1996;20:93–8
15.
ElliottL, LoomisD, LottritzL, SlotnickRN, OkiE, ToddR. Case-control study of a gastroschisis cluster in Nevada. Arch Pediatr Adolesc Med2009;163:1000–6
16.
FriedPA. Marijuana use during pregnancy: consequences for the offspring. Semin Perinatol1991;15:280–7
17.
SchempfA. Illicit drug use and neonatal outcomes: a critical review. Obstet Gynecol Surv2007;62:749–57
18.
DownerEJ, CampbellVA. Phytocannabinoids, CNS cells and development: a dead issue?Drug Alcohol Rev2010;29:91–8
19.
Fernández-RuizJ, BerrenderoF, HernándezML, RamosJA. The endogenous cannabinoid system and brain development. Trends Neurosci2000;23:14–20
20.
ClappJFIII, KeveTM, VialC, McLaughlinMK. Ovine placental perfusion balance: effect of marijuana smoke. Am J Obstet Gynecol1988;159:1430–4
21.
GoldschmidtL, RichardsonGA, CorneliusMD, DayNL. Prenatal marijuana and alcohol exposure and academic achievement at age 10. Neurotoxicol Teratol2004;26:521–32
22.
FergussonDM, HorwoodLJ, NorthstoneK, ALSPAC Study Team. Maternal use of cannabis and pregnancy outcome. BJOG2002;109:21–7
23.
ZuckermanB, FrankDA, HingsonR, Effects of maternal marijuana and cocaine use on fetal growth. N Eng J Med1989;320:762–8
24.
ChiribogaCA. Fetal alcohol and drug effects. Neurologist2003;9:267–9
25.
GhuranA, NolanJ. Recreational drug misuse: issues for the cardiologist. Heart2000;83:627–33
26.
ChasnoffIJ, BurnsKA, BurnsWJ. Cocaine use in pregnancy: perinatal morbidity and mortality. Neurotoxicol Teratol1987;9:291–3
27.
DraperES, RankinJ, TonksAM, Recreational drug use: a major risk factor for gastroschisis?Am J Epidemiol2008;167:485–91
28.
AfonsoL, MohammadT, ThataiD. Crack whips the heart: a review of the cardiovascular toxicity of cocaine. Am J Cardiol2007;100:1040–3
29.
TowersCV, PirconRA, NageotteMP, PortoM, GariteTJ. Cocaine intoxication presenting as preeclampsia and eclampsia. Obstet Gynecol1993;81:545–7
30.
KuczkowskiKM. The effects of drug abuse on pregnancy. Curr Opin Obstet Gynecol2007;19:578–85
31.
PatelTG, LaunganiRG, GroseEA, Dow-EdwardsDL. Cocaine decreases uteroplacental blood flow in the rat. Neurotoxicol Teratol1999;21:559–65
32.
CoxS, PosnerS, KourtisAP, JamiesonDJ. Hospitalizations with amphetamine abuse among pregnant women. Obstet Gynecol2008;111:341–7
33.
LandrySH, WhitneyJA. The impact of prenatal cocaine exposure: studies of the developing infant. Semin Perinatol1996;20:99–106
34.
FengT. Substance abuse in pregnancy. Curr Opin Obstet Gynecol1993;5:16–23
35.
FrankD, AugustynM, Grant KnightW, PellT, ZuckermanB. Growth, development, and behavior in early childhood following prenatal cocaine exposure: a systematic review. JAMA2001;285:1613–25
36.
PerezJAJr, ArsuraEL, StrategosS. Methamphetamine-related stroke: four cases. J Emerg Med1999;17:469–71
37.
PlüddemannA, FlisherAJ, MathewsC, CarneyT, LombardC. Adolescent methamphetamine use and sexual risk behaviour in secondary school students in Cape Town, South Africa. Drug Alcohol Rev2008;27:687–92
38.
ZapataLB, HillisSD, MarchbanksPA, CurtisKM, LowryR. Methamphetamine use is independently associated with recent risky sexual behaviors and adolescent pregnancy. J Sch Health2008;78:641–8
39.
KuczkowskiK. Postpartum convulsions with acute haemodynamic instability in the parturient with recent amphetamine intake. Arch Gynecol Obstet2009;280:1059–61
40.
ElliotR, ReesG. Amphetamine ingestion presenting as eclampsia. Can J Anaesth1990;31:130–3
41.
RamamoorthyJ, RamamoorthyS, LeibachFH, GanapathyV. Human placental monoamine transporters as targets for amphetamines. Am J Obstet Gynecol1995;173:1782–7
42.
PhupongV, DarojnD. Amphetamine abuse in pregnancy: the impact on obstetric outcome. Arch Gynecol Obstet2007;276:167–70
43.
StewartJL, MeekerJE. Fetal and infant deaths associated with maternal methamphetamine abuse. J Anal Toxicol1997;21:515–7
44.
GrayTR, KellyT, LaGasseLL, Novel biomarkers of prenatal methamphetamine exposure in human meconium. Ther Drug Monit2009;31:70–5
45.
BermanS, O'NeillJ, FearsS, BartzokisG, LondonED. Abuse of amphetamines and structural abnormalities in the brain. Ann N Y Acad Sci2008;1141:195–220
46.
SmithLM, LaGasseLL, DeraufC, Prenatal methamphetamine use and neonatal neurobehavioral outcome. Neurotoxicol Teratol2008;30:20–8
47.
ErikssonM, JonssonB, ZetterströmR. Children of mothers abusing amphetamine: head circumference during infancy and psychosocial development until 14 years of age. Acta Paediatr2000;89:1474–8
48.
HoE, Karimi-TabeshL, KorenG. Characteristics of pregnant women who use ecstasy (3, 4-methylenedioxymethamphetamine). Neurotoxicol Teratol2001;23:561–7
49.
PhamJV, PuzantianT. Ecstasy: dangers and controversies. Pharmacotherapy2001;21:1561–5
50.
Gouzoulis-MayfrankE, ThelenB, HabermeyerE, Psychopathological, neuroendocrine and autonomic effects of 3,4-methylenedioxyethylamphetamine (MDE), psilocybin and d-methamphetamine in healthy volunteers. Psychopharmacology1999;142:41–50
CampbellNG, KoprichJB, KanaanNM, LiptonJW. MDMA administration to pregnant Sprague-Dawley rats results in its passage to the fetal compartment. Neurotoxicol Teratol2006;28:459–65
SkeltonMR, WilliamsMT, VorheesCV. Developmental effects of 3,4 methylenedioxymethamphetamine: a review. Behav Pharmacol2008;19:91–111
55.
WinklbaurB, JungE, FisherG. Opioid dependence and pregnancy. Curr Opin Psychiatry2008;21:255–9
56.
ChasnoffIJ, BurnsWJ, SchnollSH. Perinatal addiction: the effects of matenal narcotic and non narcotic substance abuse on the fetus and neonate. NIDA Res Monogr1984;49:220–6
57.
FischerG, ElderH, JagschR, Maintenance therapy with synthetic opioids within a multidisciplinary programme: a stabilising necessity for pregnant opioid dependent women. Arch Womens Mental Health1998;1:109–16
58.
JonesHE, JohnsonRE, JasinskiDR, Buprenorphine versus methadone in the treatment of pregnant opioid dependent patients: effects on the neonatal abstinence syndrome. Drug Alc Depend2005;79:1–10
59.
FischerG, OrtnerR, RohrmeisterK, Methadone vs buprenorphine in pregnant addicts – a double blind, double dummy comparison study. Addiction2006;1001:275–81
60.
BinderT, VavrinkováB. Prospective randomised comparative study of the effect of buprenorphine, methadone and heroin on the course of pregnancy, birthweight of newborns, early postpartum adaptation and course of the neonatal abstinence syndrome (NAS) in women followed up in the outpatient department. Neuro Endocrinol Lett2008;29:80–6
CarterLP, PardiD, GorslineJ, GriffithsRR. Illicit gamma-hydroxybutyrate (GHB) and pharmaceutical sodium oxybate (Xyrem): differences in characteristics and misuse. Drug Alcohol Depend2009;104:1–10
63.
LeeSJ, LevounisP. Gamma hydroxybutyrate: an ethnographic study of recreational use and abuse. J Psychoactive Drugs2008;40:245–53
64.
MunirVL, HuttonJE, HarneyJP, BuykxP, WeilandTJ, DentAW. Gamma-hydroxybutyrate: a 30 month emergency department review. Emerg Med Australas2008;20:521–30
65.
JonesAW, EklundA, KronstrandR. Concentration–time profiles of gamma-hydroxybutyrate in blood after recreational doses are best described by zero-order rather than first-order kinetics. J Anal Toxicol2009;33:332–5
66.
KuczkowskiKM. Liquid ecstasy during pregnancy. Anaesthesia2004;59:915–26
67.
68.
ZhangL, DyerD. Lysergic acid diethylamide is a partial agonist at 5-HT 2 receptors in ovine uterine artery of late pregnancy. Eur J Pharm1993;230:115–7
69.
HashimotoH, MayashiM, NakaharaY, NiwaguchiT, IshiiH. Actions of d-lysergic acid diethylamide (LSD) and its derivatives on 5-hydroxytryptamine receptors in isolated uterine smooth muscle of the rat. Eur J Pharm1977;45:341–8
AaseJ, LaestadiusN, SmithDW. Children of mothers who took LSD in pregnancy. Lancet1970;296:100–1
72.
HaslerF, GrimbergU, BenzMA, HuberT, VollenweiderFX. Acute psychological and physiological effects of psilocybin in healthy humans: a double-blind, placebo-controlled dose–effect study. Psychopharmology2004;172:145–56
73.
EspiardML, LecardeurL, AbadieP, HalbecqI, DollfusS. Hallucinogen persisting perception disorder after psilocybin consumption: a case study. Eur Psychiatry2005;20:458–60
74.
BickelM, DittingT, WatzH, Severe rhabdomyolysis, acute renal failure and posterior encephalopathy after ‘magic mushroom’ abuse. Eur J Emerg Med2005;12:306–8
75.
NefHM, MöllmannH, HilpertP, Apical regional wall motion abnormalities reminiscent to Tako-Tsubo cardiomyopathy following consumption of psychoactive fungi. Int J Cardiol2009;134:e39–41
76.
BalsterRL, CruzSL, HowardMO, DellCA, CottlerLB. Classification of abused inhalants. Addiction2009;104:878–82
DoddJ. Petrol sniffing in a pregnant Aboriginal population: a review of maternal and neonatal outcomes. Aust N Z J Obstet Gynaecol2001;41:420–3
79.
PowellST, BolisettyS, WheatonGR. Succimer therapy for congenital lead poisoning from maternal petrol sniffing. Med J Aust2006;184:84–5
80.
MarsdenJ, GossopM, StewartD, Psychiatric symptoms among clients seeking treatment for drug dependence: intake data from the National Treatment Outcome Research Study. Br J Psychiatry2000;176:285–9
81.
WilsonGS. Clinical studies of infants and children exposed prenatally to heroin. Ann N Y Acad Sci1989;562:183–94
82.
SoepatmiS. Developmental outcomes of children of mothers dependent on heroin or heroin/methadone during pregnancy. Acta PaediatrSuppl. 1994; 404:36–9
83.
NSW Department of Health. National Clinical Guidelines for the Management of Drug Use During Pregnancy, Birth and the Early Development Years of the Newborn, 2006. Report commissioned by the Ministerial Council on Drug Strategy under the Cost Shared Funding Model. See www.health.nsw.gov.au/pubs/2006/ncg_druguse.html
84.
ChristensenC. Management of chemical dependence in pregnancy. Clin Obstet Gynecol2008;51:445–55
85.
FalconM, ValeroF, PellegriniM. Exposure to psychoactive substances in women who request voluntary termination of pregnancy assessed by serum and hair testing. Forensic Sci Int2010;196:22–6
86.
WilliamsonS, JacksonL, SkeochC, AzzimG, AndersonR. Determination of the prevalence of drug misuse by meconium analysis. Arch Dis Child Fetal Neonatal Ed2006;91:F291–2
87.
ACOG Committee Opinion Number 422. American College of Obstetricians and Gynecologists. At-risk drinking and illicit drug use: ethical issues in obstetric and gynecologic practice. Obstet Gynecol2008;112:1449–60
88.
ChezRA, AndresRL, ChazotteC, LingFW. Illicit Drug Use and Dependence in Women: A Slide Lecture Presentation. Washington, DC: American College of Obstetricians and Gynecologists; 2002. See http://www.acog.org/from_home/departments/underserved/DependenceinWomen.ppt
89.
RayburnW, BogenschutzM. Pharmacotherapy for pregnant women with addictions. Am J Obstet Gynecol2004;191:1885–97
