ABSTRACT
Fertility is regularly reduced in women as addiction becomes more severe, 1 but there are still a great number of abusers who become pregnant. Pregnancy in drug and alcohol addicts is quite common in metropolitan areas throughout America, and the problems produced in the unborn child are myriad and are increasingly coming to the attention of doctors and legislatures. 2 The medical problems include permanent damage to the unborn child, lower birth weight of the child, withdrawal in the child, and all of the problems associated with lack of prenatal care. As a part of the continuing abuse, malnutrition, severe drug intoxication, and other diseases associated with addiction such as AIDS and hepatitis may also be present. Education about these problems is believed to have the greatest impact on the occasional user, but little or no influence on the habituated person. A recent review of Illinois data indicates that in 1988 at least 2160 children were reported as having a problem at birth or after, from addictions with opiates being most common, cocaine second most common, and alcohol and other drugs making up about 20% of the total. 3 The calculations of the cost to society of this problem for a single fetal alcohol child exceeds $1 million for life-long care. A recent urine screen of 1226 mothers receiving obstetrical care at Boston City Hospital revealed that 16% had urines positive for marijuana at delivery and 9% were positive for cocaine. An additional 11% who tested negative reported marijuana use, and 264an additional 8% reported cocaine use. Although cocaine or marijuana use were not associated with a shortened gestation period, mothers who used marijuana had a child on average 79 g smaller than average, and women who had used cocaine, 93 g smaller. The effect of the two drugs was additive, and both were made worse by concomitant smoking. 4 It is no surprise that, when specifically tested, marked underreporting of alcohol use during pregnancy was found. 5 Similar findings can be anticipated for illicit drug use. Table 77 indicates the problems that will be discussed in this chapter. Influence of Addictions During Pregnancy on Unborn Child and on the Newborn
Fetal alcohol syndrome
Nonspecific alcohol effects
Cocaine problems
Opiate problems
Other drugs affecting the child
