Birth Defects and Adverse Birth Outcomes
The safest choice for a pregnant woman is not to use alcohol, tobacco,
and other drugs. To do otherwise can lead to birth defects or other adverse
birth outcomes. Problems associated with alcohol, tobacco, and other drug
use during pregnancy are well documented in the research literature. Alcohol,
tobacco, and other drug-exposed infants are more likely to suffer from
a greater range of medical problems and in some cases require costlier
medical care. Most important, perinatal alcohol, tobacco, and other drug
use exacts a high toll on families and communities.
About 1 out of every 10 newborns in the United States--375,000 per year--is
exposed prenatally to one or more drugs. In major cities, many hospitals
report that the percentage of newborns showing the effects of drugs is
20 percent or even higher.
Alcohol-Related Birth Defects
Babies whose mothers drink during pregnancy, especially those who drink
heavily, may be born with fetal alcohol syndrome (FAS). As set by the
Fetal Alcohol Study Groups of the Research Society on Alcoholism, the
criteria for diagnosing FAS are:
- weight and/or length below the 10th percentile;
- central nervous system involvement, including neurological abnormalities,
developmental delays, behavioral dysfunction, intellectual impairment,
and skull or brain malformations; and
- a characteristic face with short eye openings, a thin upper lip, an
elongated, flattened midface, and a groove in the middle of the upper
lip.
When only some of these criteria are met, the diagnosis is fetal alcohol
effects (FAE). The harmful effects of prenatal exposure to alcohol are
now known to exist on a continuum, ranging from full-blown FAS to mild
FAE that may include more subtle cognitive and behavioral defects.
Mental disabilities and hyperactivity are probably the most debilitating
aspects of FAS. Problems with learning, attention, memory, and problem
solving are common, along with lack of coordination, impulsiveness, and
speech and hearing impairment. Deficits in learning skills persist even
into adolescence and adulthood.
FAS and FAE cost nearly a third of a billion dollars a year to treat
and are among the leading known causes of mental retardation. Recorded
cases of FAS more than tripled between 1979 and 1992, according to the
Centers for Disease Control and Prevention. In 1979, about 1 in every
10,000 births involved FAS. By 1992, nearly 4 of every 10,000 births were
diagnosed with FAS. Although the increase may be the result of better
reporting by doctors, FAS may be even higher. The characteristic facial
features are difficult to recognize in newborns, and mental retardation
may not be identified until several years after birth.
Not all women who drink alcohol during pregnancy have babies with FAS
or FAE. Variables affecting outcome include genetics, cigarette smoking
and other drug use, nutrition, and time of use during pregnancy.
Unlike other known causes of mental retardation, FAS and FAE are totally
preventable. Prevention efforts have focused on educating the public about
the risks of consuming even small amounts of alcohol during pregnancy.
In 1988 Congress passed a bill requiring warning labels on alcoholic beverage
containers, including the risks of birth defects. Communities across the
country have conducted education campaigns, and some require posting warning
signs about the risk of alcohol-related birth defects at establishments
where alcoholic beverages are sold.
Perinatal Tobacco Use
According to the U.S. Office on Smoking and Health, exposure to tobacco
smoke poses grave risks to babies before and after they are born.
Spontaneous abortion, preterm births, low-weight full-term babies, and
fetal and infant deaths all occur more frequently among mothers who smoke
during their pregnancy. In addition, smoking in the presence of babies
and young children places them at greater risk for health problems. Hospital
admissions for bronchitis, pneumonia, and related illnesses occur twice
as often for children whose parents smoke. The greater the exposure--two
parents smoking rather than one--the greater the risk.
Tobacco control efforts across the country now focus on eliminating environmental
tobacco smoke as well as preventing smoking initiation and promoting smoking
cessation. Prevention strategies include education efforts, environmental
controls on smoking, and restrictions on tobacco availability, including
increased tobacco excise taxes in some States, and bans on cigarette vending
machines in some communities.
Other Drug-Related Birth Defects
Approximately 11 percent of pregnant women use at least one of the following
drugs: heroin, methadone, amphetamines, PCP, marijuana, and cocaine. Infants
of drug users may go through drug withdrawal or have other medical problems
at birth.
A national study conducted by the National Institute on Drug Abuse (NIDA)
found that the average annual number of drug-affected newborns more than
doubled from the time period 1982-84 to 1985-86, and nearly doubled again
between 1985-86 and 1987. In all, there was a 339 percent increase in
the average annual number of drug-affected newborns between 1979 and 1987.
Approximately 38,000 drug-exposed babies were born in the United States
in 1987.
Only about 1 in 10 (11 percent) of the 280,000 pregnant women in need
of drug treatment in the United States receives such services, according
to a survey conducted by the National Association of State Alcohol and
Drug Abuse Directors (NASADAD). In response to the low rate of treatment,
a White House publication reported "The need to increase the availability
of treatment for pregnant women who use drugs, combined with the difficulty
in persuading many such women to enter and remain in drug treatment, are
among the most persistent and troublesome problems in the treatment field."
Many treatment programs do not accept pregnant women or mothers and their
infants. And according to a 1990 survey of 24 Pregnant and Postpartum
Demonstration Projects funded by CSAP and conducted by the National Council
on Alcoholism and Drug Dependence (NCADD), significant barriers to women
seeking services included housing, transportation, and child care. Waiting
lists are also cited in the literature as barriers to receiving services.
Often women identified through prenatal assessments as needing services
for alcohol, tobacco, and other drug problems must languish on waiting
lists or run the gauntlet of an often daunting referral process before
services are available.
Recent research studies reported that drug-exposed infants may develop
poorly because of stress and chaos caused by the mother's drug use. These
children experience double jeopardy. They often suffer from biological
vulnerability due to prenatal drug exposure, which then may be exacerbated
by poor caretaking and multiple separations due to the drug user's lifestyle.
In contrast, drug exposed children who are nurtured in a warm, supportive
environment are often able to develop well. The National Association for
Perinatal Addiction Research and Education (NAPARE) calls for increased
funding for prevention and treatment programs and health care systems
to answer the needs of the highest risk populations.
References
Identifying the Needs of Drug-Affected Children: Public Policy Issues.
CSAP Prevention Monograph 11 (1992) BK195
Alcohol, Tobacco, and Other Drugs May Harm the Unborn (1992) PH291
Prevention Resource Guide: Pregnant/Postpartum Women and Their Infants
(1991) MS420
Alcohol Alert #13. Fetal Alcohol Syndrome (1991) PH297
"Fetal Alcohol Syndrome--United States, 1979-1992," MMWR 42(117):339-341,1993
Day, N. "The Effects of Prenatal Exposure to Alcohol," Alcohol,
Health & Research World 16(3):238-244,1992 (BL0077)
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