Maternal and fetal effects from substance use

Drug use is most prevalent in the reproductive age population. Among women aged 15 to 44, almost 90% have used alcohol, approximately 44% have used marijuana, and at least 14% have used cocaine [1]. Even though a reduction in substance use may occur during pregnancy, some women may not alter their drug use patterns until pregnancy is diagnosed. For these reasons, a large number of fetuses are exposed to illicit substances in utero. Patient interviews and urine toxicologic testing at the initial prenatal visit and at delivery suggest that substance use during pregnancy ranges from 0.4% to 27%, depending on the population surveyed [2-4]. This finding is not surprising, as more than one third of the total adult population interviewed admitted to some illicit drug use [5]. Care of substance-using pregnant women is complex, difficult, and often demanding. Providers must be aware of their unique psychologic and social needs, and the related legal and ethical ramifications surrounding pregnancy. In addition, relating specific substances to perinatal outcome is difficult, as concurrent use of multiple substances is frequent and many users are members of economically disadvantaged segments of society in which unfavorable perinatal outcomes are more common than in other segments of society. It is also very difficult to follow neonatal outcomes in such pregnancies and to analyze research data. This article discusses a variety of issues related to pregnancies complicated by substance use. Identification of substance use, perinatal pharmacology and teratogenic risks, limitations with reported investigations, treatment approaches, and comprehensive perinatal management are reviewed.