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PREGNANCY AND DRUGS

September 9, 2010 on 8:25 pm | In Antenatal | No Comments

Pregnancy is a time of change for women and can sometimes be uncomfortable physically and stressful emotionally. It is a time when women try to take particular care of their health. Getting plenty of rest exercise, and good nutrition are all aspects of a pregnant woman’s health. Drug use is another important aspect of a woman’s health during pregnancy.

Drugs that are of concern in pregnancy include: alcohol, tobacco, cannabis, amphetamines, heroin, cocaine, tranquillisers and sleeping pills, painkillers, LSD, Ecstasy and other designer drugs, glues and aerosols. Some prescription drugs can also be a problem during pregnancy, so discuss this with your doctor as soon as you know you are pregnant.

Drugs can be harmful to a developing foetus throughout the pregnancy but the first three months is considered the time of most risk because the major organs and limbs of the baby are forming. The placenta is the means by which all supplies of nutrients, water and oxygen pass through from the mother to the baby. All drugs taken during pregnancy will reach the baby through the placenta, however there is an enormous variation in babies’ responses to these drugs

The variation in response to drugs depends on the following factors:

The actual nature of the drug, whether the drug is a sedative (for example, benzodiazepines), or a stimulant (for example, amphetamines).How often the drug is used and the dose taken. Whether one or more drugs are used. Some drugs have a cumulative or combined action which is more likely to be harmful for the baby. Each baby, for reasons that are not clear, seems to have its own response to different drugs. Mothers can use the same drugs in the same amount for the same duration or length of a pregnancy, and the babies can react differently. There appears to be something in each individual baby which allows this to occur. you may know someone who has had a healthy baby even though they took drugs during their pregnancy. you cannot assume that your baby will be healthy if you take drugs during your pregnancy. No one can predict how a baby will be affected.  

Ante-natal checks, the visits you make to the doctor, hospital or community health centre while you are pregnant are important The best way to avoid or reduce complications and the risk to the baby is to have good ante-natal care. A much lower risk of obstetric complications occurs in women who attend ante-natal visits early in the pregnancy and continue to attend throughout the pregnancy. It is at these appointments that you could discuss with the doctor or midwife any drugs you may be taking. The information you give them will be confidential whether you are discussing legal or illegal drugs.

A common complication in pregnancy, where the mother has been taking drugs or alcohol, is an increased incidence of premature labour, with babies often arriving more than six weeks early. Overall, babies born to mothers who are using drugs or alcohol are smaller than the average baby. Low birth weight babies often have breathing difficulties and are more vulnerable to infections. During a pregnancy where the mother has been using alcohol or other drugs, the baby needs to be carefully monitored at ante-natal visits. This is done by using ultrasound to check the baby’s growth and other tests to check that the placenta continues to work well.

Withdrawal is the reaction of the body to going without drugs on which it has become dependent to feel normal. Babies whose mothers have taken drugs during pregnancy may experience withdrawal. This will depend on the drug, the dose, the purity, how often it is used and the woman’s general health. Drug withdrawal symptoms for the baby can occur both during the pregnancy and after birth. There are common signs and symptoms of drug withdrawal in the new-born baby regardless of which drug is used by the mother.

Withdrawal often develops after the first 24 hours of life. The babies are agitated and irritable, difficult to settle and suck poorly. They often have diarrhoea and scratch themselves; hiccups and coughs sometimes occur. Withdrawal can be so severe that the babies have convulsions if not treated. In about 75% of cases the only treatment which is required is supportive care, that is, soothing the baby by bathing more often and feeding frequently. The baby is wrapped tightly in blankets to make him/her feel secure. If the irritability is extreme the baby may need medication.

Although some drugs are excreted into breast milk, breast feeding may still be the right choice to make for feeding your baby. One important reason to consider breast feeding is the bonding that it can encourage.

Breastfeeding

Most drugs pass through the bloodstream and will be present in small amounts in the mother’s milk. Some drugs can be a problem for the baby. You will need to discuss this with your doctor or midwife.

Although there may be problems with drugs being passed through breast milk and therefore affecting the baby, breast feeding has a number of advantages which may override this disadvantage.

Breastfeeding helps form close ties between you and the baby. If a baby is going through withdrawal or is sick, it can be a long and difficult process to feel close to your baby.

Breast milk is a safe and easily available food for your baby and gives your baby a balanced diet as well as some protection from infections.

If you are using alcohol or other drugs for any reason then it is a good idea to plan with your midwife or doctor how you will feed, so that your baby is least likely to be affected.

You can express your breast milk and save it (the midwives will show you how to do this if you don’t already know). If its not possible to express, substitute formula for breast milk for a couple of feeds until the effects of the drug have worn off.  If you think you are going to use any drug it would be better to feed the baby before you do this, so that the concentration of the drug will have decreased in your breast milk by the next feed.

Mixing Drugs

Taking two or more drugs at one time can increase the risks associated with their use and can be more dangerous than either drug on their own. An example of this is taking alcohol and tranquillisers together. Using two or more drugs together can also complicate withdrawal symptoms in babies and cause a severe withdrawal reaction. The effects on the babies may even be more severe because of the cumulative effects of different drugs. Mothers using heroin and Rohypnol at the same time, for instance, can have babies who undergo severe withdrawal.

Glue and Aerosol Sniffing

Very little is known about the long term effects of sniffing substances such as glue, aerosols and petrol. Abuse of these substances has been known to cause death.

Effects During Pregnancy

Inhaling glues and aerosols during pregnancy can harm the baby. The most likely result will be early labour, a premature baby, and the associated breathing problems and risk of infection.

What You Can Do

If you are pregnant and having problems reducing or stopping your use of aerosols talk to an alcohol and drug counselling service, or your doctor or midwife.

Designer Drugs

Effects During Pregnancy

The use of hallucinogens and the other designer drugs during pregnancy is not recommend as they may be harmful to the baby. Any drug obtained illegally might have been mixed with other substances or drugs. While these substances can have harmful effects on you, it is also possible that miscarriage can result from their use.

What You Can Do

If you are pregnant and having difficulty reducing or stopping your use of designer drugs you can contact your local alcohol and drug counselling service, your doctor or midwife.

Marijuana

Effects During Pregnancy

Women who smoke marijuana often smoke it with tobacco and therefore there will be risks to the baby from tobacco smoke. THC (Tetrahydrocannabinol) is the active ingredient in marijuana and does cross the placenta. It is stored in the amniotic fluid that the baby lives in prior to birth.It is possible that marijuana use in pregnancy is associated with premature labour and small babies, with all the associated dangers of low birth weight including infections and breathing problems.

What You Can Do

Try to reduce your use. Any reduction to the amount you smoke will lessen the effects on the baby. The earlier in the pregnancy that you stop or reduce your use the better for the baby.

Always inform your doctor or midwife if you use a drug so they can properly check the baby’s health.

Breast Feeding

There is very little known about the effect of marijuana smoking on breast feeding.

It is believed that some of the drug will pass through the breast milk to the baby and the baby may become unsettled and demand frequent feeding.

If possible it is best to avoid using marijuana while breast feeding.

Cocaine

Effects During Pregnancy

Considerable research into the effects of cocaine use in pregnancy indicates that cocaine may cause bleeding, miscarriage, premature labour and stillbirth. It also indicates that cocaine use may have an effect on the baby’s growth and development before, and even after birth. Cocaine increases the heart rate in both the mother and baby and the supply of oxygen and blood to the baby is reduced. Because of the reduced supply the baby is more likely to be small and grow slowly. Several cases of bleeding in the brain have been reported in babies whose mothers were dependent on cocaine. A number of foetal abnormalities have been reported concerning the use of cocaine during pregnancy.If cocaine is used close to the birth the baby may be born excessively active and appear distressed and restless.

Withdrawal symptoms can occur in the babies of mothers who use cocaine regularly. These symptoms appear similar to those of adults experiencing withdrawal and can include sleepiness and lack of responsiveness.

What You Can Do

Try to stop using cocaine early in your pregnancy.

If you find it difficult to stop using cocaine talk to your doctor, midwife, alcohol and drug counselling agency, or the Chemical Dependency Unit at the Royal Women’s Hospital.

Breast Feeding

It is likely that cocaine will reach the baby through breast milk. This will depend on the amount you have taken and whether it was around the time of feeding.

As a result of cocaine the baby may be irritable, unsettled and difficult to feed.

The use of cocaine is not recommended if you are breast feeding.

Amphetamines (Speed)

Effects During Pregnancy

Using amphetamines during pregnancy can affect the baby’s development before birth and has been linked with bleeding, early labour and miscarriage. Amphetamines cause the heart rate of the mother and baby to increase. Amphetamines also cause the baby to get less oxygen, which means that he/she may grow slowly and be smaller at birth. When amphetamines are injected there are risks associated with using or sharing injecting equipment It is possible to become infected with HIV (the virus which causes AIDS) and this virus can be passed on to the baby.

Withdrawal

If amphetamines are used close to the birth, the baby may be born directly affected. Shelhe may be over-active and agitated. The babies of mothers who regularly use amphetamines may also experience withdrawal symptoms in the first few weeks after birth.

Mother’s who have been using amphetamines during pregnancy and continue after the birth may have difficulty coping with the usual crying and unsettled noises a baby will make.

Combining other drugs with amphetamines such as tranquillisers, alcohol or heroin can increase the risks associated with their use. It can also complicate withdrawal symptoms in babies.

What You Can Do

If you are thinking of becoming pregnant reducing your drug use would help you and your baby.

Talk to your doctor, midwife, or drug and alcohol counsellor about the drugs you are using. If you are able to reduce your use during pregnancy you will reduce the risks to the baby and lessen the severity of withdrawal.

Breast Feeding

Not much is known about the effects of amphetamines on breast feeding, although there is evidence to suggest that babies can feed poorly and be irritable. However it is not recommended to continue injecting drug use while breast feeding due to the HIV risk.

Analgesics and Over-The-Counter Drugs

Over-The-Counter Drugs

These include things like cold cures, antihistamines, allergy medications, vitamins, painkillers, herbal teas, antacids, laxatives, diet pills. They are easy to get from chemists, health food shops and supermarkets, and we don’t usually think of these medicines as harmful. However, medical research indicates that particularly if taken in higher than the recommended dose, they can be harmful. Always check with your doctor or chemist before taking any medicines or cough mixtures. Analgesics – Painkillers These are generally aspirin, paracetamol, and codeine based painkillers. They are the most common over-the-counter drugs. If a painkiller is required it is usually recommended that pregnant women take Paracetamol, in recommended doses, for pain relief. It is considered safe to use during pregnancy.

Aspirin can cause a longer pregnancy and subsequent labour. If taken in high doses towards the end of the pregnancy it can cause bleeding problems in the mother and baby.

Codeine based painkillers are much stronger and can cause constipation, which is especially a problem in late pregnancy. Codeine can be addictive if taken in large doses or over the recommended dose.

Any painkillers can be over-used and if you are taking more than the recommended dosage on the package you may be suffering effects from them. Your baby will also be experiencing these effects.

Both you and the baby can suffer withdrawal symptoms when stopping the use of painkillers if more than the recommended dose has been taken for long periods.

Vitamins and Herbal Remedies

Herbal remedies can be dangerous during pregnancy, especially if large doses are taken.

Some aromatherapy oils are not recommended during pregnancy or immediately after birth.

It is a good idea to check any of these substances with your doctor or naturopath.

Breast Feeding

Check with your doctor about any preparations you may be taking while breast feeding.

If you do need to take medication tell your doctor, naturopath or pharmacist that you are breast feeding.

Check your baby for side effects such as: poor feeding, rashes, upset stomach and irritability.

Prescribed medicines are best taken just after the baby has fed. This way the drug will be at its lowest concentration in the milk for the next feed.

What You Can Do

If you are having trouble reducing the amount of drugs you are taking you could talk to an alcohol and drug counselling service or your doctor.

INFORM YOUR DOCTOR OR MIDWIFE OF ANY PREPARATIONS OR MIXTURES YOU ARE TAKING AND NEVER TAKE MORE THAN THE RECOMMENDED DOSE ON THE PACKAGE.

Alcohol

Effects During Pregnancy Alcohol crosses the placenta to the baby. It can accumulate in the amniotic fluid surrounding the baby before the birth. Alcohol can cause problems in pregnancy such as bleeding, miscarriage, stillbirth and premature birth. There is evidence to suggest that if a woman drinks two or more standard drinks each day the baby can be affected and grow slowly. If a woman drinks six or more standard drinks each day the baby may have slow physical growth, poor coordination and movement and intellectual disability.

Unfortunately it is not known whether or not there is any safe level of drinking alcohol during pregnancy. It is also uncertain whether any particular stage of the pregnancy is the most vulnerable to the effects of drinking.

THE WORLD HEALTH ORGANISATION SUGGESTS THAT THERE IS REALLY NO SAFE LEVEL OF DRINKING ALCOHOL DURING PREGNANCY AND THAT NO ALCOHOL AT ALL IS THE SAFEST APPROACH.

Babies of women who are heavily dependent on alcohol can suffer withdrawal after birth. The symptoms can include tremors, irritability, fits and bloated abdomen.

What You Can Do

If you are trying to become pregnant you would be better to limit your alcohol drinking to small amounts, not too frequently. (One standard drink no more than once a week.)

If you are pregnant the safest approach is not to drink at all, or at least drink very small amounts (one drink) very infrequently (less than once a week).

If you are finding it difficult to cut down your drinking discuss this with your doctor, alcohol and drug counselling service.

If you do continue to drink, you need to avoid dehydration by drinking plenty of water regularly. you may need a Vitamin B supplement. Your doctor will advise you on this. It is also important that you tell your midwife or doctor as accurately as you can how much you drink so that they can monitor your baby’s development.

ANY REDUCTION IN YOUR DRINKING IS HELPFUL, ESPECIALLY IF YOU CONTINUE TO REDUCE AS THE PREGNANCY PROGRESSES.

Breast Feeding

While the effects of drinking alcohol on breast-feeding are unclear, it is known that alcohol is excreted into breast milk- It may be that having one drink occasionally is safe, but in general it is better to avoid using alcohol as much as possible.

During the first twelve months of the baby’s life the brain is still developing and may be damaged by alcohol.

Alcohol use can reduce the milk supply.

Tobacco

Effects During Pregnancy

Carbon monoxide and nicotine in tobacco both reach the baby very easily through the placenta. Both of these can cause problems with the baby’s growth and development before birth.Carbon monoxide will reduce the amount of oxygen available in the mother’s blood, which can affect the development and size of the baby.

Nicotine reduces the amount of oxygen available to the baby and may affect growth and development before birth.

Smoking can cause problems in pregnancy such as miscarriage, stillbirth, placental problems, bleeding during pregnancy and premature birth.

Babies practise breathing movements while in the womb. It has been shown that cigarette smoking can disrupt these breathing movements. The long-term effects of this are still unknown.

The reduced oxygen supply to the baby can delay his/her growth. Research has shown that babies of smokers are generally lighter than babies of non-smokers and that these babies can develop complications such as infections and breathing problems during the first weeks of life. (The birth is not necessarily easier for the mother or baby if the baby is smaller.)

Some research has indicated that smoking may increase the risk of cot death.

During pregnancy increased blood volume, as well as upward pressure from the baby pressing upward, can cause breathlessness in many women.

Passive Smoking

Spending a lot of time around other smokers means inhaling cigarette smoke which is harmful for you and your baby.

What You Can Do

The fewer cigarettes you smoke while you are pregnant the better for the baby.

Birth weight is less likely to be affected if you stop smoking by the fourth month of pregnancy.

Try to avoid being in a smoky environment Ask your friends to smoke outside for the sake of your baby.

Not smoking at all during pregnancy is the safest approach.

Breast Feeding

Smoking by the mother can reduce the milk supply and reduce the amount of Vitamin C in the milk.

Smoking just before breast feeding can delay milk “let down” (the process of the milk beginning to flow).

Heroin & Methadone

Effects During Pregnancy

The baby will get some heroin through the placenta and the baby’s growth and development may be affected. If you are not eating or sleeping properly the baby may be further affected.Heroin use can result in low birth weight babies who can experience complications such as infections and breathing problems in the first weeks of life.

Injecting heroin increases the risk of becoming infected with HIV (the virus which causes AIDS) which may then be passed onto the baby. Infection can result from sharing needles and other injecting equipment or having unsafe sex with someone who is infected.

Withdrawal

The baby could experience heroin withdrawal after birth. The severity of withdrawal can depend on other factors, such as your own health.

If you use heroin during pregnancy and regularly go through withdrawal the baby will too. The baby cannot be treated at this stage and there is evidence to suggest that this results in a higher risk of premature labour and the baby being undernourished. There is also some suggestion of a higher incidence of cot death.

The symptoms of withdrawal in new-born babies can include: sweating, fever, breathing problems, high pitched crying, excessive sucking, muscle spasms and irritability.

Withdrawal symptoms in new-born babies are initially treated with Supportive Care, this means cuddling, bathing and feeding the baby more frequently. Babies will also be wrapped tightly in their blankets to make them feel secure. Babies who do not respond to supportive care may need to be given morphine until their withdrawal stabilises.

Medical staff treat drug use details of patients as confidential if requested to do so.

What You Can Do

DON’T STOP USING HEROIN SUDDENLY. It will make you and your baby uncomfortable and your baby will be much more affected by withdrawing than you will be.

You could consider going on a methadone program while you are pregnant which would help control the amount of drugs you need as well as enabling you to look after your general health.

Pregnant women who are dependent on heroin should contact an Alcohol and Drug Counselling agency. Sudden withdrawal can harm the baby.

Effects During Pregnancy

Women who are on a methadone program have fewer complications during pregnancy and childbirth and are generally healthier than those who are using heroin. This is probably due to a combination of clean, controlled drug use and easier access to medical/ante-natal care as well as easing some of the stresses caused by the need to raise the money to buy drugs.

Complications are less likely to occur if methadone treatment is started early in the pregnancy. Speak to your doctor or health worker early in the pregnancy about the methadone program.

Methadone crosses the placenta so when taken some will reach the baby.

There is some evidence of a reduction in foetal and obstetric complications with Methadone. Babies cope better with a controlled and constant drug environment

Managing Withdrawal

Your baby may still go through withdrawal even if you are taking methadone.

The baby will be treated with either supportive care or medication to ease the withdrawal symptoms.

As the withdrawal symptoms ease, the baby’s medication (if it has been necessary) will be slowly reduced. When the baby is progressing well both in her/his general health and withdrawal you will be able to take your baby home.

It may be recommended that you stay on the methadone program for some time after the baby is born. This allows you and the baby to settle into new routines. you will be able to discuss this with your doctor.

Breast Feeding – Methadone and Heroin

If you are breast feeding and using heroin your baby may receive a small amount as well.

It is not recommended to continue injecting drug use while breast feeding due to the risk of HIV.

If you are on a methadone program it may be a good idea to breast feed, as some methadone in the mother’s milk may be helpful in reducing the baby’s withdrawal.

Methadone reaches its maximum level in breast milk between two and four hours after a dose. Feeding your baby just before you have your dose, or having it just before s/he is going to have along sleep will reduce the amount available to the baby.

You could ask your doctor, district nurse or alcohol and drug counsellor to advise you on breast feeding.
Prescription Drugs

Commonly prescribed benzodiazepines include: Valium, Serepax, Mogadon, Xanax, Ativan, Rohypnol, Normison and Tranxene.

Effects During Pregnancy

Benzodiazepines are the most common minor tranquillisers and sleeping pills used. Benzodiazepines are addictive to both the mother and the baby. The baby is less able to cope with tranquillisers than the mother.

It is recommended that the use of benzodiazepines be avoided during pregnancy and close to the time of birth as they can be harmful if taken continuously or in high doses (Australian Drug Evaluation Committee).

Benzodiazepines can produce withdrawal symptoms in new-born babies. Withdrawal symptoms can include breathing problems, poor body temperature control, poor muscle tone, and difficult sucking. The babies can appear floppy or limp and this poor muscle tone can last for a number of months, although the babies do eventually recover.

If benzodiazepines have been used consistently throughout the pregnancy, withdrawal symptoms can last for one week or more (although they can take some days to appear).

What You Can Do

NEVER STOP TAKING BENZODIAZEPINES SUDDENLY. People who stop taking benzodiazepines suddenly will often experience withdrawal symptoms which can be severe and can include a withdrawal seizure or fit. Withdrawal can occur for the baby as well. A tapered reduction is the recommended way of coming off benzodiazepines.

Consult your doctor, alcohol and drug counselling service if you wish to reduce your use of benzodiazepines during pregnancy.

If you are thinking of becoming pregnant talk to your doctor or other health services about going on a reduction program before pregnancy.

The lower the dose of benzodiazepines, the safer for the baby’s development and risk of withdrawal.

Breast Feeding

Benzodiazepines reach the baby through breast milk. The baby’s body cannot process them quickly and they can accumulate in high doses. The baby may be more affected if the mother is taking high doses or if the baby is sick.

The baby may have a lowered body temperature, poor muscle tone and breathing problems. The baby may also appear to be sedated and feed poorly. Each baby requires individual observation.