Impact of Maternal Substance Use During Pregnancy on Childhood Outcome

The impact of maternal substance abuse is reflected in the 2002–2003 National Survey on Drug Use and Health. Among pregnant women in the 15–44 age group, 4.3%, 18%, and 9.8% used illicit drugs, tobacco, and alcohol, respectively. Maternal pregnancy complications following substance use include increases in sexually transmitted disorders, placental abruption, and HIV-positive status. Effects on the neonate include a decrease in growth parameters and increases in the central nervous system and autonomic nervous system signs and in referrals to child protective agencies. In childhood, behavioral and cognitive effects are seen after prenatal cocaine exposure; tobacco and alcohol have separate and specific effects. The ongoing use of alcohol and tobacco by the caretaker affects childhood behavior. Therefore, efforts should be made to prevent and treat behavioral problems as well as to limit the onset of drug use by adolescent children born to women who use drugs during pregnancy.

Introduction

Currently, about 11% of the adult population of the United States suffers from a substance-abuse problem during any one year. The cost to society of this drug use is estimated at over US$300 billion annually; this figure includes the costs of crime, heath-related problems and reduced work productivity. The impact of maternal substance abuse is reflected in the 2002–2003 National Survey on Drug Use and Health, which found that, of pregnant women aged 15–44, 4.3%, 18% and 9.8% used illicit drugs, tobacco and alcohol, respectively. In 2002, the approximate numbers of births complicated by maternal use of drugs were 172,934 for illicit drugs, 723,911 for tobacco and 394,129 for alcohol.¹ Thus, from the public health perspective, the impact of substance use during pregnancy in the United States extends far beyond the health of the mother and affects a large number of the unborn population.

In the 1980s, the ‘war on drugs’ associated with the crack-cocaine epidemic focused national attention on to the relationship between drug use and social and economic problems in society. Early reports on the effects of prenatal cocaine exposure created a public frenzy and prompted the myth about ‘unfit to parent’ women and their damaged ‘crack babies’. This in turn had an impact on legal and policy decisions made by individual US States and affected women who use illegal drugs during pregnancy. However, studies performed since the 1980s have failed to support significant associations between prenatal cocaine exposure and the increased prevalence of serious newborn congenital malformations and medical complications at birth.

The focus of this paper is the impact of substance use on maternal, neonatal, and preschool child outcomes. Data from recent cohort studies and from studies using state-of-the-art methods of documenting substance use will be examined.