Physical Complications of Substance Abuse: What the Psychiatrist Needs to Know

Michael F Baigent


Curr Opin Psychiatry. 2003;16(3) 

In This Article

Prenatal Effects

Recent literature outlines the effects of substance use in pregnancy on the mother and the foetus, as well as on health in later life.

Obstetric complications such as abortion, intrauterine death, placental insufficiency, eclampsia, gestational diabetes, premature labour and rupture of membranes, and postpartum haemorrhage are more commonplace among illicit substance users.[1**] Cocaine use has caused placental dysruption because of its vasoactive effects.[2]

'Thanks to the efforts of dedicated researchers, there is no longer any doubt that alcohol is teratogenic'.[3] We know now that in-utero exposure to alcohol can lead to effects ranging from foetal alcohol syndrome (characterized by distinctive facial features and mental retardation in 85%) to behavioural abnormalities in children without the phenotypical features of foetal alcohol syndrome.[1**,3] Various classification systems have been devised.[4]

Drinking in pregnancy does not always lead to alcohol-related birth defects. It depends on maternal risk factors such as age, socioeconomic status, ethnicity and genetic predisposition, as well as maternal alcohol metabolism. A high peak alcohol level on drinking occasions is of more relevance than the total consumption during confinement,[4] although the exact amount to produce foetal damage is unknown.[1**]

Babies exposed to drugs in utero are more likely to have problems early in life than are nonexposed babies. Of such exposed babies, 27% are born prematurely (versus 6% among nonexposed) and 75% are affected by major medical problems (versus 27%). Rates for sudden infant death syndrome are four times higher in this group also.[1**] Three case-control studies of maternal cannabis use have reported a link with two distinct childhood cancers, namely acute nonlymphoblastic leukaemia and rhabdomyosarcoma.[5**] There is no epidemiological evidence to support this.

Most abused inhalants are highly lipophilic and therefore will cross the placenta. Toluene (found in glues) exposure in utero has been consistently associated with malformations such as oral clefts, micrognathia, microcephaly, growth deficiency and developmental delay.[6] Testing of foetal hair has been used to show intrauterine drug exposure to nicoteine, morphine, cocaine and benzoylecgonine, and meconium has been used to demonstrate exposure to morphine, cocaine, methadone and cannabinoids.[1**] It is difficult to correlate this evidence of exposure to specific harmful outcomes, however, and so further research is needed for more meaningful interpretation of results.


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