Drugs and the foetus

Women who use illicit drugs are generally advised to stop taking them before getting pregnant or as soon as they find out. This has met some criticism as sudden cessation of use can in itself cause problems. Advice also needs to be accurate in relation to the type and amount of substance being taken (Klee et al. 2002).

While the impact of illicit drugs on pregnancy and the foetus is not fully known it is generally assumed that drug use will pose a risk to the unborn child because of its impact on the mother’s physiology.

Women who are heavy users of opiates, eg. heroin, will likely need referral to antenatal care to ensure their own health, and that of the unborn child, is monitored. This would also allow for substitute prescribing for mother where appropriate. Some of the risks of illicit drug use during pregnancy include:

• Miscarriage
• Growth deficiencies
• Premature labour
• Baby suffering withdrawal afterbirth – up to several weeks
• Stillbirth
• Physical abnormalities
• Dying from SIDS (Sudden Infant Death Syndrome)

The use of cocaine during pregnancy is thought to have the additional risk of “life-threatening bleeding from the uterus in late pregnancy (placental disruption)” (Patient UK 2005).It is difficult to determine the effects of a single drug on the foetus due to drug users often using more than one substance (poly-substance use) at any one time and a combination of other environmental risk factors, eg. poor living conditions, malnutrition, domestic abuse during pregnancy to name a few.It is also difficult to determine at which stage during pregnancy the drug use can be most harmful. Like alcohol there are suggestions that the first trimester is the most risky time but this should not imply that beyond that there are no risks. It is obvious that any problematic drug use is likely to have an impact perinatally on the unborn child. What current research suggests is that the drug use is associated with a range of harms including those listed above.The social worker’s role must be to identify and recognise potential risks, discuss them openly with mother (and partner if appropriate and safe to do so), make referrals to specialist agencies as required and support the woman through the process of accessing services, receiving support, antenatal and postnatal care. Particular attention also needs to be paid to the increased risk of domestic abuse drug using women face, particularly during pregnancy. Statutory powers under the Children Act 1989 must only be used as a last resort.

References
Patient UK (2005) ‘Pregnancy and Street Drugs.’ Available online at http://www.patient.co.uk/showdoc/27000496.htm. Accessed 7th July 2005.