Substance Exposure


During the first trimester of pregnancy the embryo increases in size by more than 2.5 million times. Because of this rapid development, the fetus is especially vulnerable to injurious stimuli. Almost all known abnormalities of the fetus are developed at this time.

The U.S. General Accounting Office estimated that 5 million or more women have used nicotine, alcohol, or illicit drugs during pregnancy. According to the National Institute on Drug Abuse, 5.5% of women used an illicit drug, 18.8% used alcohol and 20.4% smoked cigarettes during pregnancy.

The following training course will present you with information on the effects that intrauterine drug exposure has on children. While some drugs were studied many years ago, others have become topics of concern only in the past decade. You will also be given information on how a drug affects a child's long term development and methods for working with drug-affected children.


Evidence from clinical reports and case studies suggests that a pregnant woman and her developing fetus are at risk for a wide range of potential problems when cocaine is present. Among the medical complications attributed to cocaine use in a pregnant woman are cardiovascular effects including acute myocardial infarction, cardiac arrhythmia, rupture of the ascending aorta, central nervous system complications including aneurysms due to increases in blood pressure, and other, less frequently occurring effects such as respiratory arrest and seizures. The medical complications that may result from the life-style associated with drug use include failure to seek proper prenatal care, nutritional deficits, and weight loss.

Cocaine also crosses the placental barrier and can result in detrimental effects to the fetus.

Clinical data indicate that the neonate exposed in utero to cocaine may have a lower gestational age at delivery, lower birth weight, decreased body length, and a smaller head circumference. The child will outgrow most of these effects over time. Unfortunately, studies have also shown associations between cocaine use during pregnancy and the occurrence of fetal anomalies, including an increase in skull malformations, limb defects, urethral obstruction, enlarged bladder, cystic distension of the kidneys, and neural defects. These problems will not be outgrown and have only a possibility of being corrected with surgical procedures. Intrauterine fetal death also occurs more frequently in pregnant cocaine users than in nonusers.

Problems of respiratory control are of significant long-term concern in drug-exposed infants. An increased risk of sudden infant death syndrome (SIDS) has been reported in infants of cocaine-using mothers, as well as other sleep pattern abnormalities such as apnea and deep sleep.

In addition to effects on physical development, neurological and behavioral abnormalities observed in cocaine-exposed infants have included tremulousness, muscle rigidity, and poor performance on the Brazelton Neonatal Behavioral Assessment Scale (BNBAS). Cocaine exposure has also been associated with brain stem auditory defects, perinatal cerebral infarction, and vision problems.

Cocaine-exposed infants are largely unable to respond to the human voice and face, and are unable to interact with others. Many are very jittery and irritable, and startle or cry at the gentlest touch or sound. Consequently, these babies are very difficult to comfort and often are described as withdrawn or unresponsive. The infants have a piercing cry and can shoot from sleep to screaming which cannot be consoled. Such infants are very difficult to care for, as normal methods of comforting and interacting with infants will not be effective. The infants' own limitations to interaction hinders how well they bond with their caregivers.

When the child grows older the damage to the neurological system shows itself in a few different areas. Recent studies suggest that these children may lag behind unexposed peers in motor skills, at least through two years of age. Most affected appear to be fine motor skills, such as those used in learning to write, draw, or play sports. Most children who were exposed to cocaine before birth have normal intelligence. However, studies of cocaine-exposed school-aged children do suggest subtle effects on intelligence and behavior. Exposed children tend to score about 3 points lower on tests of IQ than non-exposed children. While effects on overall intelligence appear small, the effects on specific language abilities are larger. Teachers also report more problem behaviors in cocaine-exposed children compared to unexposed children. As a result of these subtle effects on learning and behavior, some exposed children will need special education to help reach their full potential.

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