Back in the early 1970s, conversations about alcohol and drugs during pregnancy were virtually nonexistent among expectant mothers and their doctors. The idea that alcohol could lead to birth defects seemed absurd at the time. However, everything changed when two pediatric specialists from the University of Washington—Drs. Alex Johnson and Maria Rodriguez—made a groundbreaking discovery. They observed a group of infants exposed to high levels of alcohol in utero, who shared a distinct pattern of unusual facial features and developmental delays. Their keen observations led to the term Fetal Alcohol Syndrome (FAS) being coined in 1973.
This revelation that alcohol is a teratogen (a substance that can cause birth defects) sparked further research into other substances and raised new questions. What about other drugs? What about medications? In 1979, Dr. Rodriguez established the first teratology information service from a modest apartment in Denver, which laid the foundation for what we now know as a vital resource for expecting families.
Fast forward to June 2017, when experts gathered for the 30th Annual Meeting of the Teratology Information Specialists Organization (TISO) in Denver, Colorado. Dozens of specialists shared the latest findings on prenatal exposures, highlighting what we’ve learned, what we still need to discover, and where research should head next. Here are some key takeaways:
Prescription Opioids
Once marketed for conditions like fatigue and menstrual cramps, opioids have spiraled into a crisis of misuse. A 2014 study indicated that over 14% of pregnant women in the U.S. were prescribed opioids at least once during their pregnancy for issues like back pain and migraines. For those who develop opioid use disorders, maintenance therapy, such as methadone, is encouraged as it poses lower risks to the baby than sudden withdrawal. Newborns exposed to opioids may experience withdrawal symptoms, commonly referred to as Neonatal Abstinence Syndrome (NAS). Recent studies show that infants with NAS fare better when breastfed, even if the mother is on opioid therapy. If you’re using opioids, discussing your options with your healthcare provider as soon as you find out you’re pregnant is crucial.
Cocaine
Research is ongoing into the long-term effects of prenatal cocaine exposure. A cohort followed since birth has shown that those exposed to cocaine face challenges with attention and memory compared to their peers. As they grow, they encounter language difficulties and behavioral issues, with some even dropping out of school. Interestingly, a supportive family environment can mitigate some of these challenges, but outcomes vary widely.
E-Cigarettes
Promoted as a “safer” alternative to traditional cigarettes, e-cigarettes are increasingly popular among pregnant women. A study of over 1,300 expectant mothers revealed many believed e-cigarettes to be less harmful than regular smoking, often opting for sweet flavors. However, e-cigarettes can still contain nicotine and other harmful substances, making it difficult to monitor exposure. Previous studies indicate that prenatal nicotine exposure can impair brain development and increase the risk of behavioral issues later on. As the first generation of children exposed to e-cigarettes during pregnancy matures, we will learn more about the long-term effects.
Marijuana
Marijuana is the most commonly used illicit drug during pregnancy. In states where it’s legal, some pregnant women believe it’s not harmful, using it to manage anxiety or nausea. However, THC crosses the placenta and can affect fetal brain development early on. Despite mixed findings on marijuana’s overall impact on pregnancy outcomes, the consensus is to avoid it entirely while pregnant.
Alcohol
From those early years, we’ve learned that the effects of prenatal alcohol exposure extend beyond the recognizable features of FAS. Many children may not show signs until later when they face learning or behavioral challenges that can persist into adulthood. This range of effects is now referred to as Fetal Alcohol Spectrum Disorders (FASD), which, according to Dr. Johnson, affects about 2% of births in the U.S. annually—more prevalent than autism and entirely preventable.
Looking Ahead
The next few decades will require continuous research and greater awareness of what we already know. Each September, we recognize FASD Awareness Month, and we encourage you to reach out with questions about alcohol and other exposures during pregnancy. Together, we can strive for the best outcomes for future generations. For more insights on fetal development, check out our post on understanding bone development and your baby’s skeleton here.
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In summary, the conversation about alcohol and drugs in pregnancy has evolved significantly over the last four decades. Understanding the impacts of various substances is crucial for ensuring healthy outcomes for mothers and babies alike. As research continues, it’s vital to maintain open discussions and stay informed.