Title: Drugs, Alcohol and Pregnancy
Author: Christina Dye
Publisher: Do It Now Foundation
Publication Date: August 1999
Catalog Number: 211



News & Bad News

Chapter 1

Here to Maternity

Baby Beginnings

Chapter 2


Alcohol, Tobacco,
and Caffeine

Drugs, I

Uppers, Downers,
and Painkillers

Drugs, II

Marijuana and Other

and Non-Prescription Drugs



Chapter 3


Beating the Blues




Chapter 4

in the Making: Handle with Care


Good News & Bad News

There’s good
news and bad news about having babies.

The good news
is that a baby born today is more likely to be born healthy and
to live longer than babies born at any other time in the 20th
century — and probably all the centuries before that.

Not only that,
but having a baby is easier today than ever before, too. New
advances in reproductive science and medicine–and the “borrowing”
of older techniques like breathing exercises and birthing chairs–make
pregnancy and childbirth safer for baby-to-be and more comfortable
for mom.

That’s the good

The bad news
is that the job of being a mother is bigger and starts sooner
now than ever before.

Now the good
news about the bad news is that the bad news is also good news
(great news, in fact, depending on how you look at these things).
Because just as we have a greater responsibility to safeguard
the health and safety of our children in today’s complex world,
we also have an unprecedented opportunity to care and provide
an ideal environment for them even before they’re born.

That’s what this
booklet is all about.

Because of all
the advances in medical knowledge made in understanding pregnancy
in recent years, none has been quite as powerful (or nearly as
magical) as the love and concern of a mother for her baby. And
the form that love takes before birth is no less important than
the form it takes after, and quite possibly even more so.

This, then, is
not a book about waiting–at least not about waiting for something
else to happen. It’s a book about creating, about shaping the
most powerful force in the world–a healthy new life.

Chapter 1
From Here to Maternity

In many ways,
prenatal health care today is more complicated than it was only
a few years ago and involves a lot more than simply visiting
a doctor and getting eight hours sleep at night–although that’s
still important, too.

Mothering an
unborn baby today involves attending to the total needs of mother
and child–emotional and psychological needs as well as physical
and nutritional. And taking care of all those needs often requires
changes in a mother’s habits and lifestyle, from exercising regularly
and eating sensibly to just plain learning how to relax.

Probably the
most important single thing an expectant woman can do to protect
her future baby’s health is to get drug- and alcohol-free–and
stay that way.

And even though
for some women that may require the biggest change of all (or
at least the most uncomfortable change of all), there’s still
no better time to start than now.

Because over
the past dozen years or so, we’ve learned a lot of disturbing
facts about the effects of drugs and alcohol during pregnancy.

We’ve learned
that many popular drugs like alcohol and tobacco can pose serious
risks to unborn babies.

And we’ve discovered
that nearly every drug a pregnant woman uses’whether commonplace
chemicals like caffeine or exotic ones like cocaine–ends up
in her baby’s body, too, and often in higher–and more harmful–doses
than in the mother.

And at this point,
there’s still one more bit of good/bad news to consider.

The good news
is that most problems related to drug use in early pregnancy
are probably preventable as long as a woman discontinues use
as soon as she discovers that she’s pregnant.

The bad news
is that most experts fear that if she postpones that decision
for even a short time, the decision–when it does come–may not
be soon enough.

And they say
so for a growing number of reasons. And one growing reason in


Baby Beginnings

Like Christmas
packages, babies come in an assortment of sizes, shapes, and
colors. But even though the wrapping may be entirely different,
inside all babies are basically the same and all start from similar

Where they all
start from is conception–the split-second link-up of the mother’s
egg cell and the father’s sperm, and that’s the same in all babies
whether they’re conceived in Africa or Australia–or in a test

We’re not going
to spend much time discussing those beginnings.

What we will
say is that lots of changes take place in the embryo from Day
1 of conception until the beginning of babyhood–from the building
of bones and blood vessels and brain tissue to the shaping of
arms and eyes and legs.

Many of the most
important changes take place in the first month or two of pregnancy.

During this time
the fetus is hard at work on its own–growing and changing from
a pinpoint-sized egg to an inch-long embryo with miniature versions
of soon-to-be eyes, ears, and lungs.

By the end of
just the second month, the heart is beating and a brain and nervous
system have begun to form.

And that’s when
things can start to get tricky.

Because a number
of things can go wrong in the first, critical months of pregnancy.
And during this time, when many women don’t even realize that
they are pregnant, one thing that often goes wrong happens when
mothers-to-be use drugs or alcohol.

Although no month
is ever “safe” for chemical use–and no doses of drugs
are “safer” than others–drugs taken in the first months
of pregnancy carry the highest risks of damaging organs and tissue.

Drugs used later
in pregnancy, particularly after the fifth month, are more likely
to slow growth or affect development of the brain and nervous
system, often showing up later in life as learning or behavioral

But the range
of drug-related problems doesn’t end there.

Women who use
addictive drugs, such as heroin or barbiturates, give birth to
addicted infants.

And women who
inject drugs or who trade sex for crack (or other chemicals)
gamble on infecting their unborn children with AIDS.

Given all the
changes happening inside her–and all the potential threats on
the outside–an expectant woman needs to take care to keep drug
and alcohol use to an absolute minimum throughout her pregnancy.

That’s where
this booklet comes in.

Because there
are steps a pregnant woman can take to insure a happier pregnancy
for herself and a safer one for her child. And the first step
is simply being informed about possible problems and being prepared
to handle them before they happen.

That, and a little
loving care from mom, is the best formula of all for a growing

Because nothing
beats the love and concern of a mother in keeping her child healthy,
safe, and happy. And since babies, like Christmas, only come
every so often, they need all the care they can get.


Chapter 2
‘Everyday’ Drugs: Alcohol, Tobacco, and Caffeine


Rule #1: If you
drink, so does your unborn baby. Rule #2: The more you drink
the greater your chances of harming your child.

We’ve known that
heavy use of alcohol causes birth defects and behavioral problems
in infants for many years.

But only recently
have doctors discovered that light-to-moderate drinking carries
equally serious risks. And one study even linked pre-conception
drinking by the father to reduced birth weight and delayed growth
in the infant.

Still, the most
dreaded of all alcohol-related birth defects is Fetal Alcohol
Syndrome. FAS symptoms include:

  • Growth Retardation: Below-normal size and
    weight at birth. Affected children may never “catch up”
    in later life.
  • Facial Changes: Alcohol-induced malformations
    include a small head, narrow eyes, a flat nose, and a thin upper
    lip. Bones, muscles, skin, eyes, heart and sex organs may also
    be damaged.
  • Behavioral

    Restlessness, irritability, poor coordination, and hyperactivity.
    Many children suffer mild to moderate mental retardation and
    learning disabilities.

Researchers believe
that the full-blown Fetal Alcohol Syndrome may occur in as many
as two of every 1,000 live births in this country. It is the
leading form of preventable birth defect with mental retardation.

And for every
child born with the full Fetal Alcohol Syndrome, 10 others suffer
other alcohol-related problems.

So, if you’re
pregnant, how much alcohol is too much?

According to
the U. S. Surgeon General’s Office, there is no safe level of
use. Any amount of drinking poses risks to an unborn baby.

While FAS is
most likely to occur in children of “heavy drinkers”–women
who have five or more drinks per day–as little as one or two
drinks a week can raise the risk of miscarriage or stillbirth.
And even an occasional drink may affect nervous system and intellectual

And that’s a
chance that more and more women today are saying they just won’t



We really have
come a long way, baby. What’s questionable is just what some
of us have gotten ourselves into.

Because in spite
of the constant barrage of studies linking tobacco use with disease,
smoking rates among women continue to soar–as do levels of such
once-“male-only” health problems as lung cancer and
heart disease. And studies show that smoking is just as harmful
to unborn babies.

That’s because
tobacco smoke contains over 4,000 different chemicals which cross
the placenta linking mother and child, and end up in the fetal
bloodstream. These chemicals reduce the amount of oxygen available
to the fetus, and can also cause–or contribute to– longer-term
problems, including:

  • Higher risks
    of miscarriage and premature birth. Researchers say that as many
    as 18,925 miscarriages a year are attributable to smoking during
  • Increased risk
    of infant death in the first year. Some experts believe the risk
    of infant death rises as much as 20-30 percent in pregnant smokers.
  • Slowed growth
    and low birth weight.
  • Bleeding and
    problems in delivery.
  • Higher levels
    of infant heart and lung disease.

More than one
recent studies have even warned of a possible “Fetal Tobacco
Syndrome.” Linked to women who smoke two or more packs of
cigarettes a day, the syndrome includes many of the problems
— including facial malformations, small body size, and mental
retardation — usually associated with FAS.

Researchers think
tobacco is most harmful in the last six months of pregnancy,
so if you’ve tried to quit in the past, try again.

And if you’re
due next month and haven’t stopped yet, try anyway. Any reduction
in smoking is better than none at all.

If you’ve already
quit, congratulations. You really have come a long, long way.
So has your baby.



Caffeine is the
all-time, all-around, all-American drug.

We down more
than 35 million pounds of caffeine every year in coffee and colas
and other caffeine-containing beverages alone. And that doesn’t
include the hundreds of over-the-counter drug products–from
aspirin and diet aids to allergy and asthma medicines–that also
contain the drug.

Still, caffeine’s
never been given a completely clean bill of health for all of
us all the time.

Animal studies
linking it with possible birth defects (in doses equivalent to
three or four cups of coffee a day) convinced the U.S. Food and
Drug Administration to remove caffeine from its safe additives
list back in 1980. The FDA also advises pregnant women to avoid
the drug.

Recent studies
have expanded those findings. One showed that two or three cups
of coffee each day can double the risk of delayed fetal growth.
And some researchers have linked a single cup of coffee a day
with increased risks of miscarriage.

That’s why you
might want to rethink the value of coffee and other caffeine
drinks in you life if you’re pregnant–for at least as long as
you’re pregnant.

Because caffeine
is a drug and it does cross the placenta to the fetus. And even
if it doesn’t cause serious troubles, it can cause sleeplessness,
anxiety, and irritability–all of which can be a problem, whether
you’re thirty years or thirty weeks old.


Street Drugs, I: Uppers, Downers, and Painkillers


(Biphetamine®, Dexedrine®, Desoxyn®)
Cocaine and cocaine free base (“crack”)
Street “speed,” “crystal meth,” “ice,”
and over-the-counter “herbal ecstasy”

Stimulant drugs
are often called “uppers” because they produce feelings
of energy and alertness.

Doctors occasionally
prescribe them to control weight and treat fatigue, although
on nowhere near the scale of a few years ago — mostly because
the drugs create more problems than they ever helped resolve.

No matter which
type of upper you’re talking about — whether cocaine, methamphetamine,
or their smokable versions, “crack” and “ice”
— stimulant drugs are trouble when taken during pregnancy.

Potential problems
can include:

  • Heart, brain,
    and liver damage.
  • Abnormal bone
    and organ development (stomach, kidneys, intestines).
  • Miscarriage,
    stillbirth, premature birth.
  • Sudden infant
    death–estimated at 5-10 times the rate of drug-free newborns.

Experts worry
most about cocaine and “crack,” and with good reason.
Reports have tied the drugs to high rates of miscarriage, bleeding
in delivery, and fetal stroke. Cocaine-exposed children are also
smaller and weigh less.

“Crack babies”
suffer most.

A number of studies
comparing birth outcomes among drug-using women found crack smokers
— children were smaller, lighter, and had more neurological
problems than other drug-exposed infants.

Serious trouble
is most common in women who use cocaine throughout pregnancy.
But even short-term use can cause problems, including poor muscle
control and disturbed behavior (difficulty staying alert, poor
emotional responses).

And for cocaine
injectors, even one-time use may be all it takes to infect an
unborn child with the AIDS virus.

If you’re pregnant
— or are thinking about pregnancy — and you’re using cocaine
or other stimulants, stop now.

Because speed
(in all its forms) really does kill. And it causes all kinds
of other problems, too.



(Amytal®, Nembutal®, Seconal®, Tuinal®)
Non-Barbiturate Sedatives (Dalmane®, Placidyl®, Doriden®)
Tranquilizers (Valium®, Librium®, Ativan®, Xanax®,

Depressant drugs
are often called “downers” because they slow body systems
down. Doctors prescribe depressants to induce sleep, relieve
anxiety, or to otherwise calm the nervous and help the restless
to relax.

Like stimulants,
depressants pose their greatest risks to baby-to-be during the
first months of pregnancy. Typical problems include:

  • Sleeping
    addiction and severe, life threatening withdrawal. Breathing
    problems, internal bleeding. Poor coordination, slow reflexes.
  • Tranquilizers. Infant addiction and
    withdrawal. Defects in lips and mouth. Damage to heart and arteries.
    Malformed joints. Deafness. Mental retardation.

Just a few years
ago, we didn’t realize how many depressant drugs could be dangerous
during pregnancy. But all that’s changed.

We now know that
depressants can be harmful, both during pregnancy and after.
In fact, one study released in 1995 even showed that children
born to women who used phenobarbital — long thought to be the
one of the least harmful of all the depressant drugs — continue
to show lower I.Q. than their peers as they grow up.

On the other
hand, we’ve also learned that using depressant drugs usually
isn’t necessary. Today, physicians and psychiatrists rely more
on non-drug methods of managing stress and teaching relaxation
than in the past.

So if you don’t
need depressants, don’t use them.

And if you do
have a prescription for a depressant drug, talk with your doctor
about continuing your treatment as soon as you discover that
you’re pregnant.

Together you
can review your reasons for using depressants and determine if
the benefits outweigh the possible risks for your baby.



Opiates (codeine,
heroin, morphine)
Synthetics (Demerol®, Darvon®, Talwin®, Percodan®,
methadone) and some “designer drugs” (fentanyl, “China

A lot of people
think all drugs are narcotics.

Medically, though,
narcotics are drugs that relieve pain and induce sleep. Some
narcotics, especially Demerol, are given to ease the pain of
labor, while codeine is a common ingredient in prescription cough

Probably the
one thing everyone knows about narcotic drugs is that they’re
addicting. And they’re not just addicting to the mother, if she
uses them during pregnancy. The fetus is just as addicted as
the mother — and is born that way.

Withdrawal symptoms
— which include vomiting, weight loss, and anxiety — are particularly
dangerous for newborn babies. And even though the symptoms eventually
pass, drug-related problems don’t always stop there.

Babies exposed
to narcotics face higher risks of miscarriage, AIDS, and early
death. And many suffer slowed growth, learning disabilities,
and other problems throughout life.


Street Drugs, II: Other Drugs


Since marijuana
is so widely used in the United States, it shouldn’t be surprising
that it’s also commonly used during pregnancy. About 19 million
women of child-bearing age are current smokers, and 8.3 percent
of all expectant women smoke pot at least occasionally during

They shouldn’t.
If you’re pregnant and smoke pot, chemicals from the drug pass
through the placenta to your unborn child. THC (marijuana’s main
psychoactive chemical) is stored in the fatty tissues of the
body–including the fetus–and may stay there days or weeks after

Pot-related problems
during pregnancy include:

  • Changes in hormone
    levels that control fetal growth.
  • Low birth weight
    and smaller birth size.
  • Stillbirth,
    miscarriage, and premature birth.
  • Behavioral problems
    in newborns: shivers, irritability, difficulty adjusting to light.

Although marijuana
has not been found to cause birth defects with occasional use,
some pot chemicals produce malformations in animals at high doses.
One human study tied heavy marijuana use to FAS-like facial changes
in exposed infants.

Other research
findings are less certain, including evidence for lasting changes
in learning abilities or behavior in pot-exposed children. Still,
experts agree that marijuana can cause delays in growth that
make it more difficult for newborns to thrive.

So if you’re
a pot smoker, do yourself and your baby a favor: Leave marijuana
alone. Because the simple fact is that turning on while pregnant
can turn into trouble.



Inhalants are
“invisible” drugs. That’s because many of the chemicals
people sniff are not regarded — or restricted by law — as drugs.

They include
products as common as gasoline and typewriter correction fluid.
Other inhalants include amyl, butyl, and isopropyl nitrite (“liquid
incense”) and nitrous oxide.

Scientists say
that sniffing solvents like glue, gasoline, and paint thinner
may trigger a “Fetal Solvents Syndrome,” resulting
in defects and retardation similar to FAS.

In addition,
most inhalants reduce the flow of blood and oxygen to both mother
and fetus and can raise blood pressure to dangerously high levels.

And since they
easily cross the placenta, sniffing any inhalant can increase
your chances of miscarriage or stillbirth, as well as raise the
risks of poisoning from inhalant chemicals containing lead.



LSD (“acid”),
MDA/MDMA (“ecstasy”), mescaline (peyote), psilocybin
(mushrooms), PCP (“angel dust”)

Like most other
drugs, hallucinogens can easily cross the placenta and circulate
in an unborn child’s bloodstream.

And while most
don’t appear to cause the type of damage or birth defects that
was once feared, they do carry high risks of miscarriage and

PCP is particularly
dangerous. Unlike LSD, which passes rapidly through the body,
PCP is stored for weeks in muscles and fat — including the fetus.
One study showed that the drug accumulates in higher concentrations
in the brains of newborn rats than in the brain of the mother.

The result? Human
infants suffer reactions identical to the symptoms of the PCP
high: rapid mood changes, staring, tremors, and facial twitching
and grimacing. Long-term effects also reflect the drug’s presence,
and include abnormal eye movements, poor coordination, and poor
socialization and speaking skills.


Prescription and Non-Prescription Drugs

Many medications
that you may have taken without a second thought before you were
pregnant can cause problems during pregnancy. This includes drugs
prescribed by a dentist or dermatologist as well as a personal
physician, such as antibiotics, antihistamines, and birth control

It also includes
common non-prescription drugs that we buy over the counter in
grocery stores and pharmacies. Aspirin and antacids, for example,
are not generally considered hazardous drugs. But during pregnancy,
both can pose serious risks — including heavy bleeding and complications
in delivery — if too many are taken too often.

When drugs are
taken can be just as important. An example involves the anti-acne
drug Accutane® (isotretinoin). The FDA not only warns against
its use by pregnant women, but also by those who may soon become

Accutane produces
major birth defects in one of four pregnant users when taken
during the critical period of 28 to 70 days after the start of
the last menstrual period. Another 40 percent of pregnancies
miscarry, although the drug appears to have no effect on babies
conceived after use is stopped.

Because we don’t
have all the answers about all the medicines prescribed by doctors,
we can’t simply advise expectant mothers to stop taking their
prescriptions. But we can provide a few simple rules for making
those medicines safer for mothers and their babies-to-be:

  • Check with a
    doctor or clinic about your prescription medications as soon
    as you think you’re pregnant.
  • Avoid using
    all over-the-counter drug products unless taken under your doctor’s
  • Take medications
    only at prescribed times and in prescribed amounts.
  • Look for chemical-free

Probably the
best thing you can do to protect your child is simply to ask
questions. Ask your doctor, ask a pharmacist, or ask both. They
may provide the most important answers to questions you’ll ask
in your — or your baby’s — life.


Non-Drug Dangers


Many people believe
that the more vitamins you take the healthier you will be. But
vitamins are a supplement to — not a substitute for
proper nutrition. And when you’re pregnant, starting with a healthy
diet is even more important. Because while vitamin deficiencies
are a well-known cause of certain birth defects, too many of
the wrong kind of vitamin supplements can be just as dangerous.

How do you tell
how many are too many?

Simple. Take
your vitamins only in the recommended doses and if you forget
your daily dose, don’t try to “catch up” by doubling
or tripling your dose. Check with your doctor in your first few
months and don’t take vitamins he or she doesn’t prescribe. Together
you can work out the best diet and vitamin plan to meet your
needs — and your baby’s.


AIDS/HIV Disease

disease) is probably the drugs-and-pregnancy issue of
all time. And for good reason.

An estimated
30-40 percent of children born to infected women are also infected
— most by their mothers’ IV drug use.

And cocaine is
creating a new high-risk group: women (and men) who contract
the disease via sexual activity as a means of exchange for crack
cocaine. Crack-for-sex exchanges in New York City drove the syphilis
rate up by 500 percent between in the late 1980s. And in recent
years, sex-for-drug exchanges has helped propel HIV into the
general, heterosexual population.

Women who believe
they may be infected should consult a doctor for testing. Many
public clinics perform confidential AIDS testing and offer counseling
and treatment services.

Infected women
should also be treated with AZT (zidovudine) or the newer anti-AIDS
combination-drug therapies as early as possible. Studies have
shown their value in preventing transmission of the AIDS virus
from mother to child, without risk of birth defects or other
harm to the child.

Chapter 3
Aftercare, I: Beating the Blues

After your baby
is born, you may get less sleep and have more minor aches and
pains and frustrations than during pregnancy. Your child will
require constant care and attention and there’ll often be a lot
to do in a little time.

Many women experience
temporary feelings of depression and fatigue in the first days
and weeks after delivery.

The feelings
are so common that they even have a name: postpartum blues. And
it shouldn’t be surprising that some women try parting with their
blues with a few well-timed drinks or by taking some other drug.

Don’t be surprised
— or worry unnecessarily — if postpartum blues happen to you.

Postpartum blues
are a natural reaction to fluid and salt imbalances brought on
by the stress and strains of delivery. And although they can
be uncomfortable (and lots of women report they frequently are),
these down-in-the-dumps feelings usually disappear on their own
within 10 days or so.

Be aware: Drugs
or alcohol will probably only make you feel low longer, and leave
you a lot less prepared to handle new motherhood in the long


Aftercare, II: Breastfeeding

If you choose
to breastfeed your child — or to use your own milk to bottle
feed — you’ll have another good reason for limiting your use
of drugs and alcohol.

Many drugs taken
after delivery — alcohol, cocaine, marijuana, tobacco, and heroin,
to name a few — are passed on to your baby through breast milk.

And because the
human brain and nervous system continue developing long after
birth, your child can be affected by any drugs you pass on at
dinner time. One study of drinking by breastfeeding mothers found
that exposed infants tended to crawl and walk later than normal.

Other drugs produce
more immediate problems. Birth control pills, for example, can
slow milk production, while caffeine and nicotine may upset your
child’s appetite.

And troublesome
as it may seem sometimes, your baby needs his or her appetite
— every bit of it.


Chapter 4
Miracle in the Making

Handle with

There are a lot
of things we all want to give our children: a happy childhood,
a college education, a sense of who they are, and satisfaction
in what they are and what they eventually make of their lives.

But one of the
most important things we can ever give our kids is the gift of
health. Healthy babies start with healthy pregnancies.

And that can
call for hard work, and maybe even some sacrifices.

Because babies
are special they need special handling, including all the care
and love and tenderness we can give. That kind of care starts
early in pregnancy with a healthy diet, frequent medical attention,
and careful management of any drugs you may use.

No one has all
the answers about all the effects of drugs taken during pregnancy,
just as there is no one simple solution or all-purpose advice
for raising children.

But we do know
that medications and mood-altering substances of all types pose
risks to unborn babies. And while some dangers are more clearly
established than others, a risk is still a risk. And chances
are it is a risk you really don’t want to take with your child.

We have a special
responsibility for our unborn children. Their lives depend very
much on the quality of our own lives and our own level of physical

And we all have
those annoyingly perfect pictures of how we’d like our lives
to be. Someday.

We want to stop
smoking or cut back our drinking but haven’t gotten around to
it yet. Or we want to control our weight or start an exercise
program, but there never seems to be enough time — or the time
we have doesn’t look like the right time.

Well, ready or
not, now is the right time.

Because if the
first step to protecting a child’s health is being informed–finding
out about possible problems before they happen–the second step
is doing something about them.

So, if you’re
pregnant, see a doctor as soon as possible and as often as necessary.
Stop using any drugs or medications your doctor hasn’t approved
and all so-called recreational drugs. And if you’ve tried to
stop drinking or using a particular drug and think you need help
— get it. It’s the least you can do for your baby.

Our advice is
that the oldest advice is still the best advice: An ounce of
prevention is worth a pound of cure. And where your baby’s health,
safety, and future are concerned, it’s worth even more than that.


This is one in a series
of publications on drugs, behavior, and health published by Do
It Now Foundation. Check us out online at www.doitnow.org


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