Effects of substance abuse on unborn baby
The problem of substance abuse is increasingly permeating the social fabric of the Ghanaian society. In the past, illicit drug use was mainly confined to young males of school age but the trend has changed over the past 10 years. Advertisement
Now, young females of school age are experimenting with illicit drugs usually through the influence of their male counterparts. These young ladies, however, are not aware of the dangers of substance abuse on their health, scholastic future, reproductive health, social interaction, their families and the country at large. Once they become addicted or dependent on these drugs, they find it difficult, if not impossible, to willingly abstain.
Recent estimates in the United States of America (USA) suggest that 19 per cent of pregnant women use alcohol, 20 per cent smoke cigarettes and 5.5 per cent use illicit drugs during pregnancy.
Even though cultural and other social practices inherent in the USA are not the same and that these figures may be less in Ghana, it is an eye-opener which must be taken seriously because the world is now a global village.
The effects of pre-natal exposure to the fetal depends on many factors which include the type and form of the drug used, time of exposure during pregnancy, frequency of exposure, and the actions of the drugs on the placental tissue. Obstetricians should, therefore, look out for evidences and inquire of drug history during the antenatal visits, especially alcohol and cigarettes.
Understanding the effects
Understanding the effects of a given drug on the fetus requires knowing the stage of development when the fetal is exposed to the drug. Gestation is divided into three trimesters. Most organogenesis (development of organs) transpires during the first eight weeks of pregnancy (first trimester). During this period, the fetus is susceptible to teratogenes (drugs which deform the fetus).
Consequently, first trimesters are associated with major malformations, birth defects and spontaneous abortions. After their formation during the first trimester, these organs develop and grow during the remainder of the pregnancy.
Hence, exposure during the second and the third trimester causes functional defects, intra-uterine growth retardation, pre-term labour and pre-mature rapture of membranes.
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Different organ systems are susceptible to trans-placental drug effect at various times. The behavioural signs that the obstetricians should look out for in pregnancy at their ante-natal encounter include late registration of ante-natal visits; poor compliance with medication and attendance; reluctance to give urine test for examination (if this is a routine) altered physical appearance over course of routine visits; mood swings and being suspicious of the healthcare givers and agitation/anxiety/defensiveness about the issue of substance abuse.
The distribution of the drugs in the pregnant mother to the fetus is regulated by the placenta. The placenta also influences metabolism and the excretion of the drug.
During pregnancy, there is an increase in intra and extra vascular volume of fluid, a large accumulation body fat and other haemodynamic (blood related) changes which affect the distribution of drugs in pregnancy.
Pre-natal exposure
It is now known that pre-natal exposure to substances such as alcohol and cocaine affect the central nervous system development and can cause cognitive, affective (mood) and adaptive deficits that are difficult to quantify, especially at birth.
These deficits may manifest themselves later in life as altered attention span and poor social interactions. Such insults may be more expressed, if the child grows up in a sub-optimal environment. This, in the end, leads to a chaotic life and environment which affects the child’s optimal development in the future.
Effects of heroin on fetus include excessive nervousness, rapid breathing, and convulsive movements. In these cases, death occurs within the first week of life.
The complications associated with opiate abuse during pregnancy are toxemia of pregnancy, prematurity, retardation of intra uterine growth, and spontaneous abortion.
Those that survive post-natally show delay in mental, motor, speech and language development which is often noticed after 18 months of age. The neonates are also prone to fetal distress, neurological disorders eg. seizures, sleep deficit, diarrhoea, nasal congestion, among others.
If addiction is carried into pregnancy,effect of valium is seen in the neonate who becomes hypertonic (stiff), irritable and show poor temperature regulation. Diazepam does not cause fetal malformation (tetratogemic).
Even though there are reports of its tetratogeneity (fetal malformation) in animals, there are no substantive evidence with regard to humans. Like nicotine, the carbon mono oxide produced causes impairment of oxygen-combing capacity of the red blood cells leading to growth retardation of the fetus and longer duration of labour.
Conclusion
Drug abuse is becoming a medico-social illness in Ghana. The main factor being the modern technological achievements. We now live in a global village with no barriers to positive or negative information.
Drug abuse during the reproductive age of the young females ushers both the unborn and the pregnant mother into health hazards which may affect the child’s physiological, psychological and social well-being in the future. Medical practitioners and indeed obstetricians should be very vigilant and also to enquire about drug habits during antenatal care, especially in the first trimester. If in doubt, simple urine toxicological screening may be requested.
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After birth of, substance-exposed neonates, and symptoms of withdrawal should be watched for and treated appropriately. Post-natal monitoring and treatment of medical and psychological needs of the mother-infant pair are essential for optimal outcome. This is so important in a society in which any developmental defect or disorder is projected on or attributed to unseen evil or supernatural forces.
By Dr J. J. Lartey/Daily Graphic/Ghana
Writer email: jayjay@valleyviewclinic.org