gynecology and obstetrics
Social and Illicit Drugs During Pregnancy
Introduction
 Smoking and Other Tobacco Use None Spontaneous Abortion (fetal loss or delivery < 20 weeks) Small-for-Gestational-Age (SGA) Infant None Placental Abruption (Abruptio Placentae) (abruptio placentae) Placenta Previa None Prelabor Rupture of Membranes (PROM) None Preterm Labor None Intraamniotic Infection None Stillbirth None Neonates whose mothers smoke are also more likely to have anencephaly, congenital heart defects, orofacial clefts, Sudden Unexpected Infant Death (SUID) and Sudden Infant Death Syndrome (SIDS) , deficiencies in physical growth and intelligence, and behavioral problems. Exposure to secondhand smoke may similarly harm the fetus. Alcohol Toxicity and Withdrawal None Cocaine None Spontaneous Abortion None Small-for-Gestational-Age (SGA) Infant None Placental Abruption (Abruptio Placentae) None Preterm Labor None Stillbirth None Congenital malformations (eg, central nervous system, genitourinary, and skeletal malformations; isolated atresias) Marijuana (Cannabis) None Bath saltsrefers to a group of designer illicit drugs made from a variety ofamphetamine-like substances; these drugs are being increasingly used during pregnancy. Although effects are poorly understood, fetal vasoconstriction and hypoxia are likely, and there is a risk of stillbirth, placental abruption, and possibly congenital malformations. Hallucinogensmay, depending on the drug, increase risk of the following: Spontaneous Abortion None Preterm Labor None Withdrawal syndrome in the fetus or neonate Hallucinogens include methylenedioxymethamphetamine (MDMA, or Ecstasy), rohypnol,ketamine,methamphetamine, and LSD (lysergic acid diethylamide). Opioid Toxicity and Withdrawal None Use ofopioidsduring pregnancy increases the risk of pregnancy complications, such as Spontaneous Abortion None Abnormal fetal presentation Preterm Labor None Heroin increases the risk of having a small-for-gestational-age infant. Whether consumingcaffeinein large amounts can increase perinatal risk is unclear. Consumingcaffeinein small amounts (eg, 1 cup of coffee/day) appears to pose little or no risk to the fetus, but some data, which did not account for tobacco or alcohol use, suggest that consuming large amounts (>7 cups of coffee/day) increases risk of stillbirths, preterm deliveries, low birth weight, and spontaneous abortions. Decaffeinated beverages theoretically pose little risk to the fetus. (a dietary sugar substitute) during pregnancy is often questioned. The most common metabolite of aspartame, phenylalanine, is concentrated in the fetus by active placental transport; toxic levels may cause Intellectual Disability . However, when ingestion is within the usual range, fetal phenylalanine levels are far below toxic levels. Thus, moderate ingestion of aspartame (eg, no more than 1 liter of diet soda per day) during pregnancy appears to pose little risk of fetal toxicity. However, in pregnant women with 