The effect of toxic substances on pregnancy and fetus

Alcohol and banned substances are toxic to the placenta and developing fetus and can cause congenital syndromes, as well as withdrawal symptoms.

While the use of certain toxic substances does not mean illegal actions on the part of the mother, in some cases she violates the law. In any case, the home environment should be assessed to determine whether childcare after discharge is sufficient. With the help of relatives, friends and visiting nurses, a woman can be able to take care of her child. If not, the best option may be the transfer of the child to the upbringing or an alternative care plan for him.

Alcohol and pregnancy

The effects of alcohol during pregnancy can cause the development of fetal alcohol syndrome (FAS), a diverse mix of physical and cognitive impairment. At birth, babies with fetal alcohol syndrome can be distinguished by low physical development and a typical set of facial features including microcephaly, microphthalmia, short eye glitches, epicanth, small or flat middle face, flat elongated nasal filter, thin upper lip, small chin. Anomalous dermatoglyphics, heart defects and joint contractures can also be noted. The most serious manifestation is a deep retardation of mental development, which is considered a teratogenic effect of alcohol in a large number of children with mental retardation, born of mothers with alcoholism; Fetal alcohol syndrome may be the most common cause of non-hereditary mental retardation. No physical or cognitive sign is pathognomonic; The lower the consumption of alcohol, the less severe clinical manifestations in the child, and the diagnosis of mild degrees may be difficult. It is often difficult to distinguish the effects of alcohol on the developing fetus from the effects of other substances (for example, tobacco, drugs) and other factors (for example, poor nutrition, inadequate medical care, violence), whose influence is especially affected by women who abuse alcohol.

The diagnosis is made for infants with characteristic signs that were born in chronic alcoholics who abused alcohol during pregnancy.

Since it is not known when during pregnancy the alcohol most likely harms the fetus and there is minimal, completely safe, level of alcohol consumption, it should be advised pregnant women to completely avoid drinking alcohol. Brothers and sisters of the infant with diagnosed FAS should be examined to detect manifestations of fetal alcohol syndrome.

[1], [2], [3], [4], [5]

Barbiturates and pregnancy

Prolonged abuse of the mother by barbiturates can cause a withdrawal syndrome in a newborn, manifested by anxiety, arousal and irritability, which often do not develop until 7-10 days after birth, before the child goes home. Phenobarbital sedation may be required at a dose of 0.75-1.5 mg / kg orally or intramuscularly every 6 hours, with a gradual decrease in a few days or weeks, depending on the duration of the symptoms.

[6]

Cocaine and Pregnancy

Cocaine inhibits the reuptake of neurotransmitters of noradrenaline and epinephrine; it passes through the placenta and causes vasoconstriction and hypertension in the fetus. The abuse of cocaine during pregnancy is associated with an increased risk of placental abruption and spontaneous abortion, possibly caused by a decrease in maternal blood flow to the vessels of the placenta; detachment can also lead to intrauterine fetal death or neurologic disorders if the fetus remains alive. Newborns from mothers who use cocaine have low birth weight, reduced body length and head circumference, and low Apgar scores. Cerebral infarctions, as well as rare anomalies associated with prenatal cocaine use, including limb amputations, may develop; malformations of the gastrointestinal tract, including the divergence of the muscles of the anterior abdominal wall; atresia or necrosis of the intestine. They are all caused by rupture of the blood vessels, presumably secondary to local ischemia due to intense vasoconstriction of fetal arteries caused by cocaine. In addition, signs of light neuro-behavioral effects of cocaine are noted, including decreased attention and anxiety, lower IQ, and impaired growth and fine motor skills.

Some newborns may have an abstinence syndrome if the mother used cocaine shortly before the birth, but the symptoms are less frequent and less severe than with the opioid withdrawal syndrome, and the treatment is the same.

[7], [8]

Opioids and Pregnancy

The effects of opioids can cause withdrawal at birth. A newborn from a woman who abuses opioids should be observed to identify withdrawal symptoms that usually occur within 72 hours after birth. Characteristic symptoms of withdrawal are anxiety, excitability, hypertonia, vomiting, diarrhea, sweating, convulsions and hyperventilation, which leads to respiratory alkalosis. Similar effects can cause prenatal exposure to benzodiazepine.

Treatment for mild withdrawal symptoms includes swaddling and sedation for several days to reduce physical hyperactivity, and frequent feeding to reduce anxiety. If you are patient, most of the problems are resolved within a week. Severe symptoms are controlled by 25-fold dilution of opium tincture (which contains 10 mg / ml) in water, giving 2 drops (0.1 ml) / kg orally every 4 hours. The dose can be increased by 0.1 ml / kg every 4 hours, if necessary. Also, withdrawal symptoms can be controlled with phenobarbital at a dose of 0.75-1.5 mg / kg orally after 6 hours. The dose gradually decreases, and the treatment stops after a few days or weeks, when the symptoms disappear.

The incidence of SHS is higher in infants born to women who use opioids, but still lower than 10/1000 children, so routine use of home cardiorespiratory monitors is not recommended in such children.