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| |    Alcohol and Drugs during Pregnancy by Robert Needlman, M.D., F.A.A.P. reviewed by Marjorie Greenfield, M.D. A generation ago, the womb was thought of as a safe place. There, swimming in a warm, dark sea of amniotic fluid, the developing fetus was protected from the dangers of the world. Now we know that this is not exactly the case. Just as nutrients and oxygen flow across the placenta from the mother to the fetus, so can harmful chemicals and infections. This knowledge might make you a bit anxious, but it can also help you to avoid many of these prenatal dangers. Alcohol Worldwide, alcohol is probably the greatest single cause of birth defects. The main features of Fetal Alcohol Syndrome (FAS) are poor growth, abnormal facial features, and cognitive impairment ranging from problems of learning and attention, to more severe mental retardation. Many children who do not have the full FAS picture may have a milder form, with learning problems but not the physical signs. Not all women who drink heavily during pregnancy give birth to children with FAS. Certain ethnic groups are biologically more susceptible to the problem. For most women, it's probable that a small amount of alcohol won't cause major ill effects. On the other hand, no safe level has been defined, so the most cautious decision is to avoid alcohol altogether. This is especially true during the first three months of pregnancy, when the fetus' vulnerability to alcohol effects may be greatest. Cocaine, marijuana, and cigarettes It may seem odd to link these three substances together, but in fact their effects on the developing fetus seem to be similar in many ways. Cocaine has received a lot of negative press in the last ten years, with pictures of "crack babies" on the covers of major magazines, and pregnant women who are addicted to cocaine being arrested for "delivering drugs to a minor" (their fetus). A decade of research on cocaine has yielded mixed results. It seems clear that cocaine increases the risk of prematurity, low birth weight, and a dangerous birth complication in which the placenta separates from the uterus prematurely (placental abruption). In rare cases cocaine causes severe malformations, or damage to internal organs. But the main concern has been the effects of cocaine on the developing brain. Across the board, researchers have found that, as a group, children exposed to cocaine in the womb have lower IQ scores and more learning, emotional, and behavior problems. It is not entirely clear, though, what role the cocaine itself is playing in all of this. These children are also exposed to many other potentially harmful influences including alcohol, cigarettes, poor maternal nutrition, no prenatal care, and serious mental health problems in their mothers. The combination of these toxic factors is often tragic. Cigarettes have many of the same biologic effects of cocaine, although the effects are weaker. This is not too surprising, since nicotine and cocaine are have similar effects on the brain and circulatory system. Given the far greater number of pregnant women who smoke cigarettes, the total harm caused by cigarettes is right up there with cocaine. Marijuana, like cigarettes and cocaine, seems to interfere with fetal growth somewhat, and may cause subtle problems in brain development too. Clearly, the wise thing to do is to avoid these and other recreational drugs altogether.
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