Drug And Alcohol Abuse During Pregnancy: Risk Factors and Barrier to Care

Drug abuse during pregnancy poses significant risks and consequences, not only for the expectant mother but also for the developing foetus. This article provides a comprehensive overview of the impact of various substances on pregnancy and foetal development, including alcohol, tobacco, illicit drugs, and prescription medications. It explores the teratogenic effects of specific drugs and how they can lead to physical, cognitive, and behavioural impairments in children. Additionally, it delves into the challenges associated with addressing substance abuse during pregnancy and offers potential solutions, from reducing stigma to enhancing access to treatment. It is essential to understand the teratogenic effects of various substances and the potential physical, cognitive, and behavioural impairment they can cause in children. The challenges associated with addressing substance abuse during pregnancy are significant but not insurmountable, and there are several crucial solutions to consider. The article concludes by underscoring the significance of a holistic approach to address drug abuse during pregnancy, encompassing medical, social, and educational interventions. This comprehensive perspective aims to mitigate the risks and consequences, offering a brighter future for both mothers and their children.


INTRODUCTION:
Pregnancy is a transformative and delicate period in a woman's life, characterized by the anticipation of bringing a new life into the world.It is a time when the health and well-being of both the expectant mother and her developing foetus become paramount.However, when substance abuse becomes part of this journey, it introduces a complex web of risks and consequences that can have far-reaching effects.It delves into the teratogenic effects of specific drugs, uncovering how they can lead to physical, cognitive, and behavioural impairments in children.Furthermore, it examines the challenges associated with addressing substance abuse during pregnancy and offers potential solutions, ranging from reducing stigma to enhancing access to treatment.In the midst of these discussions, one key message resonates: the critical need for early intervention and support for expectant mothers who find themselves grappling with substance abuse.It is vital to emphasize that the healthiest option for the developing foetus is a substance-free pregnancy, and this article provides detailed information about the risks associated with different substances, reinforcing the urgency of this message.Throughout the following sections, the article delves into the physical complications that can arise due to substance abuse during pregnancy, encompassing the harrowing possibilities of placental abruption, preterm birth, low birth weight, stillbirth, and the tragic spectre of sudden infant death syndrome (SIDS).Additionally, it illuminates the developmental challenges that children exposed to drugs in utero may face, ranging from cognitive impairments to behavioural problems and emotional disturbances.Neonatal withdrawal, or Neonatal Abstinence Syndrome (NAS), is dissected in detail, underscoring the complexities and the long-term health effects it can have on infants.However, we conclude that it does not merely dwell on the challenges; it actively seeks solutions.It explores a holistic approach to addressing drug abuse during pregnancy, incorporating medical, social, and educational interventions.Such an approach aims to mitigate the risks and consequences, offering a brighter future for both mothers and their children.Through increased awareness, support systems, and the dedication of healthcare professionals, it is possible to guide expectant mothers away from the perilous path of substance abuse, towards a healthier and more promising journey into motherhood.

HOW DRUGS AFFECT THE FOETUS
Drugs that a pregnant woman takes can affect the foetus in several ways.They can act directly on the foetus causing damage or abnormal development leading to the birth defects or death.They can also alter the function of the placenta usually by constricting blood vessels and reducing the blood supply of oxygen and nutrients to the foetus from the mother and thus resulting in a baby that is underweight and under developed.Moreover, they can cause the muscles of the uterus to contract force fully; indirectly injuring the foetus by reducing the blood supply or triggering pre-term labor and delivery [1] 3. HOW DRUGS CROSS THE PLACENTA Some of the foetus's blood vessels are contained in tiny hairlike projections (villi) of the placenta that extend into the wall of the uterus.The mother's blood passes through the space surrounding the villi (intervillous space).Only a thin membrane (placental membrane) separates the mother's blood in the intervillous space from the foetus's blood in the villi.Drugs in the mother's blood can cross this membrane into blood vessels in the villi and pass through the umbilical cord to the foetus.Suboxone passes through placenta to featus therefore placing the developing foetus at risk of withdrawal. [3] Symptoms of withdrawal may include 1. Decreased respiration 2. Change in behaviour or restlessness 3. Seizures • SUBSTITUTE DRUG: Buprenorphine and methadone can be used safely used in pregnancy to treat OUD [3]

METHAMPHETAMINE
Methamphetamine during pregnancy causes wide range of problems including birth defects, foetal death, growth retardation, premature birth, low birth weight, developmental disorder and hypersensitivity to touch in the new born.Methamphetamine passes to foetus through placenta and can causes elevated fetal blood pressure, damaging the brain, heart and other major organs.Babies can be born addicted to methamphetamine and suffer withdrawal syndrome that Include [4] :  early pregnancy may increase risk of miscarriage.Newborns of mothers who have used cocaine throughout pregnancy are more irritable, jittery, and have interrupted sleep patterns [4] .
• SUBSTITUTE DRUG: Cocaine used as topical agent for anasthetic and vasoconstructive effect.Methadone has been the standard of care.Second choice is BURENORPHINE and NALTREXONE.

Ibuprofen (Advil, Motrin)
Ibuprofen is pain reliver drug that belongs to the group known as non-steroidal anti-inflammatory drug (NSAIDs) commonly used to treat arthritis, headaches, muscle aches, fever and menstrual cramp.The brand name for ibuprofen includes Motrin, Advil.Ibuprofen is also an ingredient in many over the counter combination products.High dose of ibuprofen causes many serious problems include: [5] 1. Miscarriage 2. Delayed on set of labour 3. Haemorrhaging for both mother and baby 4. Foetal kernicterus, a type of brain damage 5. Abnormal vitamin k level 6.Low level of amniotic fluid 7. Damage to the lining of intestine 8. It's especially important to avoid ibuprofen during the third trimester of pregnancy, however.
During this stage of pregnancy, ibuprofen more likely to causes heart defects in developing baby.
• SUBSTITUTE DRUG: Acetaminophen (Tylenol) can be used for pain relief in all stages of pregnancy first, second, third trimester

Warfarin (Coumadin)
Warfarin is called as anti-coagulant.Warfarin (coumadin) is a blood thinner that's used to treat blood clots as well as prevent them.it can cause birth defects.In later pregnancy can increases the risk of bleeding in babies' brain.
It should be avoided during pregnancy unless the risk of a blood clot is more dangerous than the risk of harm to the baby. [6] SUBSTITUTE DRUG: Alternative anticoagulant agent are unfractionated heparin (UFH) and possibly fondaparinux

Sulfonamides (Sulphadiazine)
Sulfonamides are a group of antibiotic medications.Sulfonamides are widely used to treat infectious disease during pregnancy.Maternal exposure to sulfonamides associated with offspring congetial malfunction.They are also known as Sulfa drugs.
They can cause jaundice in newborns.Sulfonamides may also increase the chances of miscarriage. [7]hen taken in 1 st trimester of pregnancy increased risk of: 1. Foetal neural tube defects 2. Cardiovascular • SUBSTITUTE DRUGS: Sulfadoxine is an alternative to sulfonamides .It may be beneficial when used with pyrimethamine

TRIMETHOPRIM
Trimethoprim is act as folate antagonist.It inhibits dihydrofolate reductase and thereby the synthesis of DNA.The trophoblast of the fetus is very sensitive to drugs that interefere with the folate cycle.Therefore, if trimethoprim is taken early in the pregnancy, it could interefere with fetal development.Trimethoprim (Primsol) is a type of antibiotic.When taken during pregnancy, this drug can cause neural tube defects.These defects affect brain development in a developing baby.It also causes cleft lip or palate, and urinary tract defects.Trimethoprim may lower the level of folic acid in your body due to this spina bifida defect seen in the baby. [8] SUBSTITUTE DRUG: Prozac (fluoxetine) and tricyclic antidepressant are safe during pregnancy.
There is also report on safety of celexa (citalopram).

VIII) CLONAZEPAM (KLONOPIN)
Clonazepam is used to prevent seizures and panic disorders.it's sometimes prescribed to treat anxiety.Taking clonazepam during pregnancy can lead to withdrawal symptoms in newborns.Some babies born to women who take this medication at the end of their pregnancy may have trouble in breathing, poor circulation, and floppy baby syndrome.Also chances of miscarriage. [9] SUBSTITUTE DRUG: Prozac (fluoxetine) and tricyclic antidepressant are safe during pregnancy.
There is also report on safety of celexa (citalopram)

ILLICIT DRUGS:
Illicit drugs pose significant risks to both the mother and the developing fetus.Some of the specific risks associated with the abuse of various illicit drugs include: 1. Heroin: Heroin use during pregnancy increases the risk of preterm birth, low birth weight, and a condition called Neonatal Abstinence Syndrome (NAS), where the baby experiences withdrawal symptoms [4] . 2. Methamphetamine: Methamphetamine abuse can result in preterm birth and low birth weight.Babies exposed to meth may experience withdrawal symptoms, and they may be at an increased risk of developmental delays and cognitive impairments [4] .3. Marijuana: While marijuana is often considered less harmful than other illicit drugs, its use during pregnancy is associated with potential risks, including low birth weight and developmental problems.Cannabis should not be used to treat nausea and vomiting in pregnancy and its chronic use might lead to the development of cannabinoid hyperemesis syndrome [10] .

Prescription Medications:
The misuse of prescription medications, such as opioids and benzodiazepines, during pregnancy can have adverse effects: 1. Opioids: Misuse of opioids during pregnancy can lead to NAS, a condition where the baby experiences withdrawal symptoms, which can be severe and challenging to manage.2. Benzodiazepines: Misuse of benzodiazepines can result in physical and cognitive impairments in the child.These impairments may affect a child's development and behaviour.3PHYSICAL COMPLICATIONS: Placental Abruption: Substance abuse during pregnancy increases the risk of placental abruption, a condition where the placenta separates from the uterine wall before childbirth.This can lead to severe bleeding and oxygen deprivation for the foetus, potentially resulting in stillbirth or developmental issues Preterm Birth: Drug abuse is strongly associated with preterm birth, which can lead to a range of health problems for the infant.Premature babies often require specialized care in neonatal intensive care units (NICUs) to address their underdeveloped organs and systems.Low Birth Weight: Babies born to mothers who abuse substances are more likely to have low birth weight.Low birth weight increases the risk of various complications, including respiratory distress syndrome and developmental delays.Stillbirth: Substance abuse during pregnancy significantly raises the risk of stillbirth, the tragic loss of the foetus before delivery.The exact mechanisms linking substance abuse and stillbirth are not fully understood, but it's clear that substance abuse can contribute to this devastating outcome.Sudden Infant Death Syndrome (SIDS): Infants born to mothers who abused substances during pregnancy are at a heightened risk of SIDS.SIDS is the unexplained death of an otherwise healthy baby, often occurring during sleep.Substance exposure can affect an infant's central nervous system, making them more vulnerable to SIDS.

Developmental Issues:
1. Cognitive Impairments: Prenatal exposure to drugs and alcohol can lead to cognitive impairments in children.These may manifest as difficulties with memory, problem solving, and overall intellectual functioning.Such cognitive impairments can have long lasting effects on a child's academic performance and future prospects.2. Behavioural Problems: Substance exposure during pregnancy is linked to a higher incidence of behavioural problems in children.These problems can range from attention deficits to hyperactivity and impulsivity, which are characteristics of Attention Deficit/Hyperactivity Disorder (ADHD).

Emotional Disturbances:
Children exposed to drugs in utero may be at increased risk of emotional disturbances such as anxiety, depression, and mood disorders.These emotional disturbances can affect a child's well-being, relationships, and overall quality of life.

Neonatal Withdrawal:
Neonatal Abstinence Syndrome (NAS) occurs when infants exposed to opioids or other addictive substances in the womb experience withdrawal symptoms after birth.These symptoms can be challenging to manage and may include: • Irritability and fussiness The management of NAS often requires specialized care, often involving a neonatal intensive care unit (NICU).Infants with NAS may need medication to alleviate withdrawal symptoms, and their recovery can be prolonged, leading to extended hospital stays.

Long-term Health Effects:
The effects of substance abuse during pregnancy can extend well into the child's life, potentially resulting in long-term health consequences, including: 1. Increased Vulnerability to Addiction: Children exposed to drugs during foetal development may have a heightened vulnerability to addiction themselves.They may be more likely to engage in substance abuse in adolescence and adulthood.2. Mental Health Disorders: Substance exposure during pregnancy can contribute to an increased risk of mental health disorders such as depression, anxiety, and behavioural problems in children as they grow.These disorders can significantly impact a child's quality of life and future prospects.

CHALLENGES AND SOLUTIONS: Stigma and Shame:
Addressing the stigma and shame associated with substance abuse during pregnancy is vital.Stigmatizing pregnant women who struggle with addiction can deter them from seeking help and prenatal care.
Overcoming this challenge requires a shift in societal attitudes and an emphasis on empathy and support rather than judgment.Public awareness campaigns can play a significant role in reducing the stigma and encouraging open conversations about this issue.

Lack of Access to Treatment:
Access to specialized treatment programs for pregnant women with substance abuse disorders is inconsistent in many regions.Increasing the availability of these programs is critical.
Government agencies and healthcare organizations should invest in expanding and improving the quality of treatment centres ensuring that they are equipped to address the unique needs of expectant mothers.Additionally, efforts should be made to remove financial barriers that might prevent pregnant women from seeking help.
Reducing stigma and shame, improving access to treatment, addressing polydrug use, promoting education and awareness, establishing a continuum of care, advancing research and advocacy, enhancing child welfare systems, supporting fathers, and embracing cultural competency are all critical steps toward mitigating the risks and consequences associated with substance abuse during pregnancy.By implementing a holistic approach that incorporates medical, social, and educational interventions, we can help guide expectant mothers away from the perilous path of substance abuse and towards a healthier and more promising journey into motherhood.It is imperative to emphasize that the healthiest option for the developing fetus is a substance-free pregnancy.Through increased awareness, support systems, and the dedication of healthcare professionals, we can work together to ensure a brighter future for both mothers and their children.
Ultimately, the goal is to provide comprehensive care that addresses not only the physical well-being of mother and child but also their emotional and psychological needs.By doing so, we can help break the cycle of substance abuse during pregnancy, offering hope and a fresh start to those who need it most.

Fig 1 .Fig No. 2 :
Fig 1.How drug cross placenta Cocaine passes to the foetus through the placenta.The elimination of the cocaine in the foetus is slower, meaning it is retained in the foetus body much longer than the mother.If cocaine used by the mother in • Email: editor@ijfmr.comIJFMR240111681 Volume 6, Issue 1, January-February 2024 5

Fig no. 3 :
Fig no.3: Developmental Consequences of Foetal Exposure to Drugs