Women's Healthcare Topics

Alcohol, Tobacco and Drugs Use during Pregnancy

Reviewed by James Brann, M.D.

Dangers of Alcohol

By now you’ve probably heard all about eating healthy during pregnancy, but there are some things you certainly want to avoid. Alcohol, tobacco and certain drugs are harmful to your unborn child.

Let’s start with the danger of drinking alcohol during pregnancy. If a woman is pregnant and drinks alcohol, she is not the only one to feel the effects. The alcohol goes through the placenta and to the baby. While the fully formed liver of an adult can break down alcohol, a baby is still developing.

If a woman does choose to drink during pregnancy, it could develop into what’s called “fetal alcohol spectrum disorders” in an infant. This may mean mental, physical, learning or even behavioral disabilities that affect your child for the rest of his or her life.

The most severe of the disorders is called “fetal alcohol syndrome”, or FAS. It may lead to behavioral and mental problems, abnormal facial features or growth problems. FAS is most common in a baby when the mother drinks a large amount of alcohol. For a pregnant woman this means at least three drinks in one sitting or more than seven drinks each week continually. However, FAS may also occur if a pregnant woman drinks less than that. Moderate alcohol usage translates to about a drink a day, but even that can lead to behavioral and learning problems for a child that last a lifetime.

There really is no safe amount of alcohol when you are pregnant. Because alcohol affects the fetus, the smart thing to do is abstain altogether during pregnancy. If you had some drinks while you were pregnant, but before you found out you were pregnant, you should stop immediately.

Dangers of Tobacco

Learn how to eat wisely in pregnancy.

Like drinking alcohol during pregnancy, using tobacco during pregnancy comes with some serious health risks. Smoking exposes an unborn baby to harmful chemicals including carbon monoxide, nicotine and tar. Carbon monoxide reduces the baby’s oxygen. Nicotine prevents nutrients and oxygen from reaching your baby by constricting blood vessels.

There are additional risks as well. They include:
  • Preterm birth

  • placenta problems

  • Sudden infant death syndrome (SIDS)

Babies with moms who smoked while pregnant are usually smaller than babies whose mothers didn’t smoke. These babies also have an increased risk of childhood obesity, colic and asthma. Other problems have to do with the placenta and how it attaches to the mother’s uterus.

Secondhand smoke causes problems, too. Even if a mother doesn’t smoke, if she surrounds herself with people who do, breathing in that secondhand smoke may lead to a higher risk of having a low-birth-weight baby. The risk may increase by up to 20%. There’s also an increase in the chance of SIDS for babies around secondhand smoke, as well as the chance of developing respiratory illnesses.

If you’re ready to quit, talk to your nurse or doctor. They should be able to recommend a support group in the area where you live. You can also try calling 1-800-Quit-Now, a national quit-smoking line.

Don’t think that simply switching to a nicotine replacement, like the patch or nicotine gum, is an easy fix while pregnant. You’ll want to talk to your doctor first because they need to be involved in the discussion of any potential risks these products pose versus the already known risks of smoking. Electronic cigarettes, smokeless tobacco or nicotine gel strips are not necessarily a safe substitute.

Dangers of Illegal Drugs

The next danger has to do with illegal drugs during pregnancy. This means cocaine, marijuana, heroin, methamphetamines or using prescription drugs when you don’t have a medical reason to use them. Generally, the harm you may end up doing to your unborn child depends on several factors including how often you use the drugs, how much and at what stage of your pregnancy.

Using illegal drugs at the beginning of your pregnancy is extremely risk because this is when the fetus begins forming the main body parts. Using drugs may cause problems including:

  • Birth defects

  • Miscarriage

Using drugs later on will still harm your child, though. This may lead to things like:

  • Preterm birth

  • Interference in growth

  • Fetal death

After your baby is born, drugs can also harm your child if they are passed to them via your breast milk.

If you’ve used any illegal drugs during pregnancy, it is extremely important you tell your doctor and get some help. They may want to test your urine or hair during your pregnancy or even during labor if there’s a question about whether you have used these types of drugs or if you have any complications that may be tied to them. They may also test your baby after delivery. In certain states, using drugs during pregnancy is considered child abuse and your doctor, nurse or hospital has to report it. Before the testing is done you should be told about it and consent, but the laws on how you give consent vary between states.

As for addictions to pain medications or narcotics, pregnant women need to seek out help. This is because the effects of withdrawal from certain drugs may harm the baby or cause a miscarriage.

Problems of Substance Abuse

There are a number of problems that can be tied to substance abuse, including those dealing with family issues, relationships and work. However, other serious problems may include car crashes, drunk-driving arrests or substance-related medical problems. Substance abuse many also translate to an addiction, or dependence.

Signs of addiction include at least three of the following:

  • Withdrawal after a substance is stopped

  • Increased tolerance leading to a larger amount of substance needed to get “high”

  • A larger usage amount or a longer period of usage

  • Nonsuccess or desire to control or cut down usage
  • Quitting or reducing recreational, work or social activities due to usage

  • A large amount of time obtaining the substance, recovering from usage, or using

  • Coming up with excuses for the substance

  • Using the substance even when you know there’s a problem

Prescription & Over-the-Counter Drugs

Finally, know that not all prescription drugs are harmful during pregnancy. Some do have known risks though, so if you get pregnant, and you’re on a prescription drug, make sure your doctor knows. Don’t stop taking it, though, until you talk to a professional.

Certain over-the-counter medicines, including vitamins and herbal supplements, may also cause health problems if you’re pregnant. Even ibuprofen or aspirin pain relievers may harm an unborn child. Again, the best course of action is to check with your doctor before you take any over-the-counter drug while pregnant.


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