Effect of maternal substance abuse on the fetus, neonate, and child

On the basis of observational studies, babies born to mothers who abuse legal substances such as alcohol and nicotine are at increased risk for low birthweight (LBW), developmental disabilities, and long-term behavioral problems. (3)(4)(6)(9) • On the basis of observational studies, babies born to mothers who abuse narcotics (ie, opioids) are at increased risk for microcephaly, LBW, admission to the NICU and prolonged hospital stay due to withdrawal symptoms, and long-term cognitive and behavioral impairments. (1)(4)(24) • On the basis of observational studies, babies born to mothers who abuse illegal substances such as phencyclidine (PCP), marijuana, amphetamines, and cocaine are at increased risk for microcephaly, LBW, abnormal neurobehavioral symptoms, and long-term cognitive delays. (3)(4)(6)(7)(9)(38) • On the basis of observational studies, babies born to mothers who take prescription or over-the-counter medications such as selective serotonin reuptake inhibitors and sedatives are primarily at risk for persistent pulmonary hypertension of the newborn and withdrawal-like symptoms in the newborn period, respectively. (3)(44)(45)(46) • On the basis of observational studies, the initial treatment of symptomatic neonates born to mothers who abuse illegal or legal substances involves nonpharmacologic care such as swaddling and comforting the baby. If the baby fails nonpharmacologic therapy, then pharmacologic treatment with medications such as opioids or clonidine may be indicated, especially in opioid-exposed newborns. (4)(30)(44)(50) • On the basis of observational studies, all babies born to mothers who abuse licit or illicit substances during pregnancy would benefit from long-term developmental follow-up and early intervention services. (27)(33) • On the basis of expert opinion, breastfeeding mothers who abuse cocaine, marijuana, and hallucinogens (ie, PCP) should abstain from breastfeeding their newborns. (51).