DRUGS AND ITS EFFECT ON CHILDREN

BEFORE AND AFTER BIRTH

By

Formeka Taylor

Child Health and Nutrition

INTRODUCTION More than 90% of pregnant women take

prescription or nonprescription (over-the-counter) drugs or use social drugs (such as tobacco and alcohol) or illicit drugs at some time during pregnancy. In general, drugs, unless absolutely necessary, should not be used during pregnancy because many can harm the fetus.

DRUGS THAT EFFECT THE CHILD DURING PREGNANCY During the research process of this topic

I have learn a little bit of technical name for drugs that effect the embryo or fetus during pregnancy.

Those types of drugs are called Teratogenic drugs.Which are drugs with the ability to disturb

the growth and development of an embryo or fetus.

DRUGS THAT ARE KNOWN TERATOGENIC Androgens

Steroid Hormones

ACE inhibitors Inhibitors of Angiotensin-Converting Enzyme,

Use in the treatment of Hypertension

Antineoplastic agents Alkylating agents & antimetabolites

Used in the treatment of cancers

Anti-epileptic drugs Carbamazepine Phenytoin Valproic acid

Used in the treatment of seizures

Cocaine Narcotic

Street stimulant drug (powerfully addictive)

Coumarins Warfarin

Used as a anticoagulant

Diethylstilboestrol A synthetic, nonsteroidal form of estrogen

Was given (not currently) to pregnant women in the belief that it would provide luteal support in situations such as threatened miscarriage or poor reproductive performance, in particular that associated with maternal diabetes

Fluconazole (hi-dose) Anitfungal Medication

Used to treat fungal infections, including yeast infections of the vagina, mouth, throat, esophagus (tube leading from the mouth to the stomach), abdomen (area between the chest and waist), lungs, blood, and other organs

Also used to treat meningitis (infection of the membranes covering the brain and spine ) caused by fungus

Ethanol Is best known as the alcohol found in alcoholic beverages

Lithium Antidepressants

Used primarily in the treatment of bipolar disorder as mood stabilizing drugs

Methimazole Antithyroid agent

Used to manage hyperthyroidism (overactivity of the thyroid gland) Misoprostol

Prostaglandin Used to prevent ulcers in people who take certain arthritis or pain

medicines, including Also used (and approved in other countries) to induce labor and as

an abortifacient (a substance that induces abortion) Penicillamine

Chelator- removes heavy metals from the body Used as a form of immunosuppressant to treat rheumatoid arthritis.

Retinoids Isotretinoin, etretinate, acetretin (a class of chemical compounds)

Used in medicine, primarily due to the way they regulate epithelial cell growth

Thalidomide Is a sedative, hypnotic, and multiple myeloma medication

It was used as a sleeping pill and to treat morning sickness during pregnancy in the 1950s. But is now known to cause birth defects.

Tetracyclines Antibiotic

Used to treat bacterial infections, including pneumonia and other respiratory tract infections; acne; infections of skin, genital and urinary systems; and the infection that causes stomach ulcers (Helicobacter pylori)

POSSIBLE TERATOGENS Cigarette smoking Colchicine

Oral anti-inflammatory agents Disulfiram

Used to support the treatment of chronic alcoholism by producing an acute sensitivity to alcohol

Ergotamine An ergopeptine and is used as a

vasoconstrictor for migraine prevention and is sometimes mixed with caffeine

Ethanol in “binges” Consuming heavy amount of

alcohol in an eposodic drinking regimen

Glucocorticoids A hormone that predominantly

affects the metabolism of carbohydrates and, to a lesser extent, fats and proteins (and has other effects)

Primidone It is used to treat complex partial,

generalized tonic-clonic seizures, myoclonic, Jacksonian, and akinetic seizures.

Pseudoephedrine Commonly used as a decongestant

Streptomycin Is an antibiotic drug

Trimethoprim Is a bacteriostatic antibiotic mainly

used in the prophylaxis and treatment of urinary tract infections

Vitamin A (> 25,000 U/day) Large doses of vitamin A can cause

birth defects Zidovudine

The first approved for treatment of HIV

Can decrease the number of a certain type of white blood cell in the blood and cause anemia and muscle disorders-

IF A PREGNANT WOMAN ABUSES HARMFUL SUBSTANCES, DOES IT AFFECT THE FETUS? Many substances including alcohol, nicotine, and drugs

of abuse can have negative effects on the developing fetus because they are transferred to the fetus across the placenta. For example, nicotine has been connected with premature

birth and low birth weight as has the use of cocaine Scientific studies have shown that babies born to

marijuana users were shorter, weighed less, and had smaller head sizes than those born to mothers who did not use the drug. Smaller babies are more likely to develop health problems.

Whether a baby's health problems, if caused by a drug, will continue as the child grows, is not always known. Research does show that children born to mothers who used marijuana regularly during pregnancy may have trouble concentrating, even when older.

HOW DRUGS CROSS THE PLACENTA Some of the fetus's blood

vessels are contained in tiny hair-like 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 fetus'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 fetus.

DRUGS AFFECT ON THE FETUS Drugs that a pregnant woman

takes during pregnancy can affect the fetus in several ways They can act directly on the

fetus, causing damage, abnormal development (leading to birth defects), or death.

They can alter the function of the placenta, usually by causing blood vessels to narrow (constrict) and thus reducing the supply of oxygen and nutrients to the fetus from the mother. Sometimes the result is a baby that is underweight and underdeveloped.

They can cause the muscles of the uterus to contract forcefully, indirectly injuring the fetus by reducing its blood supply or triggering preterm labor and delivery.

ALCOHOL’S AFFECT ON FETUS

Alcohol from beer, wine, or hard liquor easily crosses the mother's placenta to enter the circulatory system of the fetus. The alcohol lingers in the baby's system, since the fetus cannot rid itself of alcohol as quickly as the mother can. One study showed the rate of elimination of alcohol from the fluid surrounding the fetus was twice as long as from maternal blood.

Alcohol is a toxic agent that damages developing cells. The more the mother drinks, the higher the risk of damage - but harm can occur at as little as two drinks per day. Both heavy drinking on a daily basis and occasional binge drinking are particularly dangerous.

Alcohol is especially harmful - at any point in the pregnancy - to the developing brain. But it also damages cells in the developing skeleton, ears, eyes, lungs, heart, genitals and kidneys. If the mother is stressed, malnourished, smokes cigarettes or uses other drugs, there is an even greater likelihood that alcohol will harm her fetus

The form of alcohol makes no difference - the effect is the same. There is the same amount of pure alcohol in a 12-ounce (341 ml) bottle of beer, a 5-ounce (142 ml) glass of wine, and in 1.5 ounces (43 ml) of distilled spirits.

NIDA’S POINT OF VIEW NIDA -The National Institute on

Drug Abuse which is part of the National Institutes of Health (NIH) explains that funded studies are beginning to show that children who have been prenatally exposed to illicit drugs may be at risk of later behavioral and learning difficulties. Long-term studies using sophisticated assessment techniques indicate that prenatally exposed children may have subtle but significant impairments in their ability to regulate emotions and focus and sustain attention on a task. These neurobehavioral deficits may place these children on a developmental pathway that leads to poor school performance and other adverse consequences over time.

BIRTH DEFECTS ASSOCIATED WITH PRENATAL DRUG AND ALCOHOL ABUSE Fetal Alcohol Syndrome (FAS)

A disorder of permanent birth defects that occurs in the offspring of women who drink alcohol during pregnancy. Characteristic of fetal alcohol syndrome:

Small size, particularly the head Clubfoot, "strawberry" birthmarks, or facial

deformities Mental retardation Learning disabilities Behavioral problems Jittery gait and lack of coordination and Problems with the liver, kidneys, heart, and

joints

The main effect of FAS is permanent and nonsubsequinciel central nervous system damage, especially the brain. Developing brain cells and structures are underdeveloped or malformed by prenatal alcohol exposure, often creating an array of primary cognitive and functional disabilities. Fetal alcohol exposure is the leading known

cause of mental retardation in the Western world.

BIRTH DEFECTS ASSOCIATED WITH PRENATAL DRUG AND ALCOHOL ABUSE CONT… Smokers Babies

Pregnant women who smoke half a pack of cigarettes a day or more increase the risk of delivering a baby with deformed, extra or missing fingers or toes, and oral clefts, limb reductions, urogenital or gastrointestinal . Smoking during pregnancy is associated

with increased risk for premature rupture of membranes, abruptio placentae (placenta separation from the uterus), and placenta previal (abnormal location of the placenta, which can cause massive hemorrhaging during delivery; smoking is also associated with a modest increase in risk for preterm delivery.

It can cause sudden infant death syndrome (SIDS).

Women who smoke may have a modest increase in risks for ectopic pregnancy and spontaneous abortion.

The babies of parents who smoked had cotinine levels that were more than five times higher than babies of nonsmoking parents. Maternal smoking had the biggest effect,

quadrupling the babies' cotinine levels. Paternal smoking nearly doubled the babies' cotinine levels.

BIRTH DEFECTS ASSOCIATED WITH PRENATAL DRUG AND ALCOHOL ABUSE CONT…

Drug Babies Infants whose mothers took drugs, such as

cocaine or heroin, during their pregnancy may go through withdrawal at birth. The Infant will also will be born addicted to them.

Prenatally drug -exposed newborns cry more frequently than unexposed babies. These at risk babies will have suffer though moderate to severe withdrawal, and are harder to console. These children, when held, tend to arch their backs,

pull away and cry until they exhaust themselves. These behaviors tend to interfere with child to

parent bonding. The baby will just cry because they are in pain and are suffering, Some don’t even like to be touched.

For some drug babies, as they become older children, the slightest disruption will set-off a temper tantrum. Children in this type exhibit extreme mood swings. Thirty-four percent of at-risk children exhibit

"extreme emotional and behavioral tendencies along with a low tolerance for frustration," says Jeff Vendsel of Freedom Forum Foundation.

Drug Babies suffer long-term cognitive development effects, and exposed babies run an increased risk of mortality and morbidity.

Babies exposed to crack during their mother's pregnancy are more likely to be premature and abnormally smaller for gestational age, and have an increased risk of genital-urinary abnormalities.

A PERSONAL POINT OF VIEW This project was very close to me for two reasons.

One, a close relative of mines experienced drug (marijuana) and alcohol abuse while pregnant as a result bore a child with birth defects. When the child was born he was tested. What was found was drugs and alcohol in his system. This was a very upsetting moment for my family. My relative had to under go evaluations from Social Service to basically prove herself as a fit parent. If she wasn’t able to do so she would have lost her child. As a result she turned her life around the child is doing well his cognitive level is not quite were it should be but he is thriving and making progress.

The second reason is that as a mother and also expecting, it is very important that I keep myself healthy. Not only just eating right but to discontinue the use of prescribed drugs as well as over the counter drugs that can be harmful for my unborn child.

WORKS CITED Hitti, Miranda. Smokers' Babies Take on Cotinine , Miranda Hitti, 2007. Nicotine Byproduct

Found in Urine of Infants Whose Parents Smoke Cigarettes. Web MD Inc. 23Oct.2007http://www.webmd.com/parenting/news/20070619/smokers-babies-take-on-cotinine

Hill, Dr Mark. UNSW Embryology, Woolcock Institute of Medical Research 23-24 Aug 2005, Maternal Effects - Smoking and Pregnancy Workshop. The University of New South Wales Sydney Australia. 1Nov.2007http://embryology.med.unsw.edu.au/Defect/smokingworkshop.htm

Gittler, Josephine and McPherson, Merle. “Prenatal substance abuse: an overview of the problem” Children Today, July-August 1990. FINDARTICLES. 4Nov.2007http://findarticles.com/p/articles/mi_m1053/is_n4_v19/ai_9153202

Vendsel, Jeff. “Crack Babies Grow up Parts I and II” Freedom Forum Foundation 1999. San Francisco State University. 4Nov.2007http://books.elsevier.com/companions/0240804155/crack/crack1.htm

CBS 6. “Smoking and Reproductive Outcomes” Courtesy:  Centers for Disease Control 2007. Raycom Media station 8Nov.2007http://www.wtvr.com/Global/story.asp?s=2103452

Wilson, RN PHD, Billie Ann, Shannon RN, Phd,Margaret T., Shields,PharmD, Kelly M. and Stang, PharmD, Carolyn L. Prentice Hall Nurse’s Drug Guide 2007 New Jersey: Facts on File 2007

Mathias, Robert. “Prenatal Exposure to Drugs of Abuse May Affect Later Behavior and Learning” The National Institute on Drug Abuse (NIDA) November, 1998. National Institutes of Health (NIH)

http://www.drugabuse.gov/NIDA_Notes/NNVol13N4/Prenatal.html Unknown, “Fetal alcohol syndrome” Wikipedia, the free encyclopedia.

http://en.wikipedia.org/wiki/Fetal_alcohol_syndrome

LOCAL RESORCES For More Reading Information Check Out

CBS 6. “Smoking and Reproductive Outcomes” Courtesy:  Centers for Disease Control 2007. Raycom Media station 8Nov.2007http://www.wtvr.com/Global/story.asp?s=2103452

SMITH, TAMMIE. “Helping to save babies” “State is urging women to make healthy choices before they get pregnant” Richmond Times Dispatch Jul 16, 2007 Media General 16Nov.2007 http://www.inrich.com/cva/ric/search.apx.-content-articles-RTD-2007-07-16-0204.html

VISITS (Virginia Infant Screening and Infant Tracking System) https://vdhems.vdh.virginia.gov/hi_docs/visits.html

Places that can Help with childhood disorders and drug addiction of pregnant women Children with Special Health Care Needs, 109 Governor Street 8th floor,

Richmond, VA 23219 Phone: (804) 864-7706http://www.vahealth.org/specialchildren/cdsprogram.asp

Chesterfield Mental Health Mental Retardation Subst Abuse Servs, 6801 Lucy Corr Boulevard Rogers Building, Chesterfield, VA 23832, Phone: (804) 768-7203 www.co.chesterfield.va.us

Women, Infant, and Children Program (WIC), Contact your local Virginia Department of Health office at 1-888-942-3663 for locations near you. http://www.dss.virginia.gov/benefit/wic/