Smoking cigarettes during pregnancy is associated with adverse consequences.
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Marijuana
The effects of marijuana on prenatal development are not well understood. Marijuana use during early pregnancy negatively affects fetal length and birthweight (Gunn et al., 2016). Prenatal exposure to marijuana is associated with impairments in attention, memory, and executive function as well as impulsivity in children, adolescents, and young adults (Grant, Petroff, Isoherranen, Stella, & Burbacher, 2018; Smith et al., 2016). Prenatal exposure to marijuana is associated with a thinner cortex, the outer layer of the brain, in late childhood, suggesting that there are long-term neurological effects (El Marroun et al., 2016). Researchers and health practitioners have thus concluded that it is important to educate the public about the impact of marijuana on pregnancy and to discourage the use of medical marijuana by pregnant women or women considering pregnancy (Chasnoff, 2017).
Cocaine and Heroin
Infants exposed to cocaine and heroin face special challenges, such as signs of addiction and withdrawal symptoms, including tremors, irritability, abnormal crying, disturbed sleep, and impaired motor control (Gupta, 2017; Raffaeli et al., 2017). Prenatal exposure to cocaine and heroin is associated with low birthweight, impaired motor skills, and reduced cortical and subcortical brain volume at birth and in infancy (Grewen et al., 2014; Warton et al., 2018). Exposure to these drugs during prenatal development influences brain development, particularly the regions associated with attention, arousal, and regulation (Bazinet, Squeglia, Riley, & Tapert, 2016; Levine & Woodward, 2018). For example, at 1 month after birth, babies who were exposed to cocaine have difficulty regulating their arousal states and show poor movement skills, poor reflexes, and greater excitability (Fallone et al., 2014).
Applying Developmental Science
Maternal Drug Use While Pregnant
Is maternal alcohol and substance use during pregnancy child abuse?
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We have seen that exposure to teratogens such as drugs and alcohol adversely affects the developing fetus. Is maternal substance use fetal abuse? For many states, the answer is yes. Although laws are generally intended to promote health and protect fetuses, some developmental scientists and policy analysts argue that state laws are punitive as they potentially threaten women with involuntary treatment or protective custody during pregnancy (Seiler, 2016). As of 2017, 34 states had laws related to reporting of alcohol consumption during pregnancy (Alcohol Policy Information System, 2018). One half of states classify controlled substance use during pregnancy as child abuse, which may lead to removing the infant from parental custody or even terminating parental rights (Guttmacher Institute, 2018). In some cases, these consequences have been extended to include alcohol abuse and dependence (Paltrow & Flavin, 2013; Seiler, 2016).
Both the American College of Obstetricians and Gynecologists (2011) and the American Medical Association (2014) argue that criminal sanctions for maternal drug use are ineffective as they increase the risk of harm by discouraging prenatal and postnatal care and undermining the physician–patient relationship. Such policies can cause women to develop a mistrust in medical professionals that ultimately harms their care if they become reluctant to seek medical care for themselves and their children. Others argue that these policies are discriminatory toward women of color and those in low socioeconomic status brackets because low-income African American and Hispanic women are disproportionately tested and tried for substance use (Paltrow & Flavin, 2013). For example, a study of one California county with universal screening policies requiring drug and alcohol testing for all pregnant women found that, although Black and White women showed similar rates of drug and alcohol use, Black women were four times more likely than White women to be reported to child protective services after delivery (Roberts & Nuru-Jeter, 2012). Moreover, some experts argue that mandatory drug testing violates women’s rights as they are treated differently under the law compared with men because of their sex and pregnancy status (Hui, Angelotta, & Fisher, 2017). Punitive approaches to maternal substance use that favor criminal charges over substance abuse treatment may pit the interdependent interests of the mother and fetus against each other. Some argue that there is no evidence that punitive measures improve maternal or fetal outcomes. Instead, fetal outcomes as supported by substance abuse treatment that rewards abstention, invests in family and community supports, and promotes contact with health care and social support services hold the most promise (Bada et al., 2012; Hui et al., 2017).
What Do You Think?
1 In your view, is substance use during pregnancy a form of abuse? Why or why not?
2 What do you think could be done to reduce the prevalence of substance use by pregnant women?
Although it was once believed that cocaine- and heroin-exposed infants would suffer lifelong cognitive deficits, research suggests more subtle effects (Behnke & Smith, 2013; Lambert & Bauer, 2012). Prenatal cocaine or heroin exposure has a small but lasting effect on attention and behavioral control, as well as language skills through late childhood (Singer, Minnes, Min, Lewis, & Short, 2015; Viteri et al., 2015). In adolescence, prenatal exposure to cocaine is associated with behavior problems and substance use (Min, Minnes, Yoon, Short, & Singer, 2014; Richardson, Goldschmidt, Larkby, & Day, 2015).
The challenge of determining the effects of prenatal exposure to cocaine and heroin is that most cocaine- and heroin-exposed infants were also exposed to other substances, including tobacco, alcohol, and marijuana, making it difficult to isolate the effect of each drug on prenatal development. We must be cautious in interpreting findings about illicit drug use and the effects on prenatal development because many other contextual factors often co-occur with parental substance use and also pose risks for development. These risks include poverty, malnutrition, inconsistent parenting, stress, and diminished parental responsiveness (Smith et al., 2016). For example, parents who abuse drugs tend to provide poorer quality care, a home environment less conducive to cognitive development, and parent–child interaction that is less sensitive and positive than the environments provided by other parents (Hatzis, Dawe, Harnett, & Barlow, 2017). Children raised by substance-abusing parents are at risk for being subjected to overly harsh discipline and lack of supervision as well as disruptions in care due to factors such as parental incarceration, inability to care for a child, and even death (e.g., from a drug overdose or violence).
At the same time, quality care can lessen the long-term impact of prenatal exposure to substances (Calhoun, Conner, Miller, & Messina, 2015). Some evidence suggests, for example, that developmental differences in exposed infants are reduced and often disappear when medical and environmental factors are considered (Behnke & Smith, 2013). Disentangling the long-term effects of prenatal exposure to substances, subsequent parenting, and contextual factors is challenging. Researchers and health care providers who construct interventions must address the contextual and parenting-related risk factors to improve the developmental outlook for children exposed to drugs prenatally. The accompanying Applying Developmental Science feature examines the difficulties of addressing maternal drug use in the legal system.
Maternal