Prenatal Substance Exposure: A Growing Crisis

“Nearly 1 in 12 newborns in the United States in 2020 – or about 300,000 infants – were exposed to alcohol, opioids, marijuana or cocaine before they were born. Exposure to these substances puts these newborns at a higher risk for premature birth, low birth weight and a variety of physical and mental disabilities” (The Conversation).

Unfortunately, this number is going up, not down, and our response to this crisis is not on par. THAT is going down. In fact, as more and more states approve cannabis for either medical and/or recreational use, the general response is to not test at all for cannabis, despite our knowing that prenatal cannabis exposure leads to “adverse neonatal outcomes, such as low birth weight, preterm delivery, NICU admission, and decreased Apgar score in some situations” (JAMA).

The evidence for the JAMA article was from a meta-analysis of 16 studies for 59,000+ patients from 1983 through 2020.

Another search, however, interprets it this way: “No neonatal outcomes appeared to be associated with cannabis exposure, but the studies are limited,” from 2017 (NCBI).

My point is that statistics continue to lie, and common sense is hard to find.

When you consider that “In 1973, fetal alcohol syndrome was first described as a specific cluster of birth defects resulting from alcohol exposure in utero. Subsequently, research unequivocally revealed that prenatal alcohol exposure causes a broad range of adverse developmental effects” (PubMed), and in 2024 we’re still debating how much is too much, we’re in trouble.

For example, in 2020, Harvard kindly published this information:

While not drinking any alcohol during pregnancy is the safest choice, small amounts of alcohol early in pregnancy may be less risky to the mother’s health and the health of their babies than previously believed. Minimal alcohol use during the first trimester doesn’t appear to increase the risk for high blood pressure complications, or premature birth or low birth weights. That’s the findings of a study previously published in the journal Obstetrics and Gynecology.

Dr. Fergus McCarthy and colleagues from Ireland, England, New Zealand, and Australia compared birth outcomes among 5,628 women who were pregnant for the first time between 2004 and 2011. More than half of them reported drinking alcohol during the first three months of pregnancy. Some (19%) reported occasionally drinking alcohol. Twenty-five percent reported low alcohol consumption, or three to seven drinks per week (“a drink” defined as a glass of wine or a little less than a 12-ounce bottle of beer). Another 15% reported having more than seven drinks per week.

Rates of premature birth, babies with low birth weight or small size, and pre-eclampsia—a potentially life-threatening condition in which a pregnant woman develops high blood pressure—were similar across the alcohol consumption categories (Health).

They end the article this way: “However, since it’s not clear how much alcohol it takes to cause problems, the best advice remains the same: women should avoid alcohol if they are pregnant or might become pregnant.

“For the many women that drank some alcohol before they realized they were pregnant, this and other studies should reassure them. They almost surely did no harm to their unborn children.” The emphasis is mine, because “almost surely” seems like such confidence, doesn’t it? Really…

Note that the 5,628 women sampled were pregnant between 2004 and 2011, and the article also cites a 2012 Danish study that quotes neuropsychological testing in four Danish cities from 2003–2008, but Harvard shared this information in 2020. Maya Angelou famously advised, “Do the best you can until you know better. Then when you know better, do better,” but society today resolutely refuses to do better. In fact, well-respected bastions of education and health help us not to do better.

Addressing prenatal exposure to substances is hard. People don’t want to be told that what they did could have negatively affected their offspring, and our desire to criminalize what’s been done is bewildering. However, ignoring it isn’t the right approach, either.

We know better. Now it’s time to do better.

References

https://www.health.harvard.edu/blog/study-no-connection-between-drinking-alcohol-early-in-pregnancy-and-birth-problems-201309106667

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2788451#

https://www.ncbi.nlm.nih.gov/books/NBK425751/

https://pubmed.ncbi.nlm.nih.gov/26482673/

https://theconversation.com/hundreds-of-thousands-of-us-infants-every-year-pay-the-consequences-of-prenatal-exposure-to-drugs-a-growing-crisis-particularly-in-rural-america-217360