Child Development From Infancy to Adolescence. Laura E. Levine
students in the United States may have FASDs (Tan et al., 2015). Intervention programs can help improve the functioning of children born with FAS and FASDs, but prevention can eliminate this threat to children’s development.
Tobacco
Another preventable source of developmental risk is maternal smoking, along with exposure to secondhand smoke, during pregnancy. Cigarette smoke contains over 4,000 chemicals, including formaldehyde, arsenic, and lead, many of which cross the placental barrier to reach the fetus (de Vocht, Simpkin, Richmond, Relton, & Tilling, 2015). The more a woman smokes or the longer into the pregnancy she smokes, the greater her risk of having a baby with low birth weight (de Vocht et al., 2015). Several mechanisms contribute to this growth restriction. As a woman smokes, the level of carbon monoxide in her blood increases and this reduces its capacity to carry oxygen. Because nicotine constricts blood vessels, this further limits the flow of oxygen and nutrients to the fetus through the placenta. Also, nicotine tends to suppress appetite so pregnant smokers eat less. All these factors contribute to the growth restriction so strongly associated with babies born to smokers. Perhaps surprisingly, maternal smoking is also associated with children being obese or overweight later in development. Researchers have speculated that childhood weight gain may be the body’s attempt to catch up or rebound from the earlier prenatal growth restriction (Banderali et al., 2015; Santos et al., 2016).
Smoking is associated with problems during the pregnancy, but also problems later in development. During the pregnancy there is an increased risk of miscarriage, premature birth, and sudden infant death syndrome (CDC, 2016r). It also affects lung development in a way that places the child at lifelong risk of respiratory problems (Banderali et al., 2015; McEvoy & Spindel, 2017). The risk of developing asthma, a serious childhood illness that is discussed in Chapter 8, is significantly increased if a mother smokes while pregnant, even if she does not smoke after the baby is born (Neuman et al., 2012). Maternal smoking is also a major contributor to later developmental problems for the child, including attention deficit/hyperactivity disorder (ADHD), conduct disorders, and learning disabilities (Rogers, 2009; Shea & Steiner, 2008; Slotkin, 2008). Babies born to smokers appear to undergo withdrawal symptoms similar to those seen in babies born to mothers addicted to illicit drugs, including higher levels of irritability and muscle tension (Stroud et al., 2009). It also is a strong predictor of whether adolescents begin smoking and become addicted themselves, regardless of whether their parents smoked during their childhood (Mamun et al., 2006).
While smoking has decreased among the general U.S. population over the last couple of decades, it has decreased at a slower rate among young women ages 19 to 29 than among other age groups. Just over 10% of pregnant women report smoking during the last 3 months of their pregnancy (CDC, 2016r). The good news is that stopping smoking at any point in a pregnancy is beneficial, but stopping completely and early in the pregnancy is best (ACOG, 2010, reaffirmed 2015). The bad news is that even when women are persuaded to stop smoking while they are pregnant or breastfeeding, many resume shortly thereafter (Xu, Wen, Rissel, & Baur, 2013). It would be beneficial to both mother and infant if we could find ways to make a smoke-free environment a long-term lifestyle change rather than a brief adaptation to the pregnancy itself.
Prescription and Over-the-Counter Drugs
It is difficult to make general statements about the use of drugs (whether prescription or over-the-counter) during a pregnancy because the potential effects depend on the specific type of medication taken, when in the pregnancy it is taken, for how long, and at what dosage. Medication is most likely to be harmful in the early critical weeks of the pregnancy, but some medications, such as thalidomide, can result in severe birth defects regardless of when they are used. If a woman wants to use over-the-counter medications to relieve the discomfort of colds, headaches, or nausea, she should discuss this decision with her physician who will be able to weigh the potential benefits from using the drugs against the possible risks for the fetus. Because most herbal remedies and food supplements have not been tested by the U.S. Food and Drug Administration for safety, it is best to avoid these completely during a pregnancy. To see how safe your own medications would be for a pregnant woman, try Active Learning: Safety of Medications During Pregnancy.
Active Learning: Safety of Medications During Pregnancy
Do you know whether your medications are safe for use during pregnancy? You can find out by making a list of all your medications (both prescription and over-the-counter), vitamins, and herbal supplements, and checking their safety.
The Physicians’ Desk Reference (PDR) (PDR Staff, 2016) contains the information that comes in the insert you receive with your prescriptions, including any warnings or contraindications for a drug’s use. A separate volume of the PDR deals specifically with nonprescription drugs, dietary supplements, and herbal medicines. This information is available through the PDR Network website at www.PDR.net or as a book in your campus library.
Medications and pregnancy. A woman should be very careful about what medications she uses during her pregnancy. The labeling on the medication itself may provide a warning about use during pregnancy, but the Physicians’ Desk Reference also contains information about safety. Of course, pregnant women should check with their doctor if they are uncertain about the safety of any medication.
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You also can search the Internet by typing the name of a specific drug and the word pregnancy to see whether there are any advisories against its use. Remember to check the credentials of any sites you use. Sites maintained by the Centers for Disease Control and Prevention, the National Institutes of Health, or the American Congress of Obstetricians and Gynecologists will give you information you can trust.
When a woman has a chronic condition such as asthma, diabetes, or high blood pressure, continuing her medication during pregnancy may be necessary to protect her well-being. For example, women who are diabetic have an increased risk of miscarriage, stillbirths, preterm births, and some birth defects if they do not effectively control their glucose level while pregnant (National Institute of Diabetes and Digestive and Kidney Diseases, 2017). A pregnant woman needs to consult with her doctor and carefully weigh the benefits of any medications and supplements against the potential risk to her pregnancy and developing fetus.
In recent years, the number of prescriptions written for a variety of opiate painkillers, including codeine, fentanyl, morphine, and oxycodone, has increased dramatically. As their medical use has increased, so has the illegal use of these drugs. Whether opioids are prescribed or illegal, their use during a pregnancy is associated with a wide range of complications and numerous harmful effects for the fetus, including an increased risk of stillbirth, premature birth or low birth weight, and birth defects that include neural tube defects and heart problems (March of Dimes, 2016). Following birth, the newborn will go through drug withdrawal, which can include tremors, excessive crying, sleep problems, vomiting, and diarrhea (March of Dimes, 2015a). If a woman becomes pregnant while using an opiate drug, she needs to talk with her health care provider. She should not suddenly discontinue her use because this could be more harmful to her baby than continuing. The best advice for a woman who is using an opioid medication, whether legally or illegally, is to use contraception so that she does not become pregnant.
Illegal Drugs
Conducting research on the effect of illegal drugs on a human pregnancy is challenging because it is difficult to get mothers who are using illegal substances to provide accurate information about the amount or type of drugs they use, or the length of time they have used them. It is also hard to disentangle the effect of the drugs themselves from the effect of other factors that might damage the pregnancy. For instance, a woman who is using marijuana may also be a heavy cigarette