Nutrition During Pregnancy Part I: Weight Gain, Part II: Nutrient Supplements (1990) / Chapter Skim
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20 Substance Use and Abuse During Pregnancy
20 Substance Use and Abuse During Pregnancy
Pages 390-411
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From page 390... ...
considered at length the adverse reproductive effects of cigarette smoking and alcohol abuse as well as the teratogenic potential of caffeine in animals. The present report briefly summarizes the influence of tobacco, alcohol, caffeine, marijuana, and cocaine on the fetus and reviews the data on how these substances may affect dietary intake and nutritional status during pregnancy.
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among infants of smokers. A recent review of the literature on the determinants of low birth weight has, like previous reviews, concluded that cigarette smoking is by far the single most important modifiable factor responsible for fetal growth retardation in developed countries (Kramer, 1987~.
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The exact mechanism behind the detrimental effects of smoking on the fetus and newborn have not been established. The most widely accepted explanation is that smoking causes intrauterine hypoxia through increased carboxyhemoglobin levels or reduced uteroplacental blood flow (Abel, 1980b; Longo, 1982~.
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Since cigarette smoking has been demonstrated to increase the metabolic rate (Perkins et al., 1989) , the lower prepregnancy weight and weight gain in smokers presumably reflect a reduced availability of calories for weight gain.
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In addition, the hypothesized reduction in uteroplacental blood flow in smokers could restrict nutrient and oxygen flow to the fetus. As a result, mothers who smoke may need special counseling regarding dietary intake and may benefit from multiv~tamin-mineral supplementation, but this has not been investigated.
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From page 395... ...
It is not known whether alcohol consumption during pregnancy has declined since the 1977 and 1981 Surgeon General's reports on alcohol and pregnancy, but at least one study found no significant decrease in the relative proportion of heavy drinkers among Pregnant women in Seattle. Washington, between 1974-1975 and ~~= r -- c~ -- ~ -- -, 1980-1981 (Streissguth et al., 1983~.
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From page 396... ...
However, evidence concerning the adverse effects of alcohol on specific nutritional indices comes largely from studies of nonpregnant hospitalized alcoholics, many of whom had hepatic damage. Specifically, chronic alcohol abuse has been linked to increased urinary zinc excretion and low serum zinc concentrations (Fredricks et al., 1960; McClain and Su, 1983; Vallee et al., 1957)
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(NRC, 1977~. In a more recent study of pregnant women in Connecticut, the average daily caffeine intake was found to be slightly lower (102 ma)
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Caffeine passes readily to the fetus, but the fetus cannot metabolize caffeine effectively, nor can the infant do so until several months after birth (Aldridge et al., 1979~. Maternal consumption of two cups of coffee significantly increases maternal epinephrine concentrations and decreases intervillous placental blood flow (Kirkinen et al., 1983~.
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From page 399... ...
and depressed zinc and iron absorption (Morck et al., 1983; Pecoud et al., 1975~. In a prospective study of pregnant women in Costa Rica, investigators found that consumption of three or more cups of coffee a day was associated with significantly lower maternal and neonatal hemoglobin and hematocrit levels (Munoz et al., 1988~.
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, which in turn may impair fetal oxygenation and, consequently, fetal growth. Indeed, the increase in carboxyhemoglobin levels has been found to be substantially higher for marijuana smoking than for tobacco smoking (Wu et al., 1988~.
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Furthermore, a recent study found no association between marijuana use during pregnancy and features compatible with fetal alcohol effects at age 4 (Graham et al., 1988~. Possible explanations for the inconsistent findings include differences in the ascertainment and classification of marijuana use, variations in the underreporting of marijuana or other illicit drug use, and the difficulty of controlling for highly interrelated factors such as abuse of other substances.
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The National Household Survey on Drug Abuse in 1988 estimated that more than 20 million people in the United States had tried cocaine, including 20% of those between the ages of 18 and 25 (NIDA, 1989~. The proportion of women aged 18 to 25 years who had used cocaine in the past month increased from 4.7% in 1982 to 6.3% in 1985 but declined to 3% in 1988 (NCHS, 1989; NIDA, 1989~.
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In one study, pregnant women with urine assays positive for cocaine weighed significantly less before the pregnancy, had lower hematocrit levels at the time of prenatal registration, and gained slightly less weight during the gestation than did those with negative assays (Frank et al., 1988; Zuckerman et al., 1989~. Although the deficit in birth weight did not achieve significance when prepregnancy weight and maternal weight gain were controlled for in the analysis, significant decreases in birth length and head circumference remained (Zuckerman et al., 1989~.
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CLINICAL IMPLICATIONS · Highest priority should be given to efforts to prevent or stop substance abuse by pregnant women since there is clear evidence that cigarette smoking and alcohol and drug abuse adversely affect the health of the mother and the fetus. Since nutritional deficiencies can be expected, especially among heavy substance abusers, diet counseling and other efforts (e.g., referral to a social worker)
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1986. Zinc status of infants with fetal alcohol syndrome.
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1982. Fetal alcohol syndrome: inhibition of placental zinc transport as a potential mechanism for fetal growth retardation in the rat.
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1978. The effects of moderate alcohol consumption during pregnancy on fetal growth and morphogenesis.
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1988. Ihe effect of maternal smoking on the relationship between maternal and fetal zinc status and infant birth weight.
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1988. Coffee consumption as a factor in iron deficiency anemia among pregnant women and their infants in Costa Rica.
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1974. Examination of the relationship between birthweight, cigarette smoking during pregnancy and maternal weight gain.
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1980. Maternal alcohol consumption, birth weight, and minor physical anomalies.
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