Abstinence from substances of abuse is a top priority goal during pregnancy. Provide universal screening, which can uncover subtle issues and help you address these topics in a neutral and constructive manner. Incarceration, confrontation, and criminalization of substance abuse have all been shown to worsen outcomes of pregnancy for women and their children.
■ Tobacco. Tobacco use is implicated in 13% to 19% of all low–birth weight babies and many other poor pregnancy outcomes, including a twofold risk of placenta previa, placental abruption, and preterm labor.29,30 Risk of spontaneous abortion, fetal death, and fetal digit anomalies is also increased. Cessation is the goal, but any decrease in use is favorable.
■ Alcohol. Fetal alcohol syndrome, the neurodevelopmental sequela of alcohol exposure during fetal development, is the leading cause of preventable mental retardation in the United States. No safe dose of alcohol has been established. ACOG strongly recommends that women abstain throughout pregnancy. To promote abstinence, make use of the numerous ACOG and CDC resources, professional counseling, inpatient treatment, and Alcoholics Anonymous.
■ Illicit drugs. Illegal drugs have significant detrimental effects on fetal development; pregnant women with addiction should be referred for treatment immediately and screened for HIV and hepatitis C infection.
■ Abuse of prescription drugs. Ask about the unusual use of narcotics, stimulants, benzodiazepines, and other commonly abused prescription drugs.
■ Herbal and unregulated supplements. Herbal supplements during pregnancy have been poorly studied and can harm the developing fetus. Unregulated supplements or vitamins, especially if formulated outside the United States, may contain lead and other toxins. Review and discuss any intake of supplements and consider pregnancy toxicology, to determine specific risks related to the timing of ingestion and the extent of fetal exposure.
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