Effects of Drugs on Fetal DevelopmentDrug - Any substance which has a physiological effect when introduced into the body.

Legal drugs vs. Illicit drugs

Drugs and Fetal DevelopmentThe effect of drugs on fetal development depends on several things:1. type of drug used

2. how it’s administered to the mother (oral vs. intravenous)

3. amount & frequency of exposure

4. time of exposure during fetal development* (early vs. late stages

of pregnancy)

*Earlier exposure often causes more severe defects

Effects of Drugs on Fetal DevelopmentNeonatal Abstinence Syndrome (NAS) - - A withdrawal syndrome of infants after birth caused

by in utero exposure to drugs of dependence.

Drugs that can cause NAS:Caffeine, nicotine, opiates (heroin, painkillers), amphetamines, certain antidepressants, methadone, alcohol, marijuana, LSD

Neonatal Abstinence Syndrome (NAS)

General Symptoms:1. A distinctive cry (high-pitched, non-stop)2. Central nervous system issues (hypertonia) -convulsions,

seizures, irritability, disturbed sleep patterns3. Respiratory issues - high fever, apnea, congestion,

excessive yawning4. Gastro-intestinal issues - poor appetite, vomiting,

diarrhea

AlcoholAlcohol is the leading preventable cause of birth defects in the US. - The baby does not have a fully developed liver to process the alcohol- Alcohol interupts baby’s brain development; 1st trimester is worst

Fetal Alcohol Syndrome (FAS) - ● Problems with the heart, kidney, and/or bones● Learning disabilities and low IQ● Trouble with memory, coordination, and attention● Hyperactivity● Problems with sleep and suckling as an infant

The symptoms of FAS tend to get worse as a person grows up.

FASDiagnosis of FAS - May seem like ADHD. Doctors look for: - unusual facial features-lower-than-average height and/or weight- small head size- problems with attention and hyperactivity- poor coordination

Early diagnosis and treatment are key. Research shows that children do better when they:● Are diagnosed before age 6● Are in a loving, nurturing, and stable home during their school years● Are not exposed to violence● Get special education and social services

Caffeine- Baby’s metabolism still developing - can’t fully metabolize caffeiene- Can affect baby’s sleep and movement patterns- No conclusive studies done on humans- Some say >150mg/day is too much; others say >300mg/day

- Form of use may have different effects (smoking vs oral vs vaporizing)- Smoke in general contains chemicals hazardous to fetal

development- may cause low birth weight; attention issues later in life- Can affect development of the baby’s brain & visual-motor coordination- As teens, more likely to have behavior problems and use marijuana

Marijuana

Cigarettes - Nicotine & other chemicals added to cigarette tobacco and chemicals created by smoke (combustion) are hazardous. Inhalation of carbon monoxide (CO) can cause:● Lower the amount of oxygen available to baby● Increase baby's heart rate● Increase chances of miscarriage and stillbirth● Increase the risk of premature birth & low birth weight● Increase baby's risk of developing respiratory (lung) problems● Increases risks of birth defects● Increases risk of Sudden Infant Death Syndrome (SIDS)

Vaporizers - Ingredients are unregulated and largely un-tested. - Many have been found to cause craniofacial deformities (cleft lip, etc.)- Severity worsens with certain flavors.

Nicotine

Opioids (heroin, codeine, methadone, oxycodone, etc.) - Statistically significant increase in heart defects● Congenital heart defects.

○ Ventricular and atrial septal defects.○ Tetralogy of Fallot.○ Pulmonary valve stenosis.

● Spina bifida.● Hydrocephaly (excessive fluid in the baby’s brain).● Glaucoma.● Gastroschisis (a hole in the abdominal wall from which the

baby’s intestines stick out).

Amphetamines (meth, Ritalin, Adderall, etc)

● Cleft lip● Cardiac problems● Impaired fetal blood vessel function● Reduced growth● Reduced head size

● Low weight● Cerebral hemorrhage● Undescended Testes

● Premature labor● Stillbirth

May impair how white matter develops in the brain. White matter is essential for healthy communication between different areas of the brain.

XanaxFirst trimester - Cleft lip, cleft palate, or more serious problems

Second & third - Withdrawal syndrome in baby (Xanax can cause emotional or physical dependence/addiction)

- Floppy infant syndrome - Weak muscles. They may not be able to control their head, arms, and legs, giving them a rag doll-like appearance. This condition may last 2 to 3 weeks after birth

Over the Counter Medications Possible connection between acetaminophen (Tylenol) and ADHD

Publication: http://pediatrics.aappublications.org/content/140/5/e20163840

OTC medicines typically have warnings on their labels indicating whether they are safe for pregnant women to take.

Take-away Message:Read your labels & ask your doctor!!

Herbal supplements & Homeopathy- Little to no regulations or peer-reviewed studies- Some supplements may be beneficial or have no effect, but others may have unexpected, even severe effects- Supplements safe for an adult, may be hazardous to fetus- Possible to overdose certain supplements (ex: Vitamins A & E = liver damage or premature labor)

ALWAYS check with your medically licensed doctor before taking something!!!!

SnapshotOTC (over the counter) medicines have warnings on their labels indicating whether they are unsafe for pregnant women to take.

How do we know we can trust what is written on these labels?

Thalidomide - A class of drugs developed in 1957 by German company Chemie Grünenthal

- A sedative used to treat anxiety, insomnia, and morning sickness

- Marketed as a safe medication for all people

- Sold over the counter (OTC) all over the world under numerous names

- Pre-market testing was limited….

- ~10,000 cases of birth defects due to Thalidomide; ~50% survived

Video clips: “Call the Midwife” (S5 E1, S5 E8, S6 E7)

Show premise - main characters of this storyline

Thalidomide

- Most notable defects: undeveloped arms and legs

Also caused:

- Deformities of eyes, heart, digestive tract & urinary tract- Deafness, blindness

This global tragedy led to more structured regulations on OTC drug use and development

Modern uses- Treatment of multiple myeloma (a cancer of the white blood cells)- Side effects of leprosy

An American Heroine

Frances Oldham Kelsey

- Pharmacologist for the Food & Drug Administration (FDA)- Rejected the application for thalidomide to be distributed to the US- Not enough evidence from clinical trials to support its safeness

Although Kelsey faced corporate pressure, her steadfastness saved a generation of American babies from this tragedy.

- Aug 7, 1962, president John F Kennedy awarded her the highest honor given to a civilian in the United States, the President's Award for Distinguished Federal Civilian Service

Thalidomide Survivors

Thalidomide Survivors

- Most alive today are in their 50’s (in Britain, 468 surviving as of 2016 )

- Dealing with chronic pain and early musculoskeletal deterioration

- As their bodies age, many hate the idea of burdening their children to care for them, as they once burdened their parents

- Early settlements with Chemie Grünenthal did not consider the needs of aging survivors today

- Today’s survivors want justice:- Want company to finally admit guilt; to apologize- Want reparations from German gov’t for protecting the company