Epidemiology

• Abuse of legal psychoactive substances (alcohol, nicotine) during pregnancy is far more common than use of illicit drugs

• Incidence and choice of drugs show strong regional variability. Maternal substance abuse is seen in all socio-economic classes, ages, and races, but there is increased risk in younger women, unmarried women, and women with lower educational achievements

• Many mothers on psychoactive substances use more than one drug. Women on methadone or buprenorphine substitution may still use heroin or other illicits drugs

• Every effort should be made to stop consumption of alcohol, benzodiazepines, phencyclidine, and cocaine during pregnancy and to cut down on smoking cigarettes

• In contrast, avoid withdrawal from opioids (risks of miscarriage in the first trimester, premature labor in the third trimester, fetal distress and fetal intrauterine death close to term)

• Selective serotonin reuptake inhibitors (SSRI) are also commonly prescribed during pregnancy to women with symptoms of depression. Attempts to change an effective medication are contraindicated shortly before and after delivery (mood swings are very common around the time of childbirth, even in women without a history of depression), and women who have been taking a particular SSRI for most of the pregnancy should continue to do so after the baby is born. Women who discontinue antidepressants during pregnancy have about five times the risk for depression relapse than those who continue to take the medications. However, the risk of persistent pulmonary hypertension of the newborn (PPHN) is about sixfold increased in newborns whose mothers used SSRI after 20 weeks of gestation, with an overall incidence of approximately 6 to 12 per 1000 exposed women