Summary:
More than one-half of all women of childbearing age (18 to 44 years of age)
report alcohol use, and one in eight report binge drinking in the past month.
Alcohol
appears to have negative effects throughout pregnancy. These effects include
impaired
growth problems, facial dysmorphia, and central nervous system abnormalities
(structural abnormalities, neurological problems, below normal cognitive
performance). There is no exact dose-response relationship between the amount of
alcohol consumed during the prenatal period and the extent of damage caused by
alcohol in the infant. We recommend abstinence from alcohol at conception and
during pregnancy (Grade 1C). Identification and counseling of women who use
alcohol can decrease intake during pregnancy. Given that alcohol is a known
teratogen and a safe level of intake during pregnancy has not been established,
we
recommend screening all pregnant women for any use of alcohol (Grade 1B). The
TACE,
TWEAK, or AUDIT-C screening tool can be used to identify women who may
be at risk for prenatal alcohol use. Clinicians should choose screening
strategies that
are appropriate for their clinical population and setting. For pregnant women
who
consume alcohol but are not heavy drinkers, we recommend a brief intervention
(eg,
educational session(s), motivational counseling) rather than no intervention or
more
extensive alcohol cessation programs (Grade 1A). Women with heavy drinking
patterns who are unlikely to reduce their consumption should be referred to
professional alcohol treatment.
Women who smoke or are exposed to secondhand smoke during pregnancy are
at greater risk for spontaneous pregnancy losses, preterm delivery, low birth
weight,
PPROM, placenta previa, abruptio placentae, and stillbirth. Most of these risks
are
reduced by smoking cessation.Although smoking cessation during pregnancy is of
maximal benefit if it occurs early in the first trimester, quitting at any time
during
pregnancy can have some beneficial effects. For women unable to quit smoking,
reducing the number of cigarettes smoked still has maternal and fetal
benefits.Short
behavioral and educational interventions tailored for the pregnant woman are
associated with higher cessation rates.Pharmacotherapy is recommended for women
who are heavy smokers and are unable to quit on their own. Further studies
areneeded to evaluate the safety and efficacy of pharmacotherapy in pregnant
women.Postpartum relapse is a significant problem, with 90 percent relapsing in
the first year after delivery. These women should be considered "at risk" and
attention paid to providing continuing support. Illicit drugs are associated
with some degree of adverse effect and should not be taken by pregnant women.
Identification and treatment of women who use drugs
can decrease maternal drug use during pregnancy. Given the potential adverse
fetal and maternal effects of drug use, we recommend screening all pregnant
women for drug use (Grade 1C). The most practical screening method is to ask
specific questions about drug use. Pregnant women may not admit drug use
because they have guilt about its effect on their pregnancy, and fear legal
consequences, including loss of custody of children.
Keywords:
Alcohol, Nicotine, Illicit drugs, Smoking, pregnancy
