Intoxicants

Alcohol is an intoxicant that, when ingested, inhibits the function of the central nervous system. Alcoholic beverages, such as cider, beer, wine, and spirits, contain alcohol in variable quantities. A standard drink or serving is defined as containing 12 g of 100% alcohol; this corresponds to 12 cl of wine, a small bottle of medium beer, or 4 cl of spirits. All alcoholic beverages are harmful to the fetus.   

Some studies indicate that heavy alcohol use may impair fertility. Because a pregnancy begins before you miss a period or a pregnancy test can be considered reliable, you should avoid drinking alcohol altogether even when planning a pregnancy. 

No safe limit for alcohol consumption during pregnancy has been identified. Alcohol passes freely through the placenta to the fetus, and the alcohol level in the fetus’s bloodstream is the same as in the mother’s. Individual variations in alcohol metabolism and the sensitivity of the fetus have a bearing on what damage the alcohol will cause and to whom. The safest option is to avoid drinking alcohol altogether from the time you begin planning your pregnancy through to childbirth. 

Alcohol is harmful to the fetus throughout pregnancy and should not be drunk at any time while pregnant. Alcohol is particularly harmful to brain development. The central nervous system of the fetus is constantly developing throughout the pregnancy and is sensitive to damage caused by alcohol from very early in the pregnancy up until childbirth. Alcohol also impairs fetal growth. 

Alcohol elevates the risk of birth defects. Alcohol is also one of the major causes of developmental delays. Heavy and/or recurrent alcohol use by the mother during pregnancy may, in the worst case, lead to fetal alcohol syndrome (FAS) – a syndrome involving damage to the fetus in the form of microcephalia, developmental delays, slow growth, and typically malformed facial features. The developmental delay may range from slight learning difficulties or behavioral disorders to severe developmental disabilities. 

Studies show that alcohol use during pregnancy significantly elevates the risk of miscarriage and fetal death. 

Although no safe limit is recognized, it is unlikely that consuming a single serving would elevate the risk for your fetus. What is important for the fetus is that you discontinue drinking alcohol, at the latest when you find out that you are pregnant. The safest option is to avoid drinking alcohol altogether from the time you begin planning your pregnancy through to childbirth. 

In Finland, all pregnant women are offered structural ultrasound screening in weeks 19 to 22 of their pregnancy to examine the structures and organs of the fetus to detect any malformations. Slow growth of the fetus can also be diagnosed via ultrasound. Although ultrasound examinations during pregnancy are relatively precise, alcohol-induced damage to the central nervous system cannot be detected by ultrasound. 

If the mother herself or her family members are concerned about alcohol use during pregnancy, the matter should be brought up at the maternity clinic or with a physician. Once the attending physician knows about alcohol use during pregnancy, any potential problems can be examined immediately after the child is born, so that the appropriate help and treatment will not be delayed. 

Despite exposure to alcohol during pregnancy, the child may have a good prognosis. It is always a good idea to stop drinking, no matter how far along you are in your pregnancy. The fetus benefits from every day without alcohol. There is no curative treatment for fetal alcohol syndrome, but early diagnosis and the appropriate help and support will help the child to cope. A stable and caring growth environment where the child can be taught basic life skills and social interaction will produce the best results. 

Alcohol use close to childbirth may cause the newborn infant to suffer from withdrawal symptoms such as tremors, increased muscle tension, restlessness, and weepiness. If the mother is drunk at delivery, so is the baby. 

Repeated or copious alcohol use during breastfeeding may be harmful to the child’s development. The alcohol level in the mother’s breast milk is the same as in the mother’s bloodstream. A one-off drink will only result in low exposure, but repeated or copious alcohol use may expose the infant to harmful levels of alcohol. A child’s central nervous system develops substantially during the first few years of life, and unnecessary harmful exposure must be avoided. 

Please stop using any and all intoxicants when you are planning a pregnancy. Both smokers and heavy drinkers take longer to become pregnant than others and have an elevated risk of miscarriage. The impact is not permanent; fertility factors return to normal quickly after you quit smoking and drinking alcohol.  

Drug use may impede fertility in both women and men. Cannabis impedes fertility in many ways: by affecting the hormone system, by disrupting the menstrual cycle, and by elevating the risk of miscarriage. Opiates may also impede fertility in that they affect the secretion of pituitary hormones. For other drugs, no precise information is available on their impact on fertility. There is no information available on the impact of designer drugs on the human body, so it is impossible to even make an educated guess about their impact on fertility. 

Pregnancy and recreational drugs are not a good match. In addition to the direct damage to the fetus that may be caused by drugs, drug abuse involves multiple problems for the mother that may be transmitted to the fetus and to the progress of the pregnancy. Such problems include infections contracted through dirty needles in intravenous drug use (hepatitis B, HIV), use of other intoxicants, and poor nutrition.

A drug user’s pregnancy is a high-risk pregnancy. If you become pregnant while you are using drugs, you must urgently contact a maternity clinic, where your situation will be reviewed and you will be referred to treatment if necessary to encourage you to give up intoxicants or even to begin detoxification.

Using cannabis products (hashish and marijuana) may have a harmful impact on fetal growth. Tetrahydrocannabinol (THC) passes through the placenta, and smoking cannabis causes higher carbon monoxide levels in the blood than smoking tobacco; this may impede the fetus’s oxygen supply. Smoking, whether of cannabis or tobacco, greatly elevates the risk of fetal death. Research suggests that exposure during pregnancy can cause permanent changes in the function of the developing central nervous system of the fetus. 

Cocaine and amphetamine derivatives (including ecstasy) constrict blood vessels. Disruption of circulation in the placenta may lead to temporary hypoxia for the fetus, which in turn may cause developmental or growth defects to internal organs, or other problems. Amphetamine and ecstasy use during pregnancy may cause an elevated risk of developmental problems in the heart. Premature birth, premature separation of the placenta, and fetal death are associated with the use of amphetamine derivatives and cocaine. The newborn infant of a mother who is a cocaine user may be stiff and shaking, in what is known as ‘stiff baby syndrome’, and their voice when crying is often high-pitched.

Because of the way these substances affect the body, all of them pose a potential risk of birth defects if used in early pregnancy. Long-term impacts on the developing central nervous system are also possible. 

Heroin use carries an elevated risk of low weight and fetal death. The newborn infant may develop severe withdrawal symptoms, in some cases up to a month after birth. 

LSD use may involve an elevated risk of birth defects. Permanent harmful impacts on the developing central nervous system are also possible. 

If you are a drug user, you must not breastfeed.

THC, the active substance in hashish and marijuana, accumulates in breast milk so that it may be present at levels ten times what is in the mother’s bloodstream. THC is stored in fatty tissue and takes a long time, up to months, to be purged from the body. Regular exposure may have a harmful impact on the development of the child’s central nervous system. Thus, if you use cannabis, you must not breastfeed.

Cocaine, ecstasy and amphetamine may cause permanent neurological damage and life-threatening circulatory problems for the user. These risks affect a breastfed infant too. A breastfed infant may gain a harmful dose of such a substance through breast milk. Thus, a mother who uses any of the aforementioned substances must not breastfeed. 

Heroin accumulates in breast milk and may be present at levels many times what is in the mother’s bloodstream. Heroin degrades into morphine in the body, and this also accumulates in breast milk. Exposure presents a clear danger to a breastfed infant. Thus, if you use heroin, you must not breastfeed. 

LSD accumulates in the central nervous system and presents a clear danger to a breastfed child. If you use LSD, you must not breastfeed. 

Pregnancy and detoxification 

Buprenorphine, buprenorphine–naloxone, and methadone are therapies that may be used for treating opioid addiction during pregnancy. If taken under close supervision, these treatments are safe and can continue throughout the pregnancy. The treatment will not be discontinued before childbirth, even though the medications used in detoxification may cause long-lasting withdrawal symptoms for the newborn infant. It is important to monitor the infant for such symptoms.

Breastfeeding and detoxification 

Buprenorphine and methadone excrete into breast milk only at very low levels, and substitution therapy generally does not prevent breastfeeding. It is also usually possible to breastfeed while on buprenorphine–naloxone combination therapy. However, if you are abusing these medications and also using recreational drugs, you absolutely must not breastfeed. The decision on breastfeeding must be made together with your physician, and monitoring the infant is vital for identifying any adverse impacts. 

Tobacco is made by drying the leaves of one of several plants in the genus Nicotiana. It is smoked, taken as snuff, or chewed. Tobacco smoke contains nicotine and more than 3,000 other chemicals and toxins, including tar, arsenic, lead, and carbon monoxide. Many of these substances pass through the placenta to the fetus, impeding the transmission of vital nutrients and oxygen to the fetus, with potentially harmful impacts. Please avoid all tobacco products during pregnancy. 

Please stop smoking when you are planning your pregnancy. A smoking woman may find it harder to become pregnant than a non-smoking woman. Research shows that in as many as over 10% of cases of infertility the cause is smoking. Smoking also elevates the risk of an ectopic pregnancy. The adverse impact of tobacco on fertility is temporary: when you stop smoking, your fertility will be restored. 

Research shows that smoking elevates the risk of miscarriage to about double of that of non-smokers. Nicotine constricts blood vessels and reduces circulation in the uterus and placenta, compromising the fetus’s oxygen supply. This may result in an elevated risk of miscarriage. 

Individual studies have indicated that the disruption of circulation caused by smoking may elevate the risk of birth defects such as cleft lip/palate or congenital heart problems. However, the findings are inconclusive.   

Smoking by a pregnant woman substantially elevates the risk of premature birth. Smoking also slows the growth of the fetus and causes low weight, which may be associated with other problems. If the mother stops smoking before the halfway point of the pregnancy, fetal growth will return to normal. Smoking mothers also have a clearly elevated risk of other complications in pregnancy and delivery, such as placenta previa (where the placenta blocks the birth canal), premature separation of the placenta, hemorrhaging, and fetal death. Smoking also compromises immunoresistance and thus makes the smoker more susceptible to infections. Smoking during pregnancy has also been shown to have a harmful impact on the fetus’s brain development. 

The term ‘perinatal mortality’ refers to cases where the fetus dies in the womb or the newborn infant dies within seven days of birth. Smoking while pregnant elevates the risk of perinatal mortality by a factor of about 1.5. Smoking while pregnant also substantially elevates the risk of cot death. 

The level of smoking-related risks during pregnancy correlate with how many cigarettes you smoke. The more you smoke, the higher the risk for pregnancy complications and damage to the fetus. Even cutting down on how much you smoke will benefit both you and the baby. It is known that smoking just a couple of cigarettes a day reduces the fetus’s oxygen supply and essential nutrient supply. The best thing for both mother and baby is for the mother to quit smoking when the pregnancy is only just being planned. 

Quitting smoking is always a good idea, and it is never too late at any stage in the pregnancy. The fetus benefits from every moment that you do not smoke. 

Nicotine replacement therapy may be considered if you are smoking while pregnant and have not been able to quit or cut down on smoking although you have tried to do so. Nicotine replacement therapy while pregnant should always be undertaken with monitoring by a physician or a public health nurse. You should principally use nicotine products with short-term effects, such as a chewing gum or a spray.  

A nicotine patch may be considered in some situations, if you require frequent doses. The patch should be removed at night if possible. You must absolutely avoid smoking during nicotine replacement therapy, because otherwise you may accumulate a very high level of nicotine in your system. For the time being at least, no other pharmacotherapies for quitting smoking are recommended during pregnancy. 

Nicotine and other harmful substances in tobacco have a harmful impact on brain development. Newborn infants of smoking mothers have been found to have slower head growth and changes to the structure and function of their brain. Smoking during pregnancy, even if only early on, would seem to correlate with a smaller head circumference in newborn infants. Several studies have also demonstrated a link between smoking during pregnancy and learning difficulties and ADHD experienced by the child later in life.  

Newborn infants of mothers who had been smoking during the last weeks of pregnancy have been described as experiencing withdrawal symptoms such as irritation, stiffness, and tremors. These have been transitory and have cleared up without medication. A newborn infant of a smoking mother has a higher risk of ending up in the observation ward or intensive care ward than a newborn infant of a non-smoking mother.  The risk of cot death is five times higher for babies of smoking mothers than for babies of non-smoking mothers.  

Snuff contains ground tobacco and flavorings. Like the tobacco plant, it contains numerous chemicals and toxins, some of them carcinogenic. The adverse impacts of taking snuff are comparable to those of smoking. Although taking snuff does not expose you to harmful combustion products such as carbon monoxide, snuff can cause a nicotine high more persistent than that caused by smoking. Nicotine constricts blood vessels and can impair the fetus’s oxygen supply. Taking snuff has been found to elevate the risk of fetal death, premature birth and pre-eclampsia. 

You should absolutely avoid vaping (using e-cigarettes) during both pregnancy and breastfeeding. It is not safer than smoking tobacco. In recent studies, vaping has been found to have the same general health impacts as smoking.  

The composition of e-liquids (or ‘vape juices’) may vary greatly, and the content of these products is not systematically monitored. The e-liquids may have remarkably high levels of nicotine and may contain other substances harmful for the fetus. E-liquids have been found to contain traces for instance of pharmaceutical compounds, synthetic drugs, heavy metals, and carcinogenic compounds.

Also avoid smoking during breastfeeding. Smoking exposes your child to carcinogens both through breast milk and indirectly. Nicotine and other harmful substances in tobacco are excreted into breast milk and can have an impact on the breastfed infant. Also, passive smoking may elevate the infant’s risk of infections. 

The nicotine level in breast milk is at its highest about one hour after smoking, so if you do smoke, you should wait for at least 2 hours before breastfeeding. This recommendation is valid for reducing nicotine exposure, but the margin for other harmful chemical substances cannot be determined. 

The very same warnings apply to vaping as to smoking. Avoid vaping during breastfeeding. 

You can have nicotine replacement therapy during breastfeeding. In nicotine replacement therapy, the breastfed infant is not exposed to harmful substances in tobacco smoke. However, nicotine does excrete into breast milk, so if you use nicotine chewing gum or an inhaler, you should wait for 2 to 3 hours before breastfeeding if possible. 

No other pharmacotherapies for quitting smoking are recommended during pregnancy.