Drugs have been used for many years as a means of treatment of disease and with it came the perceived extra benefits of certain drugs. The unfortunate drawback with these drugs are addiction and dependence. Women have not been spared this evil and pregnancy is a very vulnerable period for all concerned.

These drugs may vary from over the counter drugs to engineered medications that target mood and the feeling of well-being.

Smoking

The smoking of cigarettes is a major health problem. This habit is causing the death of about 5 million people per year. More than 4000 chemicals, of which at least 60 are known carcinogens, are contained in the smoke from tobacco in cigarettes. The most harmful components are nicotine and carbon monoxide. Nicotine is highly addictive, since it can cause both stimulation and euphoria. Outside pregnancy the most common general adverse health effects of cigarette smoking are lung cancer, heart disease, atherosclerotic vascular disease, laryngeal, oral, oesophageal and bladder cancer, chronic obstructive pulmonary disease, asthma, and respiratory infections.

Before pregnancy, smoking can cause reduction of sperm quality, suppression of ovarian function, reduction in reproductive capacity, poor implantation of embryo, degeneration and aging of the placenta and an increased risk of ectopic pregnancy. Smoking essentially hampers the ability to conceive and if conception takes place, poor pregnancy outcomes are the result.

Perinatal complications include placental problems, premature rupture of membranes and preterm delivery with low birth weight babies and growth restriction. It has been associated with intrauterine deaths, birth asphyxia and sudden infant death syndrome. The smoking of cannabis (dagga) has been studied and more vigilant observation is required to ensure a healthy baby. There is no evidence to suggest that it causes fetal abnormalities, but due to its effect on the mother there are risks, especially related to trauma.

 “Tik” (crystal methamphetamine)

Methamphetamine is a powerfully addictive central nervous system (CNS) stimulant and the most potent member of the amphetamine group of synthetic drugs. The drug was developed from its parent drug, amphetamine, and was used originally (in the 1930s) in nasal decongestants and bronchial inhalers. Its side effects of CNS stimulation, anorexia and euphoria were quickly recognised, leading to its abuse.

Methamphetamine use is a growing trend in South Africa and with it comes the possibility of transplacental transfer of the drug to the fetus when used by pregnant women. In addition to adverse maternal health, current evidence suggests that this prenatal exposure might result in adverse somatic and neurodevelopmental effects on the offspring, either mediated by the vasoconstrictive or direct neurotoxic effects of the drug. The long-term consequences of this remain largely unrecorded. One study showed effects such as poor academic performance and aggression. South Africa’s experience of managing illicit drug use in pregnancy lags behind that of other international centres.

Heroin and cocaine

Due to the significant ease by which addiction is established,  the impact on personal and pregnancy prognosis/outcome is severe. The risk of overdose and death is great and if pregnancy was to continue, the complications for the baby include intrauterine growth restriction, placental infarcts leading to placental separation and death of the unborn baby due to poor placental function or abruption. Babies are born and may suffer from withdrawal and require close paediatric monitoring.

Alcohol

One of the most commonly used drugs, unfortunately even during pregnancy. This stems from the remuneration system on wine farms in the Western Cape. Fetal Alcohol Syndrome (FAS) is one of the most common abnormalities found in South Africa compared to world statistics. These women usually give birth to very small, mentally retarded and often physically challenged babies that will require long term care and as such impact on the cycle of poverty and poor health.

Caffeine

Found in coffee, cool drinks, energy drinks, chocolate, and even tea. The effects of caffeine on the pregnancy and the baby are becoming more evident. These effects include growth restriction, fetal death, preterm labour and can be seen in the same light as cigarette smoking.

Over the counter medication and homeopathic remedies

Care should be taken when self medicating during pregnancy as many medicines can be seen as harmless, but have far reaching consequences. The treatment for flu, allergic reactions, hay fever, uncomplicated upper respiratory tract infections (simple cough), pregnancy related aches and pains can be treated easily outside pregnancy, but once pregnant these harmless drugs can cause significant developmental, growth and placental complications.

Homeopathic treatment should only be used when prescribed by a qualified person, as it too can cause unintended complications.

Commonly prescribed medications

Doctors prescribe many drugs on a daily basis and consideration should be given to the effects on pregnancy especially during the critical organogenesis period (6 to 13 weeks). These include pain tablets like NSAID’S, brufen, voltaren, antidepressants, anxiolytics, treatment for chronic conditions, anti-epileptics, antihistamines, blood pressure medication and the list continue.

Before any medication is taken it must be assessed for safety in pregnancy, where the 3 important categories are 1) benefits outweigh risk, 2) safety not established during pregnancy and breastfeeding, and finally 3) contraindicated in pregnancy. Many commonly used medications have not been tested during pregnancy and  are therefore used with caution and often because experience assist in doing the right thing. 

The universal rule is lowest dose for the shortest period, but it must be remembered that dangerous drugs are not just bought on street corners, but can be found in the surgeries of well intending doctors and tablet packs of relatives.

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