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10 - Fetal and neonatal injury as a consequence of maternal substance abuse

from Section 2 - Pregnancy, labor, and delivery complications causing brain injury

Published online by Cambridge University Press:  12 January 2010

By
H. Eugene Hoyme ,
Melanie A. Manning  and
Louis P. Halamek
Edited by
David K. Stevenson ,
William E. Benitz ,
Philip Sunshine ,
Susan R. Hintz  and
Maurice L. Druzin
David K. Stevenson
Affiliation:
Stanford University School of Medicine, California
William E. Benitz
Affiliation:
Stanford University School of Medicine, California
Philip Sunshine
Affiliation:
Stanford University School of Medicine, California
Susan R. Hintz
Affiliation:
Stanford University School of Medicine, California
Maurice L. Druzin
Affiliation:
Stanford University School of Medicine, California
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Summary

Introduction

Substance abuse is widely prevalent in our society, and women in their child-bearing years are not immune to this epidemic. In addition to the many problems substance abuse causes for these women, it may also place the children they are carrying at risk for lifelong sequelae. Despite the paucity of information on the safety of drugs in pregnancy and lactation, virtually all pregnant women are exposed to prescription and/or non-prescription drugs in some form. The 1991 World Health Organization (WHO) International Survey on Drug Utilization in Pregnancy observed that 86% of women surveyed took medication in pregnancy, with an average of 2.9 prescriptions per woman, excluding over-the-counter and herbal preparations. It is estimated that approximately 10% of pregnant women are exposed to illicit substances. The purpose of this chapter is to describe the fetal and neonatal effects of various legal and illegal sensorium-altering substances ingested by pregnant women.

Drug distribution in pregnancy

It is important to first understand general principles of drug distribution during pregnancy, including the roles of the placenta and breast in biotransformation and secretion. The characteristics that favor transport of a drug across the lipoprotein barriers between the circulation and the central and peripheral nervous systems include high lipid solubility, minimal ionization at physiologic pH, low protein-binding, and low molecular weight.

Type
Chapter
Information
Fetal and Neonatal Brain Injury , pp. 110 - 126
Publisher: Cambridge University Press
Print publication year: 2009

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