Stimulants, narcotics, hallucinogens. (Drugs, Pregnancy, and Lactation).

In the late 1990s, an estimated 3% of pregnant women used illicit drugs in early gestation, according to the Centers for Disease Control and Prevention. Pregnancy complications and poor fetal outcomes are common in these women. However, drug abuse may not be solely responsible for these adverse outcomes; other contributing factors in this population include a lack of prenatal care, violence, and sexually transmitted diseases. Breast-feeding is contraindicated with all of the following agents:

* Marijuana. This drug disrupts neurodevelopment, but there is no evidence that it is a structural teratogen. Exposure in utero can cause fetal growth retardation and subtle, long-lasting neurobehavioral abnormalities related to effects in the prefrontal cortical regions of the brain. Marijuana also has been linked to transient irritability, tremors, and an exaggerated startle reflex in neonates, but after this early period, there is little evidence of adverse neurobehavior in children followed up to age 3 years. In studies of older children up to 12 years of age, however, exposure in utero, especially if heavy and/or long term, is associated with inattention, hyperactivity, increased impulsivity and delinquency, and deficits in short-term memory tasks and problem solving.

* Cocaine. Cocaine is a human teratogen that causes anomalies of the genitourinary tract, heart, limbs, face, and bowel. The toxicity of cocaine in the mother and fetus is related to the dose taken and duration of use. Toxicities result from the drug's sympathomimetic properties, which lead to hypertension and vasoconstriction, causing decreased uterine blood flow and fetal hypoxia.

Maternal toxicities include spontaneous abortions, premature labor and delivery, premature rupture of membranes, placenta previa, and abruptio placentae. Fetal and neonatal toxicities can result from maternal use at any point during gestation and include growth retardation, fetal distress, in utero cerebrovascular accidents, and abnormal neonatal neurobehavior.

* Amphetamines. This group of drugs includes amphetamine, dextroamphetamine, methamphetamine, Ecstasy (MDMA), and the structurally related agents mescaline (from peyote) and STP (4-methyl-2,5-dimethoxyamphetamine, or DOM). Amphetamine-induced malformations have been observed in some animals (pregnancy category C), but only at high doses. Various birth defects, such as oral clefts, cardiac defects, and biliary atresia, have been noted in the offspring of women taking ...