Using harmful substances during pregnancy can cause problems for you and your baby. In some cases, such as tobacco, alcohol, and drug use, you may feel that you are not able to stop using these substances. But there are ways to help you quit. This pamphlet will explain:

How harmful substances can affect your fetus How using them can affect you How to get help

Taking good care of yourself during pregnancy helps ensure you are taking good care of your baby. Stay healthy by ending harmful habits such as smoking, drinking alcohol, and taking drugs.

Making Changes During Pregnancy

Almost all women have to make some lifestyle changes during pregnancy. In some cases, this may mean adjusting an exercise routine, resting more, or eating healthier foods. In other cases, it may mean kicking a smoking or drinking habit. These changes, along with regular prenatal care, can help you have a healthy pregnancy, as well as a healthy baby.

Smoking

If a woman smokes when she is pregnant, her baby is exposed to harmful chemicals such as tar, nicotine, and carbon monoxide. Nicotine causes blood vessels to constrict, so less oxygen and nutrients reach the fetus. Carbon monoxide lowers the amount of oxygen the baby receives. Also, women who smoke during pregnancy are more likely to have certain problems:

• An ectopic pregnancy
• Vaginal bleeding
• Problems with the way the placenta attaches to the uterus
• A stillbirth
• A low-birth-weight baby (weighing less than 51¼2 pounds)

The less a woman smokes, the less harm it will do. Cutting down or stopping smoking any time during pregnancy is better than not stopping at all. However, quitting before pregnancy is the best thing to do for both the mother and baby. If a woman kicks the habit while she is pregnant, she may be able to kick it for a lifetime. She and her family will be healthier as a result.

If you smoke and have tried to quit on your own but failed, tell your doctor that you need help. If you are a heavy smoker, chewing nicotine gum or wearing a nicotine patch may help. But nicotine replacements also have some risks. They should be used only after other treatments, such as counseling, have not worked and if the benefits of using them to stop smoking could outweigh the risks of using them.

You may want to ask your partner and other family members to quit too. This will help support you in your efforts to give up smoking. Even if you do not smoke yourself, when you are pregnant, secondhand smoke from people around you can be harmful.

Alcohol

When a pregnant woman drinks alcohol, it quickly reaches her fetus. The same amount of alcohol that is in her blood is in her baby's blood. In an adult, the liver breaks down the alcohol. But a baby's liver is not yet able to do this. Thus, alcohol is much more harmful to a fetus than it is to an adult. The more a pregnant woman drinks, the greater the danger to her baby.

It is not known how much alcohol it takes to harm the fetus. One beer, one shot of liquor, one mixed drink, or one glass of wine all contain approximately the same amount of alcohol. All types of drinks pose a risk. It is best not to drink at all during pregnancy.

Drinking at any time during pregnancy can cause problems. Alcohol increases the chance of having a miscarriage or a preterm baby. Alcohol abuse during pregnancy is a leading cause of mental retardation.

Heavy drinking during pregnancy can cause fetal alcohol syndrome. This is a pattern of major physical, mental, and behavior problems in babies who were exposed to alcohol during pregnancy. Smoking, drug use, and poor diet also may play a role in how severely the baby is affected by fetal alcohol syndrome.

It may be hard to stop drinking. If this is true for you, you may need help. Talk honestly to your doctor about your drinking habits.

Drugs

Some women need to take medicine during pregnancy for their health or for the health of the baby. If you are using or thinking about using any medications (over-the-counter or prescription), herbal remedies, vitamins, or minerals, talk to your doctor to find out if they are safe to use during pregnancy. Do not stop taking your medication unless your doctor tells you to stop.

As many as 1 in 10 babies may be born to women who use illegal drugs during their pregnancies. These substances can be harmful to you and to the health and growth of your baby during pregnancy. If you are using illegal drugs, you should stop before you get pregnant.

Your drug use can affect your baby both before and after birth. Most drugs reach the fetus by crossing the placenta. This is tissue inside the uterus that provides nourishment to the fetus. If you use drugs after your baby is born, they can be passed to him or her through your breast milk.

Different drugs may affect the fetus in different ways. A drug's effect on the fetus depends on many things: how much, how often, and when during pregnancy it is used. If two or more drugs are taken together, it can be hard to predict the effects. Sometimes the drugs add to or even increase each other's effects.

Using illegal drugs can cause problems throughout your pregnancy. For instance, the early stage of pregnancy is when the main body parts of the fetus form. Using drugs during this time in pregnancy can cause birth defects and miscarriage. During the last 12 weeks of pregnancy, illegal drug use can stunt the growth of the fetus and cause preterm birth and fetal death.

Illegal drug use is widespread and includes many different types of drugs, all of which are harmful during pregnancy. Illegal drugs that may cause problems for the woman and the fetus during pregnancy include:

• Marijuana—a plant product that, when smoked, exposes the fetus to the marijuana smoke that is inhaled by the mother.
• Cocaine—a highly addictive drug that can cause preterm birth. Babies born to women who use cocaine may grow more slowly and may be more irritable or fussy than babies not exposed to cocaine before birth.
• Heroin—when used during pregnancy can cause preterm birth or even fetal death. Children of women who use heroin during pregnancy may be smaller, have trouble thinking clearly, and have behavioral problems.
• Methamphetamine (“meth”)—raises a woman's blood pressure and heart rate and puts her and her baby at a risk of stroke, brain damage, premature birth, and miscarriage. Babies exposed to methamphetamine also may grow too slowly in the womb, have trouble bonding with others, and be very fussy.

Medications also cross the placenta and enter the baby's bloodstream. In some cases, a medication could cause birth defects, addiction, or other problems in the baby. That means that you need to be careful.

Some medicines are safe to take during pregnancy. Also, the risks of some medicines may be outweighed by the effects of not taking them. For instance, certain diseases are more harmful to a fetus than the drugs used to treat them. Do not stop taking a medication prescribed for you without first talking to your doctor. If a medication you are taking poses a risk, your doctor may recommend switching to a safer drug while you are pregnant.

Prescription medications also can be harmful if they are abused. A woman who abuses prescription drugs risks overdose and addiction. Medicines sold over-the-counter can cause problems during pregnancy too. Pain relievers such as aspirin and ibuprofen may be harmful to a fetus. Check with your doctor before taking any over-the-counter drug, including laxatives and cold or allergy remedies. He or she can give you advice about medicines that are safe for pregnant women.

Addiction

People with an addiction have intense cravings for drugs or alcohol. Usually, they cannot quit by themselves, and treatment is needed to end this behavior.

Some people need emotional support while they are being treated. Treatment programs help them to look at the reasons for their drug use, to know that they are not alone, and to find new ways to cope. If you need help, ask your doctor for information or a referral.

Even if you think you do not have a problem or use drugs or alcohol only on occasion, pregnancy is a good time to quit. These substances can harm your fetus and can disrupt your health, family, and work life.

How to Get Help

The groups listed below help people with drug abuse. If you or someone you know has a drug problem, seek help.

Alcoholics Anonymous
Telephone: 212-870-3400
Web site: http://www.alcoholics-anonymous.org

Narcotics Anonymous
World Service Office in Los Angeles
PO Box 9999
Van Nuys, California 91409
Telephone: 818-773-9999
Fax: 818-700-0700
Web site: http://www.na.org

Substance Abuse and Mental Health Services Administration
Center for Substance Abuse Treatment
Telephone: 800-662-HELP
Fax: 301-443-8751
Web site: http://findtreatment.samhsa.gov

Finally...

Taking good care of yourself during pregnancy helps ensure you are taking good care of your baby. Stay healthy by ending harmful habits such as smoking, drinking alcohol, and taking drugs. Making healthy choices now will help give your baby a healthy beginning.

Glossary

Ectopic Pregnancy: A pregnancy in which the fertilized egg begins to grow in a place other than inside the uterus, usually in the fallopian tubes.

Fetus: A baby growing in the woman's uterus.

Placenta: Tissue that provides nourishment to and takes away waste from the fetus.

Prenatal Care: A program of care for a pregnant woman before the birth of her baby.

Preterm: Before 37 weeks of pregnancy.

Stillbirth: Delivery of a baby that shows no sign of life.

Sudden Infant Death Syndrome (SIDS): The unexpected death of an infant in which the cause is unknown.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

This Patient Education Pamphlet was developed under the direction of the Committee on Patient Education of the American College of Obstetricians and Gynecologists. Designed as an aid to patients, it sets forth current information and opinions on subjects related to women's health. The average readability level of the series, based on the Fry formula, is grade 6–8. The Suitability Assessment of Materials (SAM) instrument rates the pamphlets as "superior." To ensure the information is current and accurate, the pamphlets are reviewed every 18 months. The information in this pamphlet does not dictate an exclusive course of treatment or procedure to be followed and should not be construed as excluding other acceptable methods of practice. Variations taking into account the needs of the individual patient, resources, and limitations unique to the institution or type of practice may be appropriate.

Copyright © June 2008 by the American College of Obstetricians and Gynecologists. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.

ISSN 1074-8601

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