Substance abuse and parenthood: biological mechanisms--bioethical challenges

This review catalogues the long-term health effects of parental recreational drug abuse on the fetus and the subsequent well-being of the child. It is hard to conceive that parents would knowingly harm the health of their children, yet toxic effects resulting from ignorance, addiction or any of a number of socioeconomic factors are still responsible for handicapping countless potentially healthy offspring. The negative effects of female recreational drug and alcohol abuse during pregnancy are well documented, but exposure prior to conception and male-mediated effects are less well publicized. Abnormalities in the sperm are prevalent among men who consume recreational drugs, and birth defects are more often linked with paternal than with maternal DNA damage. This review is divided into three parts. Part I describes the biology and potential mechanisms of adverse alterations in reproductive potential, Part II explores the socioeconomic determinants of substance use, and raises the question of poverty. Drug-induced disability is not evenly distributed among the population as there are ethnic and socioeconomic disparities of infant mortality, childhood morbidity and reproductive dysfunction. Part III describes the author's conclusion that fundamental social change is needed to protect future children without threatening parents' basic freedom, and real change requires new beliefs and prioritics that must evolve from the ground up. An ecological model of care concentrating on health issues is described. Such an ecological model of care is in tune with the fundamental principles of bioscience ethics and emphasises that high quality education, health and good preconceptional/prenatal care are essentials in the search for greater equity in standard of living across a population.