Obstetrical issues in substance abuse

Substance abuse complicates between 10% and 25% of pregnancies, and has been associated with increased perinatal morbidity and mortality. The mechanisms of action of certain drugs predispose to specific types of complications, but the explanations for obstetrical effects of other drugs are more obscure. It is often difficult to differentiate the effects of drugs from the socioeconomic issues surrounding the drug abuser. There is no doubt, however, that the infants of pregnant drug abusers suffer from increased risks of low birthweight, preterm delivery, possible teratogenic effects, fetal dependence and withdrawal, and possible neurobehavioral effects. Health-care providers must encourage these patients to seek prenatal care early and to continue care throughout pregnancy. With a coordinated system for antenatal monitoring and support, these risks hopefully can be decreased and the perinatal outcome improved.