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Substance Abuse During Pregnancy:
Studies Cite the Effects of Tobacco and Methamphetamines
by Sharon K. Eskam, M.D., F.A.C.O.G

The use of tobacco and methamphetamines in Wyoming are well above national averages. Even pregnant women are part of these statistics: one in 5, or 20% of pregnant women, in Wyoming uses tobacco during pregnancy. This is nearly double the national average. More than 4% of young Wyoming adults, ages 18-25, use methamphetamines. As a state, we can no longer afford to ignore these issues.

Some steps have been made to decrease smoking in Wyoming, but generally few people realize the dangers that smoking and other substance use impose upon pregnancy. While patients may understand that smoking is unhealthy, most aren’t aware of the real danger to the fetus and the effect smoking can have on physical and mental deformities.

In the largest study of its kind, plastic surgeons have found that smoking during pregnancy significantly elevates the risk of having a child with excess, webbed or missing fingers and toes.

The January 2006 issue of Plastic and Reconstructive Surgery states, “Women who smoked one to 10 cigarettes per day increased the risk of having a child with a toe or finger deformity by 29 percent. The more a woman smoked, the higher the risk became.  Women who smoked 11 to 20 cigarettes a day raised the risk 38 percent, and women who smoked 21 or more cigarettes per day raised the risk 78 percent.”

Other studies demonstrate the teratogenic effects of maternal smoking:

• Prenatal exposure to tobacco smoke in otherwise healthy babies is linked with significant changes in brain physiology associated with basic perceptual skills that could place the infant at risk for later developmental problems. These children have lower verbal scores and poorer performance on specific language and auditory tests.
• Continuing to smoke during pregnancy leads to compounded, reduced growth of the fetal head. The longer a woman smoked during pregnancy, the smaller the head circumference of her infant.
• There is an in utero imprinting on the brain of children whose mothers smoked during pregnancy making them more predisposed to addictive smoking behaviors. Astoundingly, studies indicate that children of mothers who stopped smoking just during their pregnancies were just as unlikely to smoke as children of mothers who NEVER smoked.

Another problem impacting Wyoming pregnancies is methamphetamine use. Many young women who use methamphetamines are unaware of the dramatic and long term dangerous effects upon themselves and their families. 

According to the U.S. Department of Health, young adults aged 18 to 25 were the most likely to use methamphetamines in the past year.  For adults aged 18 to 25, Wyoming has the highest meth use rate in the nation at 4.6 percent. Arkansas (4.4%), Minnesota (3.8%) and Nevada (3.8%) followed while methamphetamine use was the lowest among young adults in New York (0.3%), Connecticut (0.4%), and Vermont (0.4%). In children ages 13-17, Wyoming ranked second per capita in use.

Studies on methamphetamine abuse during pregnancy indicate:

• Prenatal methamphetamine use is associated with fetal growth restriction.
• Neural circuit alterations to the developing brain may result from exposure to methamphetamine and that may underlie functional defects.
• Children exposed to meth prenatally exhibit smaller subcortical volumes and associated neurocognitive deficits. These preliminary findings suggest prenatal meth exposure may be neurotoxic to the developing brain.

As with educating patients about any risk factor during pregnancy, providers must make sure that mothers are aware of the life-long impact their behavior has on their unborn child. Not only are the prenatal risks severe, but children of meth users have shown visual motor, verbal memory, attention, and long-term special memory deficits compared to children of non-users.