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What's All the Hype?
By: Colleen Meade
The effect of substance abuse on growing fetuses has been avidly researched in recent years. The birth of the Thalidomide babies in the early 1960 awakened the world to the fact that drugs ingested by the mother can severely impact the development of the growing baby. Thalidomide was widely prescribed to relieve morning sickness in pregnant women. It was the use of Thalidomide that affected "nearly 12,000 infants in 46 countries" and caused defective "limbs, eyes, ears, genitals, and internal organs" (Bethune, 2001). The birth of these children soon became known as "history's greatest medical disaster" (Bethune, 2001).
To study the effects of substance abuse, or misuse, during pregnancy, one must determine exactly what substances will be included. While much uproar has formulated around the use of illegal drugs during pregnancy, one cannot eliminate the effects of legal drugs such as, nicotine, alcohol, caffeine, and over-the-counter and prescription medications. Additionally, in order to determine the long-term effects of substance abuse on children, one must include the study of other environmental issues. The development of children impacted by maternal substance use does "not stem from prenatal exposure alone, but rather are the result of a constellation of biological, psychosocial, and environmental circumstances" (Poulsen, 1999). While the child has most likely incurred damage due to the intake of substances by the mother, the proper support and assistance will help to further the development of the child to maximize his abilities within the limitations of his condition.
This paper seeks to describe the possible effects of substance abuse in gestation, the environmental effects from typical substance-abusive households, and the implications in the field of education. It also seeks to outline curricular adaptations, which can be made to appropriately educate children affected by these issues.
While the specific effects of substances taken during pregnancy are unclear, much recent research has shed light on a number of physical and cognitive abnormalities mainly found in connection with exposure to substances in utero. The most commonly researched substances are: alcohol, cigarettes, cocaine (in various forms), and heroin. The fact that there is more information available about the effects of these substances does not mean that they are the only substances that will cause damage to a fetus.
Alcohol is a "teratogenic substance" which, in connection with pregnancy, causes a fetus to be born with a condition termed, Fetal Alcohol Syndrome (FAS) (Hess, 1998). Due to the commonalities between signs and symptoms of children affected by FAS, this has received a tremendous amount of attention by researchers because it is more easily detectable than the effects of other drugs on the fetus. Currently, alcohol abuse during pregnancy hails as "the third leading cause of birth defects...and one of the leading causes of mental retardation" (Butcher, Carson, & Mineka, 2000).
Diagnosis of FAS in children is made after "three major clinical manifestations are seen in the patient: prenatal and/or postnatal growth deficiency, a specific pattern of facial anomalies, and indications of Central Nervous System dysfunction" (Hess, 1998). The physical signs of FAS are as follows: "short palpebral fissures, flat midface, indistinct philtrum, thin upper lip, epicanthal folds, low nasal bridge, minor ear anomalies, micrognathia strabismus, ptosis of the upper eyelid, narrow receding forehead, and a short upturned nose" (Hess, 1998). These physical deficiencies make it difficult to overlook the damage from alcohol on children displaying these characteristics. While the physical effects of FAS are quite recognizable, it is more difficult to ascertain whether a child has sustained any of the cognitive effects. It is believed that many children with FAS might also display "hyperactivity, fine and gross motor developmental delays or incoordination, impaired language development, impulsivity, problems with memory, poor judgment, learning problems, distractibility, seizures, and structural abnormalities of the brain or indications of deficient brain growth" (Hess, 1998).
Because there are over 2500 chemicals found in a single cigarette, it is difficult to analyze the effects of each specific chemical and easier to analyze the effects of cigarettes in general on a growing fetus. However, researchers have established that "the majority of the adverse effects are attributable to two main ingredients; nicotine and carbon monoxide"
One reason for concern regarding the effects of cigarette smoking on pregnancy is that "it is estimated that over 22 million women in this country smoke, and among women of reproductive age, almost one-third are smokers"
Smoking during pregnancy causes a variety of problems including: "low birthweight, fetal, neonatal, & perinatal mortality; Sudden Infant Death Syndrome; and spontaneous abortion" (available: http://domino.ama.com.au/AMAWeb/health.nsf). One reason for low birthweight is the belief that infants "do not fully develop" (available: http://domino.ama.com.au/AMAWeb/health.nsf). It is believed that the problems associated with smoking during pregnancy might affect children later in life.
Cocaine and Crack (the freebase form of Cocaine) use in the United States has increased in recent years (Askin, 2001). "In 1997, the National Household Survey on Drug Abuse estimated that 1.5 million Americans were using cocaine and 2.6 million were considered occasional users" (Askin, 2001). While the long-term effects of Cocaine exposure in utero have not been conclusively established, many researchers agree that children who were exposed to Cocaine in utero most likely sustained some degree of damage. The difficulty researchers find with labeling specific problems associated with Cocaine use during pregnancy is the fact that many women abuse more than one drug (polydrug use) thereby making it difficult to isolate the affects of Cocaine (Kandall, 1999). However, "brain, kidney, and urogenital system malformations in neonates are strongly associated with maternal cocaine intake; gastroschisis is one other fetal anomaly that may be related to cocaine use" (Askin, 2001).
Many infants whose mother's used Cocaine while pregnant are born addicted to Cocaine. The withdrawal symptoms exhibited by cocaine-addicted infants include: "irritability, tremulousness, course tremors, feeding difficulties, tachypnea, diarrhea, vomiting, high-pitched crying, and seizures (D'Apolito, 2001). One reason that the unborn child easily becomes affected by Cocaine use by the mother is because "cocaine easily and rapidly crosses the placenta, and is not significantly metabolized during maternal-fetal transfer" (Askin, 2001). While evidence exposing long-term effects of cocaine exposure in utero remains inconclusive, some research does suggest that these children will have "difficulty with self-regulation and impulse-control" (Askin, 2001).
Heroin is classified as an opiate drug. When discussing heroin use during pregnancy, one must also study methadone use during pregnancy. Methadone is a drug given to heroin addicted individuals to alleviate the severe withdrawal symptoms experienced when these individuals stop using heroin. Infants born addicted to heroin and methadone typically exhibit presence of neonatal opiate abstinence syndrome (NOAS). This syndrome is "characterized by dysfunction of the central nervous system, autonomic nervous system, gastrointestinal tract, and respiratory system" (Kandall, 1999). The specific symptoms of NOAS include: irritability, tremulousness, hypertonia, excessive crying, voracious appetite, exaggerated sucking drive, abnormal coordination between sucking and swallowing, regurgitation, pulmonary aspiration, and abstinence associated seizures (Kandall, 1999). The quantity and severity of the symptoms varies, therefore, the treatment of NOAS must be tailored to specific situation. Some treatments include providing the drug for the child to wean him off the drug without causing severe health problems.
As is the case with cocaine, conclusive data relating to long-term effects of prenatal exposure to heroin and methadone is inconclusive. Barry Zuckerman et al reported that "a preliminary study of school performance of older heroin-exposed children...as many as 40 percent required special educational classes, and 25 percent needed to repeat one or more grades" (Zuckerman, Frank, & Brown, 1999). However, it can not be determined whether or not this low performance is a result of early exposure to heroine, or environmental factors.
Although alcohol, cigarettes, cocaine, and heroin were discussed specifically, one must realize that many drugs may affect the development of a fetus. Because of the fact that concrete evidence is difficult to find, many frustrated doctors feel that they "can't give patients definitive information because it's not there" (The Toronto Star, 2000). Additionally, there are many drugs that are ingested regularly, which are so ingrained in society, that they are viewed as harmless. For example, caffeine is a drug that is "widely practiced and socially promoted in contemporary society...problems can occur as a result of excessive caffeine intake" (Butcher, Carson, & Mineka, 2000).
It is virtually impossible to discuss the long-term effects of substance abuse in gestation on child development without also discussing the environmental factors contributing to the development of children. These factors include: nutrition, familial conditions (substance abuse, child abuse, etc.), socioeconomic status, and issues related to general healthcare. It seems that the higher the socioeconomic status, the better opportunity a family has for good healthcare and nutrition. Additionally, "empirical studies and clinical experience show that addiction or substance abuse interferes with parenting and contributes to developmental, behavioral, and health problems" (Zuckerman, Frank, & Brown, 1999).
While exposure to drugs and alcohol in the womb might cause damage to the developing fetus, environmental factors might further damage the development of the child, leading to secondary disabilities. Secondary disabilities include: "mental health problems; inappropriate sexual behavior; disrupted school experience; trouble with the law; confinement through incarceration for a crime or inpatient treatment for mental health, or alcohol and drug abuse problems" (Hess, 1998). The "chaotic lifestyle of the addicted mother" tends to lend itself to a home environment containing neglect and poor parental influences. Often times, a woman who abuses drugs during pregnancy will abuse drugs after the birth of the child. "Drug and alcohol abuse by any member of the family can lead to chronic instability, disharmony, and possible violence such that a child's psychosocial, developmental, behavioral, and learning competencies can become seriously compromised" (Poulsen, 1994). Additionally, "substance-using mothers have been found to have less prenatal care (and) were more likely to be hospitalized as a result of violence" (Askin, 2001).
Other common factors among the homes of drug-abusing parents are a lack of adequate health care and good nutrition. Studies have shown that "women who use cocaine during pregnancy were more likely to use other drugs, consume alcohol or smoke, had a lower socioeconmic standard, were more likely to be malnourished" (Askin, 2001). The poor parental care found in many drug-abusive homes leads to neglect of the children, which retards their natural development. "The multiple risk factors in the lifestyle of drug-abusing pregnant women appear to be major factors in the poor growth reported both prenatally and postnatally" (Zuckerman, Frank, & Brown, 1999).