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Hundreds of thousands of US infants every year pay the consequences of prenatal exposure to drugs, a growing crisis particularly in rural America

Amna Umer, West Virginia University, The Conversation on

Published in News & Features

Nearly 1 in 12 newborns in the United States in 2020 – or about 300,000 infants – were exposed to alcohol, opioids, marijuana or cocaine before they were born. Exposure to these substances puts these newborns at a higher risk for premature birth, low birth weight and a variety of physical and mental disabilities.

These substances can have direct and indirect consequences on fetal development. By crossing the placental barrier directly, they can cause abnormal development. And by affecting the mother’s organs, they can reduce blood flow to the placenta and damage the health of the growing fetus.

Considerable sociodemographic and geographic disparities exist in the U.S. regarding the rates of prenatal substance exposure. This includes in West Virginia, where I live, a rural Appalachian state struggling with extraordinary rates of substance use and an opioid crisis.

As an epidemiologist, I study the relationship between substance use during pregnancy and infant health outcomes. I am a member of the Project WATCH team, which is a long-standing, state-mandated surveillance and referral system in West Virginia funded by the West Virginia Department of Health. The surveillance system expanded in 2020 to include substance exposure data from all births in the state.

Our research work showed that between 2020 and 2022, prenatal substance exposure in West Virginia was nearly 50% higher, at 124 per 1,000 births, than the national rate of 80 per 1,000 births. This means that nearly 1 in 8 infants born in the state had exposure to substances during pregnancy.

We found that the rate of prenatal cannabis exposure in West Virginia was 80 per 1,000 births, similar to the national rate. However, the rates of opioid exposure, 44 per 1,000 births, and stimulant exposure, 21 per 1,000 births, during pregnancy were nearly 10 times higher than national rates. Additionally, 1 in 5 women in the study smoked, and 64% of the infants exposed to substances were also exposed to smoking during pregnancy.


There are many reasons why the numbers in West Virginia are staggering. Economic challenges, including poverty, low education and limited job opportunities, contribute to chronic stress, a known risk factor for substance use. Moreover, nearly half the population lives in rural areas with a limited number of hospitals and clinics. The geographic isolation limits access to health care and substance use treatment services. Finally, stigma and judgment within close-knit rural communities may discourage these mothers from seeking help.

Our earlier work demonstrated that alcohol consumption during pregnancy was associated with preterm birth, which is when a baby is born before the 37th week of pregnancy, and low birth weight, defined as babies born weighing less than 5 pounds, 8 ounces (2,500 grams).

Our more recent study has shown that prenatal opioid exposure is also associated with low birth weight, while stimulant exposure was associated with preterm birth.

Stimulants include cocaine, methamphetamines, ecstasy and prescription stimulants such as those used for the treatment of attention-deficit/hyperactivity disorder. Illicit or misuse of prescription stimulants have increased among pregnant women over the past decade.


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