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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

While many national and statewide efforts have focused their attention on addressing the opioid crisis, the prevalence of prenatal stimulant use remains a growing and underrecognized epidemic in the U.S.

After alcohol, cannabis is the most common psychoactive substance used during pregnancy and its rate is increasing. This trend in cannabis use may be due to the increasing legality for medicinal or recreational purposes and the social acceptability that comes with it.

In addition, many people wrongly assume that cannabis is relatively safe and helps manage pregnancy-related conditions such as morning sickness, nausea, vomiting, weight gain and sleep difficulty.

However, a growing body of research, including our own, has shown that prenatal cannabis exposure is associated with adverse pregnancy outcomes, including low birth weight, preterm birth, stillbirth or hypertensive disorders of pregnancy.

In addition, using multiple substances during pregnancy poses a higher risk to infants than using a single substance. We found that compared to no substance exposure during pregnancy, the risk of low birth weight was twice with opioids alone, four times with concurrent exposure to opioids and stimulants, and almost six times with concurrent exposure to opioids, stimulants and cannabis.

Another adverse outcome that is associated with prenatal substance exposure, primarily to opioids, is a set of withdrawal symptoms experienced by the newborn known as neonatal abstinence syndrome. Symptoms include irritability, feeding difficulties, tremors and respiratory issues. The syndrome requires specialized care and attention in neonatal units and a prolonged stay in the hospital.

Alongside the rising prevalence of opioid use in pregnancy, a fivefold increase in incidence of infants with this condition has been documented over the past two decades. The highest rate has been observed in West Virginia, at 53 per 1,000 births. Other states with high rates include Maine, Vermont, Delaware and Kentucky, which are between three and four times the national average of 7.3 per 1,000 births.

Research on long-term outcomes of infants exposed to substances in the womb is still evolving. Limited studies have shown an association between neonatal abstinence syndrome and long-term neurodevelopmental consequences that may develop as early as 6 months old and persist into adolescence. These include delays in learning and language skills, physical growth and motor skills, as well as difficulty in regulating behavior and emotions.

However, research on the long-term effects of prenatal alcohol exposure is well established. A broad range of deficits are referred to as fetal alcohol spectrum disorders. These include growth deficiency, developmental delay, craniofacial malformations, intellectual disabilities, behavior issues and emotional well-being. A recent study of first graders in the U.S. estimated that the prevalence of fetal alcohol spectrum disorders range from 1% to 5%, which means up to 1 in 20 school-age children may have this disorder.


With the changing landscape of substance use in the U.S., more research is needed to understand and establish the association between the various emerging types and forms of substance exposures and their lasting effects. But the findings are difficult to discern because of the influence of other environmental factors, preexisting medical conditions and social determinants of health.

As a maternal and child health epidemiologist, I am fortunate to be part of the Project WATCH team that works closely with health care providers and policymakers.

As high-risk infants are identified through this program, its referral system notifies pediatricians of substance exposure and connects these families to early intervention services and home visitation programs.

These services include developmental testing, interventions appropriate to the child’s needs and case management during the first few years of life. The data also informs state-level strategies and initiatives to address the substance use crisis for this vulnerable population.

This article is republished from The Conversation, a nonprofit, independent news organization bringing you facts and trustworthy analysis to help you make sense of our complex world. It was written by: Amna Umer, West Virginia University

Read more:
Increases in opioid overdoses in Pennsylvania varied by county during the COVID-19 pandemic

Mounting research points to health harms from cannabis, THC and CBD use during pregnancy, adolescence and other periods of rapid development

Dozens of US adolescents are dying from drug overdoses every month − an expert on substance use unpacks the grim numbers with 3 charts

Project WATCH is a grant funded by the West Virginia Department of Health.


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