1

Behavioral

Most drug dependent mothers fail to care for their health and are as such susceptible to

health problems that affect the morbidity and mortality of their newborns at birth. Obstetrical

complications have been found in connection with heroin addiction. These complications include

abortion, intrauterine growth, retardation, placental insufficiency, polyglycolic and pulmonary

hemorrhage. Factors contributing to this failure to take care of their health may include financial

difficulty, lack of health insurance, lack of education, unemployment, home issues, poor diet,

and the difficult lifestyle of the addicts such as being a heavy smoker and various illegal

activities/ crimes carried out to get money.

The two articles used for the research studied mostly methamphetamine (MA) as the drug

of use because methamphetamine is a worldwide problem with more users than cocaine and

opiates combined. MA users comprise mostly of women as first time users, as a result there is

increasing concern about the effect of prenatal use on women and newborns. According to the

Substance Abuse and Mental Health administration; in 2009, 6.7% of those seeking treatment of

MA abuse in the United States were pregnant women.3

Though the research on cocaine addicted pregnant women is illuminating because both

MA and cocaine are sympathomimetic agents, nevertheless MA’s Neurotoxicity outcome may

have a larger adverse effect than cocaine due to its longer half-life and multiplied effect4, MA

has vasoconstrictive effects, resulting in decreased uteroplacental blood flow and fetal hypoxia.5

Infants born to drug addicted mothers have been found to have high incidence of neonatal

abstinence syndrome (NAS).

 2

Neonatal

NAS is a group of problems that occur in babies exposed to addictive illegal or

prescription drugs, such as MA, it is characterized by neurologic excitability, for example;

tremors, irritability, and high pitched crying, gastrointestinal dysfunction such as poor feeding,

poor weight gain, diarrhea, dysfunction and anatomic signs of increased sweating, mottling and

temperature instability. 6

The onset of the withdrawal symptoms can range anywhere from minutes to two weeks

after birth and can last for six days to eight weeks. However, symptoms or irritability may

continue for more than three months7, Wilson et al8 described a phase of substance withdrawal

upon transfer from the hospital to the home environment that consisted mainly of hyperphagic

and hyperacusis.

Toddlers

According to Linda. L.L. Lagrasse et al.9 Their study found that developmental changes

in children exposed to MA at more externalizing ages as well as ADHD problems at 5 years but

not at 3 years however internalizing behaviors and syndrome scores for withdrawal behavior and

somatic complaints were found to increase from 3 years to 5 which may be unrelated to MA

because it is consistent with normal development trajectories10 but both ages are characterized by

higher emotional reactivity and anxiety and depression problems than compared age groups.

Toddlers of Opiate-Addicted mothers have been found to be highly energetic, talkative,

and easily distracted with brief attention spans. Their goal directedness have been found to be

brief.11 It has been suggested by some studies that these toddlers may have immature object

manipulation, especially with regard to fine motor skills, cognitive, speech and perceptual

disturbances and sleep disturbances. These characteristics may put these children at high risk for
 3

child abuse because their mothers may become frustrated with what they perceive as negative

attributes.

Preschool

According to Bauman and Levine11, the children of methadone maintained mothers have

increased incidences of adverse behaviors such as yelling, whining, and physical abuse of their

children in comparison to children of non-addicted mothers. These attributes may be due to drug

addicted mothers’ tendency to yell, command and disapproval of their children. Ramon et al also

suggested that these children showed lower intelligence quotient scores than children of non-

addicted mothers based on the Stanford-Binet intelligence scale. This may be due to the children

not receiving adequate intellectual stimulation at home because the mothers themselves may

have low average intelligence scores. Furthermore, these children may have lower levels of

learning and adapting to new situations at home. Bauman and Levine suggested that there may

be an intergenerational cycle of addiction.

 4

References

1. Finnegan P. Effects of maternal opiate abuse on the newborn. Symposium, Drug Toxicity in

the Newborn, April 5, 1984.

2. United National Office on Drugs and Crime. World Drug Report, Analysis. Vol. 1. Vienna,

Austria: United Nations Publication; 2004

3. Substance Abuse and Mental Health Services Administration. Treatment Episode Data Set

(TEDS). 1999 - 2009. National Admissions to Substance Abuse Treatment Services,

DASIS Series: S-56, HHS Publication No. (SMA) 11-4646. Rockville, MD: Substance

Abuse and Mental Health Services Administration; 2011

4. Mayes LC. A behavioral teratogenic model of the impact of prenatal cocaine exposure on

arousal regulatory systems. Neurotoxicol Teratol. 2002;24(3):385–395pmid:12009493

5. Stek AM, Fisher BK, Baker RS, Lang U, Tseng CY, Clark KE. Maternal and fetal

cardiovascular responses to methamphetamine in the pregnant sheep. Am J Obstet

Gynecol. 1993;169(4):888–897pmid:8238145

6. Finnegan LP, Kaltenbach K. Neonatal abstinence syndrome. In: Hoekelman RA, Friedman

SB, Nelson NM, Weitzman ML, Wilson MH, editors. Primary Pediatric Care. 2. Mosby;

St Louis: 1992. pp. 1367–78

7. Hutchings DE. Methadone and heroin during pregnancy: a review of behavioral effects in

human and animal offspring. Neurobehav Toxicol Teratol. 1982 Jul-Aug;4(4):429–434.

[PubMed]

8. Wilson GS, Desmond MM, Verniaud WM. Early development of infants of heroin-addicted

mothers. Am J Dis Child. 1973 Oct;126(4):457–462.

 5

9. Bongers IL, Koot HM, van der Ende J, Verhulst FC. The normative development of child and

adolescent problem behavior. J Abnorm Psychol. 2003;112(2):179–192pmid:12784827

10. LaGasse, L. L., Derauf, C., Smith, L. M., Newman, E., Shah, R., Neal, C., & ... Lester, B. M.

(2012). Prenatal Methamphetamine Exposure and Childhood Behavior Problems at 3 and

5 Years of Age. Pediatrics, 129(4), 681-688. doi:10.1542/peds.2011-2209

11. Bauman PS, Levine SA. The development of children of drug addicts. Int J Addict. 1986

Aug;21(8):849–863