Drug Use by Selected Population Groups - Pregnant Women And Unborn Children

Drug use during pregnancy places both mother and infant at risk for serious health problems. A child may become addicted to heroin in its mother's womb—provided the child is born at all (fetal death is a possibility). Cocaine use by the pregnant mother carries similar risks to the fetus and may kill the mother too. LSD use may lead to birth defects. PCP users may have smaller-than-normal babies who later turn out to have poor muscle control. Learning disabilities are associated with children born to pregnant women using cocaine, Ketamine, and Ecstasy. Smoking marijuana may prevent an embryo from attaching to the uterine wall and halt pregnancies. Pregnant women who smoke tobacco and drink alcohol further handicap their unborn child in its development.

The National Institute of Drug Abuse (NIDA) conducted its first national survey of drug use during pregnancy in 1992 by interviewing 2,613 women all over the United States ("NIDA Survey Provides First National Data on Drug Use During Pregnancy," NIDA Notes, January/February 1995, http://www.drugabuse.gov/NIDA_Notes/NNVol10N1/NIDASurvey.html). Data projected from this national sample suggested that 221,000 women in 1992 used illegal drugs while pregnant. Of these women, 119,000 had used marijuana and 45,000 had taken cocaine. Substantially larger numbers smoked at some point during their pregnancy (820,000); some 757,000 drank alcohol. Regarding racial/ethnic categories, the NIDA survey found as follows:

Overall, 11.3% of African-American women, 4.4% of white women, and 4.5% of Hispanic women used illicit drugs while pregnant. While African Americans had higher rates of drug use, in terms of actual number of users, most women who took drugs while they were pregnant were white. The survey found that an estimated 113,000 white women, 75,000 African-American women, and 28,000 Hispanic women used illicit drugs during pregnancy.

NIDA's survey was a one-time study not repeated since, but the Substance Abuse and Mental Health Services Administration (SAMHSA) has been collecting similar data annually in its National Survey on Drug Use and Health (formerly called the National Household Survey on Drug Abuse). The latest survey available, 2003 National Survey on Drug Use and Health (NSDUH), was published in September of 2004 (http://www.oas.samhsa.gov/nhsda/2k3nsduh/2k3ResultsW.pdf). Among other things, the survey determines the drug use of pregnant women within the last thirty days of the actual survey date; the data are thus somewhat narrower in definition than those used in the 1992 NIDA study. Data for 1994-2001 are presented in Figure 4.1. The graphic shows that 62,000 pregnant women (2.3% of all pregnant women) had taken some kind of illegal drug in the 1994-95 period (the data are two-year averages). Over time, SAMHSA's observations show a variable rate of drug use by pregnant women, but with a definite upward trend, so that in the 2002-03 time frame 105,000 pregnant women were using drugs, or 4.3% of all pregnant women. (See Table 4.1 and Table 4.2.)

Data for drug use during the 2002-03 period are shown in Table 4.3 for all women, subdivided into total, pregnant, and not pregnant categories by demographic characteristics. The data are for women ranging in age from fifteen to forty-four. Pregnant women in this group are much less likely to be using drugs than women who are not pregnant (4.3% versus 10.4% of those not pregnant). That gap is smallest in the fifteen-to-seventeen age group: 12.8% of those pregnant are involved with drugs versus 16.5% of those who are not pregnant: pregnancy, in this age FIGURE 4.1
Pregnant women using any illicit drug in the last 30 days, 1994-2001
SOURCE: Adapted from "Substance Use among Pregnant Women during 1999 and 2000," in National Household Survey on Drug Abuse (NHSDA), Substance Abuse and Mental Health Services Administration (SAMHSA), May 2002, and "Illicit Drug Use," 2001 NHSDA, SAMHSA, 2003 group, may be the consequence of the same behavioral patterns that lead to drug use. In fact, for the 2000-01 period, according to SAMHSA's report from that year, a higher percentage of pregnant fifteen-to-seventeen-year-olds used drugs than of their nonpregnant peers.

Drug use among pregnant women is highest in the youngest group and decreases with age. Based on averages from SAMHSA's 2002 and 2003 surveys, 12.8% of pregnant women aged fifteen to seventeen had recently used some kind of illegal drug. In the 2002-03 period pregnant African-American women had the highest rates of illicit drug use at 8.0%, compared to 4.4% and 3.0% for whites and Hispanics, respectively. Survey numbers were too imprecise to permit estimates for other races.

Drug use among pregnant women is highest in the first trimester (7.7%) and drops thereafter. Still, an estimated 18,000 women were taking drugs in the third trimester of pregnancy (2.3%).

Marijuana was by far the drug most used by pregnant women on drugs. (See Table 4.1 and Table 4.2.) The next most-used category was psychotherapeutic drugs taken without medical supervision. Within that category, use of pain relievers lead in frequency. The National Institutes of Health has

TABLE 4.1
Annual average drug use by women, by pregnancy status 2002–03
[Numbers in thousands]
SOURCE: "Table 7.62A. Illicit Drug Use in the Past Month among Females Aged 15 to 44, by Pregnancy Status: Numbers in Thousands, Annual Averages Based on 2002 and 2003 NSDUHs," in Index for 2003 NSDUH: Detailed Tables, U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies, 2004, http://www.oas.samhsa.gov/nhsda/2k3tabs/PDFindex.htm (accessed February 11, 2005)

		Pregnancy status
Drug	Totala	Pregnant	Not pregnant
Any illicit drugb	6,300	105	6,152
Marijuana and hashish	4,575	86	4,452
Cocaine	601	8	587
Crack	116	1	115
Heroin	34	1	32
Hallucinogens	354	6	344
LSD	35	0	35
PCP	15	2	14
Ecstasy	223	4	217
Inhalants	131	1	130
Nonmedical use of any psychotherapeuticc	2,329	30	2,285
Pain relievers	1,630	21	1,596
Tranquilizers	692	5	684
Stimulants	492	7	483
Methamphetamine	207	1	205
Sedatives	124	2	123
Any illicit drug other than marijuanab	2,961	35	2,907
aEstimates in the total column are for all females aged 15 to 44, including those with unknown pregnancy status.
bAny illicit drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic used nonmedically. Any illicit drug other than marijuana includes cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic used nonmedically. c Nonmedical use of any prescription-type pain reliever, tranquilizer, stimulant, or sedative; does not include over-the-counter drugs.

shown that marijuana use can terminate pregnancies in some cases; marijuana use also leads to low birth weight in babies. In the 2002-03 period, eight thousand pregnant women used cocaine and, of those, one thousand smoked crack. SAMHSA reported one thousand pregnant heroin users, but reporting of heroin use is, according to SAMHSA, least reliable because the survey respondents often withhold such information. Six thousand pregnant women reported using hallucinogens (four thousand of those using Ecstasy) and one thousand said that they had used methamphetamine.

Babies of women who are using cocaine, heroin, hallucinogenics, and methamphetamines are most at risk for major health problems. The Center for the Evaluation of Risks to Human Reproduction, an element of the National Institutes of Health, reports that cocaine use can cause miscarriage or trigger premature labor ("Cocaine Use During Pregnancy" http://cerhr.niehs.nih.gov/genpub/topics/drugs-ccae.html). The

TABLE 4.2
Annual average drug use by pregnant females, 2002-03
[Numbers are percentages]
SOURCE: "Table 7.62B. Illicit Drug Use in the Past Month among Females Aged 15 to 44, by Pregnancy Status: Percentages, Annual Averages Based on 2002 and 2003 NSDUHs," in Index for 2003 NSDUH: Detailed Tables, U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies, 2004, http://www.oas.samhsa.gov/nhsda/2k3tabs/PDFindex.htm (accessed February 11, 2005)

		Pregnancy status
Drug	Totala	Pregnant	Not pregnant
Any illicit drugb	10.2	4.3	10.4
Marijuana and hashish	7.4	3.5	7.6
Cocaine	1.0	0.3	1.0
Crack	0.2	0.0	0.2
Heroin	0.1	0.0	0.1
Hallucinogens	0.6	0.3	0.6
LSD	0.1	0.0	0.1
PCP	0.0	0.1	0.0
Ecstasy	0.4	0.1	0.4
Inhalants	0.2	0.0	0.2
Nonmedical use of any psychotherapeuticc	3.8	1.2	3.9
Pain relievers	2.6	0.9	2.7
Tranquilizers	1.1	0.2	1.2
Stimulants	0.8	0.3	0.8
Methamphetamine	0.3	0.0	0.3
Sedatives	0.2	0.1	0.2
Any illicit drug other than marijuanab	4.8	1.4	4.9
aEstimates in the total column are for all females aged 15 to 44, including those with unknown pregnancy status.
bAny illicit drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic used nonmedically. Any illicit drug other than marijuana includes cocaine (including crack), heroin, hallucinogens, inhalants, or any prescription-type psychotherapeutic used nonmedically. c Nonmedical use of any prescription-type pain reliever, tranquilizer, stimulant, or sedative; does not include over-the-counter drugs.

unborn baby may die or have a stroke or suffer irreversible brain damage. Low birth weight is the consequence of blocked flow of oxygen and nutrients to the fetus; babies may have smaller heads and brains. Birth defects are more likely. Mothers who use cocaine early in the pregnancy, for instance, are five times as likely to give birth to babies with malformed urinary tracts than mothers who do not use the drug.