Abuse of alcohol, drugs and tobacco during pregnancy--consequences for the child.

There is an increasing awareness that alcohol and drug abuse and smoking are not only harmful for the consumer but will also, when taken by a pregnant woman, adversely affect her unborn child. The consequence of the abuse will result from a combination of specific toxic effects of abusing substances and a nonspecific effect from the often very unstable environment of an alcohol- or drug-dependent mother. Poor prenatal care is a common finding in alcohol and drug abuse leading to a high incidence of complications during pregnancy and delivery including premature labor and small-for-gestational-age babies. An increased perinatal mortality has been reported following all types of abuse including tobacco use, probably as a consequence of poor prenatal care as well as of a toxic effect on the fetus. Withdrawal symptoms after birth are most prominent in opiate addiction. The already intrauterinely damaged child will if it stays with its parents often continue to be exposed to several abverse environmental factors. However, symptoms such as mental retardation following alcohol abuse and hyperactivity and emotional disturbances following drug exposure during intrauterine life have also been found in children who have been taken from the parents and placed in foster homes immediately after birth. This means that children of abusing parents both in their custody and in foster home will have to be regarded as risk children that should be subjected to careful medical and psychological follow-up.