I read with interest the recent article in Tidsskriftet no 4/2005 by Lægreid et al discussing the use of alcohol in pregnancy and its possible fetal implications (1). The authors are to be congratulated on this thought-provoking and timely publication discussing the growing problem of alcohol consumption during pregnancy.
More than 30 % of women of childbearing age in the United States smoke cigarettes, andmore than 15 million Americans are addicted to alcohol, with women accounting for approximately 25 % of this number (2). Five million Americans are regular users of cocaine, 6,000 use the drug for the first time each day, and more than 30 million have tried cocaine at least once. Approximately 250,000 women in the United States meet the criteria for intravenous drug abuse, and nearly 90 % of these women are of childbearing age (2). In the United States alone, nearly one million people, of whom 70 % are young adults, abuse inhalants, which are by far the most easily obtainable substances for illicit use (3). Marijuana remains the most commonly used illicit drug among women of childbearing age (4), and it has been estimated that it is used by 10 – 27 % of parturients. Polysubstance abuse in pregnancy is very common.
Psychological personality characteristics seem to predispose to, rather than result from drug addiction. Most often drug abuse is first suspected or diagnosed during medical management of another condition, such as hepatitis, HIV-infection or pregnancy. Most parturients with a history of drug abuse deny it when interviewed preoperatively by primary care physicians, obstetricians or obstetric anesthesiologists. A high index of suspicion for drug abuse in pregnancy, combined with non-judgmental questioning of every parturient is therefore necessary (2). The «risk factors», which are often overlooked, suggesting substance abuse in pregnancy include lack of prenatal care, and history of premature labor with low neonatal birth weight. The diverse clinical manifestations of substance use combined with physiologic changes of pregnancy and pathophysiology of coexisting pregnancy-related disease might lead to life-threatening complications and significantly impact the pregnancy outcome and neonatal well-being.
There is little doubt that substance abuse, including during pregnancy, has crossed social, economic, and geographic borders and remains one of the major problems facing society today – worldwide.