Effects of External Factors on Neonatal Development: Depression, Drug Abuse, and Smoking

Introduction

Women with a history of drug abuse, especially opioid abuse, have exponentially increased in the last couple of years. Drugs like cocaine, opioids, marijuana, and methamphetamine harm fetal development and maternal health. Avoiding drug abuse during pregnancy to have a healthy baby is always advised.

Smoking consists of tobacco products containing nicotine, an addictive drug found in tobacco. Nicotine is unsafe to use during pregnancy. It poses a danger to the developing fetus and pregnant women. It can also damage the brain and lungs of the developing fetus. Depression in mothers has been noted to have consequences on the development of the fetus.

What Effects Do Maternal Drug Abuse Have On Neonatal Development?

• Study shows that the use of drugs during pregnancy has a direct impact on the development of the fetus. Opioid abuse during pregnancy can lead to severe health outcomes for the developing fetus and the pregnant mother. Some conditions like stillbirth (death of a baby before or during delivery), maternal mortality (death of mother due to complications from pregnancy or delivery), neonatal abstinence syndrome, and preterm birth. Neonatal abstinence syndrome is a withdrawal symptom that usually occurs in newborns after exposure to opioids during pregnancy.

• Cocaine abuse is associated with seizures, respiratory failure, heart attacks, and strokes. There are chances of passing these health issues from the mother on to the unborn baby. The use of drugs can also cause behavioral problems in early childhood and affect the child's attentiveness and memory. They are stated to have structural changes in the brain that persist into early adolescence. Babies born to mothers who used cocaine tend to have deficits in areas of the brain affecting information processing, cognitive performance (mental processes like attention span, memory, reaction time, and problem-solving ability), and attention to tasks.; These are the areas that are vital for success in life and school.

What Are the Signs of Depression?

The signs of depression vary differently among each individual. However, some of the most commonly seen signs are:

• Changes in the sleep pattern; either sleeping too much or having trouble sleeping.

• Appetite changes like loss of appetite or overeating.

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• Lack of energy or fatigue.

• Feelings of hopelessness, worthlessness, and great sadness.

• Disinterested in things that were enjoyable previously.

• Crying for no reason.

How Does Depression in Mothers Affect Neonatal Development?

Depression in mothers is considered to affect children's cognitive and socio-emotional development. Depression in pregnant women is associated with higher preterm birth, preeclampsia (high blood pressure disorder during pregnancy), inadequate prenatal care, spontaneous abortion, low birth weight, poor nutrition, dangerous risk-taking behavior, and substance abuse.

What Effects Does Smoking Have On Neonatal Development?

In tobacco smoke, there are more than 6000 chemicals, hundreds of which are toxic, like hydrogen cyanide, polycyclic aromatic hydrocarbons, and ammonia. The significant components of tobacco smoke, including nicotine and carbon monoxide, have been documented to have neurotoxic effects on the fetus. The nicotine and carbon dioxide easily cross the placental membrane during pregnancy into fetal circulation, exceeding the maternal circulating level by more than 15 %. In contrast, the nicotine levels in the amniotic fluid exceed the maternal plasma levels by 88 %.

Some studies demonstrate that carbon dioxide and nicotine initiate pathological mechanisms that disrupt the fetus's uterine artery blood flow and oxygenation. Nutritional transfer to the fetus and oxygen restriction underlays significant associations between preterm birth, low birth weight, and maternal smoking.

The effects smoking has on neonatal development include:

• Smoking is one of the major causes of preterm births and is associated with 5 % to 8 % of premature births (births that occur less than 37 weeks of gestation) yearly.

• Sudden infant death syndrome (SIDS) is associated with smoking during and after pregnancy.

• Pregnant women who smoke are also more likely to have placenta previa (a problem when the placenta partially or wholly covers the cervix), premature rupture of membranes, placental abruption (placenta dissociates from the inner uterine wall before birth) and fetal loss.

• Smoking is also linked with congenital anomalies of the face like cleft palate or cleft lip and mouth. It is also associated with defects in the gastrointestinal tract, limb, and cardiac region (heart defects, including septal defects). Smoking also increases the risk of low birth weight.

• Multiple health risks in a smoke-exposed fetus include reactive airway disease, bronchiolitis, respiratory infection, hyperactivity, decreased academic performance, obesity, and short stature.

• Even sudden unexpected deaths in infants have been attributed to maternal smoking.

What Are the Interventions to Treat Drug Abuse in Pregnancy?

• Pregnancy is considered a window of opportunity for the intervention of drug treatment.

• Behavioral therapy and counseling are used to intervene in drug abuse.

• Unsupportive interpersonal relationships, inadequate training in medical providers, low self-esteem, biased attitudes, and fear of disciplinary or legal consequences lead to pregnant women with drug abuse avoiding treatment or dropping out of the treatment. To decrease these barriers, the doctor must evaluate appropriately, increase awareness and training, and advocate and take strong stands as supporters to assist the patient in deriving their highest benefit from substance abuse treatment.

How Can Depression Be Managed During Pregnancy?

• Physicians who monitor mothers should have adequate knowledge and skills to detect any symptoms of depression in pregnant women.

• Once any depression is suspected in pregnant women, the consulting doctor can discuss and make appropriate referrals to psychiatric services.

• Any antidepressant drugs, if given, should balance the safety of the fetus and the mother's well-being.

• Antidepressant therapy should be contemplated in pregnant women who have moderate-to-severe depression symptoms and who did not show any response to nonpharmacological treatments.

• Individual therapy, family therapy, and social support also help treat depression.

What Interventions Can Be Done for Smoking Cessation?

• Individual Behavioral Counseling - Individual Behavioral counseling is the most recommended intervention for smoking cessation.

• Nicotine Replacement Therapy - Nicotine replacement therapy (NRT) is another intervention that can be done for smoking cessation. It provides nicotine systematically without any intake of cigarette smoke to reduce withdrawal symptoms and cravings with the end goal of smoking cessation. Nicotine replacement therapy is available in different forms like nasal spray, transdermal patches, gum, lozenges, and inhaler. NRT is usually taken on a needed basis for cravings. However, there is no sufficient evidence to confirm the safety and efficacy of NRT in pregnancy. Therefore, doctors provide NRT only under close supervision and when the end goal is total smoking cessation.

Conclusion

Depression, smoking cessation, and drug abuse during pregnancy negatively affect the fetus's development. Therefore, in case of any history of drug abuse, smoking, or depression, it is always recommended to seek help before getting pregnant to avoid the consequences to both mother and child.