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- Lauren M. Jansson, MD*
- Martha L. Velez, MD*
- *Department of Pediatrics, The Center for Addiction and Pregnancy, The Johns Hopkins University School of Medicine, Baltimore, MD.
Author Disclosure
Drs Jansson and Velez have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
Objectives
After completing this article, readers should be able to:
Recognize the effects of maternal substance use on the developing fetus, neonate, and growing child.
Describe the effect of maternal substance use on the mother-infant dyad.
Discuss the factors that may serve as mediators and moderators of the effects of maternal substance use on the child.
Understand the complex context within which the substance-abusing mother and her infant must be considered.
Evaluate and manage the substance-exposed dyad.
Introduction
In utero substance exposure continues to pose a public health and societal dilemma. Prenatal exposure to legal and illegal substances is a substantial and preventable risk factor for developmental alterations in infants. Intrauterine substance exposure affects more newborns than many other common major medical conditions, making the problem of the substance-exposed infant an inevitable concern for all pediatricians. Of the 4.3 million infants born annually in the United States, between 800,000 and 1 million are born to women who used drugs during pregnancy; approximately 1 in 9 infants is exposed to alcohol, 1 in 5 is exposed to nicotine, and 1 in 20 is exposed to illegal drugs. Opioid use during pregnancy is a growing concern due to the rise in abuse of prescription opioids (eg, hydrocodone, oxycodone) in women of childbearing age.
Currently, 5.4 million children live with a parent who has a substance use disorder, and 3.4 million live with a mother who has a substance use disorder in the United States. (1) Resumption of drug use following childbirth is an additional concern; in a recent report, cigarette, alcohol, binge alcohol, and marijuana use rates were higher in women with a child …
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