Health risks of substance use during pregnancy

The use of psychoactive substances during pregnancy can lead to maternal complications, fetal malformations, growth retardation, and neurocognitive disorders, as well as an increased risk of addiction in adulthood. Pregnancy is a time when screening for substance use and its management can be most effective, ideally starting before conception.

Range of psychoactive substances

Substances consumed during pregnancy include tobacco, alcohol, and illicit drugs such as cannabis, opioids, cocaine, crack, amphetamines, and MDMA. While many women stop using these substances early in pregnancy, others may not be fully aware of the risks to their unborn child, requiring medical intervention and education.

Alcohol's impact on fetal development

Alcohol crosses the placental barrier and can cause teratogenic effects, impacting organogenesis and neurological development. There is no known safe level of alcohol consumption during pregnancy, and even occasional use increases the risk of miscarriage, fetal death, and growth retardation. Heavy use in the first trimester can lead to fetal alcohol syndrome, which includes physical and neurological impairments.

Alcohol use by both parents

Studies on animals and human cohorts suggest that alcohol consumption by the father before conception can affect the child's physical development and cognitive abilities. In South Africa, research indicates that excessive paternal alcohol use before pregnancy can reduce the child's size, head circumference, and verbal IQ, independent of the mother's consumption.

Tobacco's harmful effects

Tobacco is a leading cause of obstetrical complications such as miscarriage, preterm birth, and intrauterine growth retardation. Children exposed to tobacco in the womb face higher risks of respiratory diseases, neurodevelopmental issues, and metabolic disorders later in life. Passive smoking also poses similar risks, highlighting the need for screening and support for quitting.

Recommendations for quitting tobacco

Experts recommend peer support and health education to help pregnant women quit smoking. Nicotine replacement therapies can be considered for those who need medical assistance to stop smoking, according to guidelines from the SFT-CNGOF published in 2020.

Cannabis use during pregnancy

Cannabis is the most commonly used illicit drug in the general population, with 1 to 3% of pregnant women in France using it. While no direct teratogenic effects have been proven, THC can cross the placenta and affect the child's neurological development, leading to cognitive and behavioral issues that may persist into adulthood.

Managing cannabis use in pregnant women

Cannabis use is often underreported and must be actively identified, especially in cases of intrauterine growth restriction. Understanding the reasons behind its use, such as for anxiety or sleep, is crucial for providing appropriate support, including relaxation techniques or medical treatment where appropriate. Postpartum follow-up is essential to prevent relapse and support women during this vulnerable period.