However, The addition of clonidine may reduce the duration of drug treatment needed in full-term infants. However,clonidine should not be given to preterm infants because of the risk of bradycardia. If clonidine is used, blood pressure should be monitored as the clonidine dose is tapered because there can be rebound hypertension. Prenatal exposure to amphetamines has lasting subtle effects on neonatal brain structure and function. Some studies have shown decreased volume of the caudate, putamen, and globus pallidus (anatomic components of brain) in methamphetamine-exposed children, whereas other studies have not uniformly confirmed these findings (1). A fetus that has been exposed to illicit drugs in utero can become dependent on the drug during gestation.

What causes FASD?

People with FASD, their families and carers, say a diagnosis for FASD is critical to better understand their unique strengths and limitations. Learn more about the assessment and diagnostic process for FASD in Australia including why an accurate diagnosis is important. Fetal Alcohol Spectrum Disorder (FASD) is the most common, preventable, non-genetic cause of developmental disability in Australia. Learn more here about the development and quality assurance of healthdirect content. To learn more about strategies that can lead to better results for children with FASD, visit the National Organisation for Fetal Alcohol Spectrum Disorders’ (NOFASD) website. Diagnosing FASD early is important in helping your child reach their full potential.

• Parents might learn different routines and rules that can help their child adapt to different situations.
• You might need to take a drug screening as well to help verify a diagnosis for your baby.
• FASD is often not recognised until school age, when difficulties with learning, attention, memory, and social interactions become more noticeable.
• Fetal alcohol syndrome is the most severe condition within a group of conditions called fetal alcohol spectrum disorders (FASDs).
• And other disorders, such as ADHD (attention-deficit/hyperactivity disorder) and Williams syndrome, have some symptoms like FAS.

Intrapartum Care

Unlike withdrawal from other opioids, which typically presents within 24 to 48 hours after birth, fentanyl-related withdrawal can be delayed due to its lipophilic properties and accumulation in fetal tissues. Symptoms generally emerge between 24 hours and several days postpartum, depending on the duration and dosage of maternal fentanyl use. Exposed children also exhibit signs of neuropsychiatric disorders and may be more susceptible to substance abuse (for review, see Jutras-Aswad et al (2009)). For example, children from the MHPCD cohort presented with signs of depression as early as 10 years of age (Gray et al, 2005). Moreover, decreased levels of D2 receptor transcript were found in the NAc of exposed fetuses, potentially linking susceptibility to drug use to prenatal marijuana exposure (DiNieri et al, 2011). Prenatally exposed children were also more likely to experiment with marijuana at an earlier age as well as smoke the drug more frequently (Day et al, 2006; Goldschmidt et al, 2012).

Understanding Fetal Alcohol Spectrum Disorders

The Yanai lab has provided substantial evidence to suggest that the deficits in spatial learning and memory may be tied to hippocampal cholinergic alterations. They found increased hippocampal levels of a cholinergic receptor (muscarinic M1 receptor) and the choline transporter with perinatal heroin (Steingart et al, 2000a; Steingart et al, 2000b). In addition, they observed altered levels and activity of protein kinase C—a signaling protein downstream of the M1 receptor- and enhanced inositol phosphate induction by cholinergic agonists (Steingart et al, 2000a; Steingart et al, 2000b; Yaniv et al, 2004).

And without an adequate supply of folic acid, infants have a significantly increased risk of developing major birth injuries. Genetic factors like defects in the detoxification of phenytoin arene oxide, complex interactions between multiple antiepileptic drugs, maternal age and period of gestation have also been implicated in contributing to phenytoin teratogenicity 10. Maternal exposure to secondhand drug addiction smoke (SHS) is also highly detrimental to proper fetal development and can cause long-term neurobehavioral alterations on its own (Chen et al, 2013). In addition, nicotine replacement therapies (ie, lozenges, patches, gum, etc.) are prescribed more and more to reduce fetal exposure to the additional compounds found in cigarette smoke (Coleman, 2008). Along those same lines, electronic cigarettes (e-cigarettes) have become increasingly popular as they eliminate SHS by delivering nicotine as an inhalable vapor. These devices should be used with caution, as they expose not only the user, but also passerby to aerosolized nicotine (Czogala et al, 2013).

Sidebar: A Personal Story – Raising a Child With ARND

• Environmental controls that benefit opioid-exposed neonates include low-stimulation environments, e.g., minimal noise, dim lights, and the use of white noise.
• This could possibly be because of time period of treatment—embryonic versus postnatal—or doses (once again, please see Figure 1 for a description of human and animal development timelines).

Although induced withdrawal may possibly contribute to fetal stress, naloxone should be used in pregnant women in the case of maternal overdose in order to save the woman’s life. In most situations, pregnant women initiate methadone induction in a licensed outpatient opioid treatment program. Some obstetric services initiate opioid agonist therapy with methadone or buprenorphine in an inpatient setting. Although this may allow closer monitoring of medication response, it is not always necessary or available. In cases when a pregnant woman initiates methadone treatment as an inpatient, an arrangement should be made before discharge for next-day admission to an opioid treatment program so that there are no missed days. Patients started on buprenorphine as an inpatient may receive a prescription until their appointment with a licensed buprenorphine prescriber.

The symptoms of fetal alcohol syndrome vary from child to child but are lifelong. Infants with prenatal opioid exposure are at risk for premature birth, lower birth weight, and a smaller head circumference (44–46). These likely result from the influence of maternal opioid/drug use on placental function and nutritional transport, which in turn may lead to fetal growth restriction (47). These neonates often experience postnatal growth issues, fetal drug syndrome symptoms believed to result from a withdrawal-induced hypermetabolic state, feeding difficulties, and/or gastrointestinal disturbances (48, 49). Between 1999 and 2014, the number of pregnant women with opioid use disorder (OUD) increased from 1.5 to 6.5 cases per 1,000 hospital births (1). This led to a steep increase in the number of neonates with Neonatal Abstinence Syndrome (NAS) from 1.2 to 8.0 per 1,000 hospital births, with some areas reaching 20.0 per 1,000 hospital births (2, 3).

Testing the neonatal hair for drugs has difficulties due to a small amount of drug in the hair and a slow rate of growth. Using alcohol while you are pregnant can cause another set of problems for your baby, which is called fetal alcohol spectrum disorder. Some neonates may show withdrawal symptoms if the mother used cocaine shortly before delivery, but symptoms are less common and less severe than for opioid withdrawal, and signs and treatment are the same. Neonatal abstinence syndrome (NAS) is a condition that affects your newborn when they have exposure to opioid drugs or other addictive substances while in your womb.

Early diagnosis and services can help improve your child’s ability to function. Prenatal alcohol exposure is a leading preventable cause of birth defects and neurodevelopmental disorders in the United States. Women who need help to stop drinking alcohol can talk to their health care provider about treatment options. There are a variety of treatments available for pregnant women, including behavioral treatment and mutual-support groups. Visit the NIAAA Alcohol Treatment Navigator® to learn more about evidence-based treatments for alcohol-related problems.

There is no amount of alcohol that’s known to be safe to drink during pregnancy. If you drink during pregnancy, you place your baby at risk of fetal alcohol syndrome. Some babies, especially those with more severe withdrawal signs, may need medications, such as liquid oral morphine or liquid oral methadone, in addition to the other care strategies listed above that do not include the use of medicines.

Early identification can maximize help in the treatment of FASD and in building supportive networks with other individuals and families impacted by FASD. This may be due, in part, to a lack of information about prenatal alcohol exposure or difficulty in distinguishing FASD from other developmental disorders that might have similar cognitive or behavioral symptoms. The most significant effect of prenatal opiate exposure is neonatal abstinence syndrome. There have been documented effects on fetal growth (but not on long-term growth) and infant neurobehavior as well as long-term effects on behavior. There is not a consensus as to the effects of prenatal opiate exposure on cognition, and few data are available regarding language and achievement.