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Alcohol, other drugs and pregnancy
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✽✽Contents
Alcohol, other drugs and pregnancy
Common words used in this booklet............................................. 2 Introduction....................................................................................................... 3 Drugs of concern 3
Drug types and effects...............................................................................4 Planning your pregnancy........................................................................ 5 Women 5 Men 6
Tobacco/nicotine 13 Caffeine 14 Cocaine 14 Amphetamines 15 Ecstasy 16 Khat 16
Depressants.......................................................................................................17
Managing your pregnancy and drug use.................................... 7 Alcohol and other drug use 7 Why be concerned? 8 Common complications from drug use during pregnancy 8 What if you didn’t know you were pregnant? 9 Taking care of yourself during pregnancy 9
Breastfeeding and drug use................................................................10 Alcohol and other drugs in breast milk 10
Withdrawal in the baby...........................................................................11 What you can do............................................................................................ 12
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Stimulants......................................................................................................... 13
Alcohol 17 Cannabis 18 Benzodiazepines 19 GHB 20 Inhalants 20 Heroin 21 Buprenorphine 22 Methadone 22 Naltrexone 23
Hallucinogens................................................................................................. 24 Synthetic drugs.............................................................................................25 Medicines........................................................................................................... 26 Safe sleeping with baby.......................................................................... 26 Alcohol, other drugs, pregnancy and the law........................27
Important
The information provided in this booklet is offered as general information only and should not replace discussion with your doctor or other health professional. If you are pregnant, breastfeeding or planning a pregnancy consult your doctor, midwife or other health professional for information concerning alcohol or other drugs.
Further information.................................................................................27 Websites...............................................................................................................27 Referrals.............................................................................................................. 28
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Common words used in this booklet
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Apnoea
When breathing stops for a short time.
Alcohol
A liquid produced by fermentation. Alcohol is a depressant drug, which means it slows down the message travelling between the brain and the body.
Conceive
To become pregnant.
Complementary medicines
Also known as ‘alternative’ medicines, for example vitamins, minerals, nutritional supplements, and herbal, aromatherapy and homoeopathic products.
Drug
Any substance that brings about physical and/or psychological changes.
Dependent
When a person feels they need a drug to function normally. This can occur after long term or heavy use over time.
Depressant
Drug that depresses the central nervous system to slow down messages to and from the brain.
Fertility
Physical ability to have a baby.
Fetal alcohol spectrum disorder (FASD)
A term used to describe a range of effects that exposure to alcohol during pregnancy can have on the developing fetus or child. These include delayed development and behavioural disorders.
Fetus
The growing baby in the womb of a pregnant woman.
Neonatal abstinence syndrome (NAS)
A syndrome of drug withdrawal observed in newborn babies of mothers physically dependant on drugs.
Passive smoking
Breathing in cigarette smoke from people who are smoking around you.
Placenta
Organ that forms during pregnancy and provides the growing fetus with oxygen and nutrients from the mother’s bloodstream.
Sedative
Drug used to reduce pain and soothe or calm.
Sudden infant death syndrome (SIDS)
The sudden unexpected death of a baby, when there is no apparent cause of death.
Stimulant
Drug that acts on the central nervous system to speed up messages to and from the brain.
Withdrawal
Negative effects experienced by a person who is dependent on a drug when they stop taking it or reduce the amount they use. Withdrawal symptoms are different depending on the type of drug. Withdrawal symptoms may include depression, irritability, cramps, nausea, sweating and sleep problems.
Common words Common used in thisin words used booklet this booklet
Introduction Introduction
Drug types and effects
Planning your pregnancy
Managing your pregnancy and drug use
Breastfeeding and drug use
Withdrawal in the baby
What you can do...
Introduction Pregnancy is a time of great change. If you are pregnant, breastfeeding or thinking about having a baby, it is important to think about the types of drugs you or your partner might be taking as they may affect you or your unborn baby. This booklet offers information on the effects of drug use for women who are planning a pregnancy, already pregnant, or breastfeeding. It also offers some information for men about the effects of drug use on fertility and planning a pregnancy.
Drugs of concern Drugs that are of concern in pregnancy include alcohol, tobacco, cannabis, amphetamines, heroin, new psychoactive substances (synthetic drugs), prescription medications, over-the-counter medications, LSD, and other substances such as glue and aerosols. Alternative and complementary medicines such as herbal preparations and nutritional
Stimulants
Depressants
Hallucinogens
supplements are also of concern. These have become increasingly popular in Australia—however there is limited information available about the effects of these drugs on the unborn baby. The drugs discussed in this booklet are divided into three categories: ❋❋ stimulants ❋❋ depressants, and ❋❋ hallucinogens.
Synthetic drugs
Medicines/ Safe sleeping with baby
Alcohol, other drugs, pregnancy and the law
Futher information/ Websites
Referrals
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Drug types and effects Drug type
Effects on body
Examples
Depressants
Depressants slow down the messages travelling between the brain and the body.
Alcohol, benzodiazepines, cannabis, GHB, heroin
Stimulants
Hallucinogens
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Common words used in this booklet
Introduction
Stimulant drugs speed up the messages travelling between the brain and the body.
Amphetamines, cocaine, caffeine (including energy drinks), tobacco
These drugs often have some of the same effects as depressants and stimulants, causing different levels of depression or stimulation. A specific effect of hallucinogens is to distort perception.
LSD, MDMA (ecstasy), cannabis, NBOMe
Drug types types and effects effects
Planning your Planning your pregnancy pregnancy
Managing your pregnancy and drug use
The effects of a drug on the body will vary depending on: ❋❋ age ❋❋ gender ❋❋ the individual’s state of health ❋❋ how they enter the body: by mouth, by injection, snorted or inhaled, used on the skin, used as suppositories ❋❋ the amount used ❋❋ how often they are used ❋❋ the environment in which they are used. Not all drugs are covered in this booklet. New drugs are becoming available all the time and new information about drugs is regularly discovered through scientific research.
Breastfeeding and drug use
Withdrawal in the baby
What you can do...
Planning your pregnancy The first thing to do if you are planning to become pregnant is to seek expert advice. Your doctor or other health professional can give you information about available health services and your options in pregnancy care. They can also help you to identify and manage any possible problems that may arise for you and your baby based on your personal and family history. If you are taking any medication or other drugs, your doctor or other health professional can tell you about their possible effects on your fertility or on your baby once you become pregnant. Some hospitals and community health centres provide pre-conception care and counselling to help women prepare physically and emotionally for pregnancy and becoming a parent.
Women Some drugs can have an effect on your fertility and can interfere with your baby’s development. There are a few simple steps you can take to improve your health before you become pregnant:
❋❋ If you are taking complementary medicines such as herbal preparations or nutritional supplements, make sure you ask your doctor or other health professional if they are suitable during pregnancy.
❋❋ Eat a well-balanced diet and drink plenty of water.
❋❋ Get plenty of rest and exercise.
❋❋ Quit smoking. ❋❋ Avoid caffeine, alcohol and other drugs. ❋❋ Seek counselling if you need help to reduce or stop using alcohol or other drugs.
Stimulants
Depressants
Hallucinogens
❋❋ Avoid taking medications, including those purchased ‘over the counter’, unless they are specifically recommended by your doctor or health professional when they know you are pregnant or planning a pregnancy.
Synthetic drugs
Medicines/ Safe sleeping with baby
❋❋ Try to avoid stress. ❋❋ Start taking a folic acid supplement when planning your pregnancy, and continue taking it for the first three months of your pregnancy. ❋❋ Consult your doctor or other health professional.
Alcohol, other drugs, pregnancy and the law
Futher information/ Websites
Referrals
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Men It can be as important for men as for women to think about health when planning a pregnancy. You are advised to stop or reduce your smoking and/or alcohol intake before conception. Some medications—including certain medicines available over the counter—are known to reduce sperm count. If you are concerned about drugs that may be in your system, it may be wise to abstain from all drugs for at least three months before you attempt to conceive. However, it is important to speak with you doctor or other health professional before you stop because withdrawal symptoms may occur.
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Common words used in this booklet
Introduction
Drug types and effects
Planning your pregnancy
Managing your Managing pregnancy and your pregnancy anddrug druguse use
The steps for men to improve their health are similar to those provided on page 5 for women; however there is no substitute for specific, professional advice, so inform your doctor or other health professional if you are planning a pregnancy. If either partner is stopping or reducing their use of tobacco, alcohol or other drugs, the other partner can show support by stopping or reducing their own use. It can be difficult to stop or reduce if your partner is continuing to use.
Breastfeeding and drug use
Withdrawal in the baby
What you can do...
Managing your pregnancy and drug use Receiving good pregnancy care and getting help with your drug or alcohol use will help to make sure that you have a safe pregnancy and that your baby will have the best chance of being healthy. If you haven’t already done so, you should consult your doctor or health professional as soon as you think you may be pregnant, or find out you are pregnant. Your doctor or health professional can help you with information about services and discuss your options for pregnancy care. Your choice of pregnancy care provider will depend on where you live, special needs you and your baby may have, and your own preference. It is important that you feel comfortable to discuss your drug use with your pregnancy care providers. It is also important to tell your pregnancy care provider if you:
Stimulants
Depressants
Hallucinogens
❋❋ Are taking any medications, whether prescribed or ‘over-the-counter’. ❋❋ Are taking any complementary medicines such as herbal preparations, homeopathic remedies, or nutritional or other supplements.
Alcohol and other drug use If you are using alcohol or other drugs, your baby will need to be carefully monitored during your pregnancy. Your doctor or midwife can arrange for ultrasound examinations to check the baby’s growth, and other tests to check that the placenta continues to work well.
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❋❋ Smoke cigarettes, even if it is only socially or occasionally. ❋❋ Drink alcohol, even if it is only socially or occasionally. ❋❋ Are taking any other drugs, legal or illegal, even if it is only socially or occasionally. ❋❋ Have concerns about any medications or drugs you are taking, or have been taking. ❋❋ Have had any problems with previous pregnancies.
Synthetic drugs
Medicines/ Safe sleeping with baby
Important
Tell your doctor or health professional if you are taking any medications or herbal supplements, or if you smoke, drink alcohol or use any other drugs.
Alcohol, other drugs, pregnancy and the law
Futher information/ Websites
Referrals
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Why be concerned? Drugs can be harmful to a developing fetus throughout the pregnancy. However the first three months are considered to be the time of highest risk because this is when the baby’s major organs and limbs are forming. All drugs taken during pregnancy will reach the baby through the placenta. However, there can be great variation in babies’ responses to drugs, depending on four factors: 1. Type of drug taken: Different drugs mean different things for your pregnancy and your baby. The baby’s response to a sedative drug such as one of the benzodiazepines will be different to its response to a mild stimulant such as caffeine, or a stronger stimulant drug such as amphetamines.
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Common words used in this booklet
Introduction
Drug types and effects
2. How often the drug is used and the amount taken: Generally, the greater the amount of the drug you take, and the more frequent the use, the greater the effect of the drug on the baby.
Common complications from drug use during pregnancy
3. Whether one or more drugs are used: Combining drugs can increase or alter the effects of the drugs, often in unpredictable ways. Some drugs have a cumulative or combined action, which is more likely to be harmful to the pregnancy and the fetus. For example, using two or more drugs together can increase the risk of significant withdrawal after birth.
Premature labour
4. The individual baby’s response: Each baby will have its own response to different drugs. It is not possible to predict how an individual baby will be affected.
Planning your pregnancy
Managing your Managing pregnancy and your pregnancy anddrug druguse use
Some drugs can cause a baby to be born too small or too soon, or to have withdrawal symptoms, birth defects, or learning and behavioural problems. The risk of premature labour increases if the mother has been using alcohol or other drugs, with babies often arriving more than six weeks early. Babies born prematurely may experience a number of short-term complications including difficulties feeding, lung disease, apnoea, a slowing of the heart rate, difficulty controlling body temperature, and jaundice. Long-term problems may include eye sight or hearing impairment, or learning problems, depending on the gestation at birth.
Small birth size Babies born to mothers who use alcohol or other drugs, including tobacco, may be smaller than the average baby. Babies with low birth weight are at increased risk of illness.
Breastfeeding and drug use
Withdrawal in the baby
What you can do...
Bleeding from the placenta (placental abruption) Bleeding can occur from the placenta in any pregnancy but is more common in women who use tobacco, alcohol and other drugs including ice (crystal methamphetamine) and cocaine. When there is bleeding from the placenta the baby may not get enough oxygen and nutrients causing poor growth, premature birth and possible death. This is very dangerous for the mother and the baby.
If you are dependent on alcohol or other drugs, or regularly use drugs, it is important to get medical support before you reduce or stop. Unsupported withdrawal can be dangerous for you and your baby. Your doctor or drug and alcohol service can work with your pregnancy care provider to assist you to withdraw or reduce your use safely. Medication may be prescribed to ensure you have a safe withdrawal.
What if you didn’t know you were pregnant?
Taking care of yourself during pregnancy
What will happen depends on the drug used, the amount taken, over what time period, how it was taken, at what stage in the pregnancy, and many other factors, such as diet and social circumstances. If you suspect you’re pregnant, whether at an early or advanced stage, consult your doctor or health professional as soon as possible.
Stimulants
Depressants
Hallucinogens
The visits you make to your doctor, midwife, hospital or community health centre while you are pregnant, known as ante-natal visits, are important. Research has shown that the best way to avoid or reduce complications and risks to yourself and the baby is to have good pregnancy care. Women who make ante-natal visits early on during pregnancy, and
Synthetic drugs
Medicines/ Safe sleeping with baby
continue to attend frequently during the pregnancy, generally have healthier pregnancies and babies than women who don’t attend. It is during your pregnancy care appointments that you can discuss with your doctor or other health professional any medications or drugs you might be taking. The information you give them will be treated as confidential, regardless of whether you are discussing legal or illegal drugs. Most importantly, this information will help them to assist you in caring for yourself and your baby during your pregnancy. Talking about your use of alcohol or other drugs can be difficult, especially when you are pregnant. However, drug and alcohol counselling may help you explore personal issues and make positive changes. Pregnancy and planning for your baby is a good motivator to reduce or stop your use of alcohol or other drugs. A drug and alcohol counsellor can provide you with information and advice, and refer you to other support services. Alcohol, other drugs, pregnancy and the law
Futher information/ Websites
Referrals
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Breastfeeding and drug use Breastfeeding is the best method of feeding your baby. It is also good for your health. To safely breastfeed your baby, it is recommended that you seek advice from a health worker to reduce or stop your drug or alcohol use.
Alcohol and other drugs in breast milk Alcohol in the bloodstream passes into breast milk. If you: ❋❋ are using drugs or alcohol, ask your doctor or midwife how you can safely breastfeed. ❋❋ are using drugs or alcohol on a daily basis and are unable to reduce your use, consider formula feeding rather than breastfeeding. ❋❋ are intoxicated, you should not breastfeed. It takes approximately one and a half hours per standard drink for alcohol to pass through a woman’s breast milk. However, this will be
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Common words used in this booklet
Introduction
Drug types and effects
different for each woman depending on a number of factors such as height, weight and percentage of body fat. It is best to avoid drinking alcohol in the first month of breastfeeding. If you do choose to drink after that, it is best to: ❋❋ limit alcohol to no more than two standard drinks a day
Breast milk
❋❋ Is the best fluid and nutrient for your baby. ❋❋ Provides protection for your baby against a range of infections. ❋❋ Reduces your baby’s risk and the severity of allergies such as asthma and eczema. ❋❋ Has health benefits for you and helps your uterus (womb) to return to normal.
❋❋ avoid drinking before breastfeeding ❋❋ express breast milk to keep for the baby before you drink alcohol. Some drugs such as cannabis or anti-depressants remain in your system longer than alcohol, so it is more important that you avoid using these drugs while breastfeeding.
Planning your pregnancy
Managing your pregnancy and drug use
Babies who are not breastfed still thrive. If you are unable to breastfeed or choose not to breastfeed, your midwife or maternal and child health nurse can advise you about feeding your baby with formula.
Breastfeeding Breastfeeding and and drug drug use
Withdrawal Withdrawal inin baby the baby
What you can do...
Withdrawal in the baby Neonatal abstinence syndrome (NAS) is a syndrome of drug withdrawal observed in newborn babies of mothers who are physically dependent on drugs. NAS is more common in babies born to women dependent on opioids (such as heroin or morphine, or prescribed opiates such as MS Contin, methadone or buprenorphine) than in babies born to women dependent on other drugs or alcohol. Symptoms of NAS in babies of opioid-dependent mothers include poor feeding, sleep-wake abnormalities, vomiting, dehydration, poor weight gain and occasionally seizures.
Stimulants
Depressants
Hallucinogens
Babies also experience withdrawal from amphetamines and from benzodiazepines. The symptoms and signs are similar to the withdrawal from opioids. Babies born to women who have used drugs or alcohol in pregnancy will be referred to a paediatrician and observed for about a week after birth to ensure they are settled, feeding well and gaining weight. This requires both mother and baby to stay in hospital longer than usual.
Synthetic drugs
Medicines/ Safe sleeping with baby
Alcohol, other drugs, pregnancy and the law
Futher information/ Websites
Referrals
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What you can do… The information below is of a general nature only. If you are using opiates such as heroin or morphine, or are on a methadone, buprenorphine or naltrexone program, see pages 21, 22 & 23.
Planning a pregnancy? ❋❋ Stop or reduce your use of alcohol and other drugs. ❋❋ Attend pre-pregnancy counselling at your maternity hospital or health service. ❋❋ If you are using medication, inform your doctor or health professional that you are planning a pregnancy.
Pregnant?
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❋❋ Contact your doctor or health professional to discuss your use of alcohol and other drugs before you attempt to stop or reduce your drug use. ❋❋ If you experience withdrawal symptoms, contact your doctor or health professional. ❋❋ Attend for regular pregnancy care as soon as you know that you are pregnant. ❋❋ A drug and alcohol counsellor can provide you with information, advice and referral to other support services, and support to reduce or stop using alcohol and other drugs. Contact details for these are at the end of this booklet.
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Common words used in this booklet
Introduction
Drug types and effects
Planning your pregnancy
Managing your pregnancy and drug use
Breastfeeding and drug use
Withdrawal in the baby
What What you you can can do... do...
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Stimulants
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Stimulant drugs speed up the messages travelling between the brain and the body.
Tobacco/nicotine The harm caused by tobacco smoking during pregnancy has been proven and includes an increased threat of spontaneous miscarriage, premature birth, low birth weight, Sudden infant death syndrome (SIDS) and other longterm health problems. Babies of smokers are also more likely to suffer from asthma and other respiratory infections than babies of non-smokers. Stopping smoking at any point in pregnancy is beneficial and improves the chance of successful birth, as well as being beneficial for the mother’s health. Giving up smoking reduces the risk of SIDS.
Stimulants
Stimulants
Depressants
Hallucinogens
Effects on fertility (women & men) Smoking reduces fertility in both men and women. Studies have shown that smoking makes it more difficult for women to become pregnant. In men, smoking increases the risk of impotence and reduces the quality of semen. Men who smoke have a lower sperm count than non-smokers and their semen contains a higher proportion of malformed sperm.
by exercising some of its chest muscles. Nicotine causes a reduction of these breathing movements. Carbon monoxide replaces oxygen in your blood, so the amount of oxygen made available to your baby through the umbilical cord and placenta is reduced when you smoke. Nicotine gum can be used after the first trimester in pregnancy. Discuss this with your doctor or health professional. Every cigarette you don’t smoke is better for you and your baby.
Effects of use during pregnancy
Important
Tobacco smoking is associated with reduced oxygen supply and blood flow to the fetus. Nicotine increases your heart rate and your baby’s heart rate. It causes your blood vessels to narrow, reducing the flow of blood through the umbilical cord. To prepare for breathing after birth, your unborn baby will be practising
Babies of smokers are at high risk for SIDS, and children are particularly vulnerable to the effects of passive smoking. Nobody should smoke inside or in the car when around babies or children.
Synthetic drugs
Medicines/ Safe sleeping with baby
Alcohol, other drugs, pregnancy and the law
Futher information/ Websites
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Pregnant women who consume high amounts (more than 600 mg per day) of caffeine are at increased risk of miscarriage, difficult birth and delivery of low-weight babies.
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Caffeine crosses the placenta, with caffeine levels in the fetus found to be similar to that of the mother. Some research suggests that babies whose mothers consume large amounts of caffeine while pregnant may experience withdrawal symptoms after birth such as a fast and irregular heartbeat, rapid breathing and tremors.
Caffeine Caffeine is a mild stimulant found in drinks such as coffee, tea, cola and energy drinks and in chocolates and snack bars. It is also available in over-the-counter preparations such as No-Doz®.
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Common words used in this booklet
Introduction
Drug types and effects
Effects on fertility (men & women) Research has shown links between heavy use of caffeine and high blood pressure, severe insomnia and infertility.
Planning your pregnancy
Managing your pregnancy and drug use
Cocaine Cocaine use during pregnancy has been associated with poor growth of the fetus; also with placental abruption, which can lead to excessive bleeding and premature rupture of membranes—a condition in which the membranes that hold the amniotic fluid rupture before labour. Cocaine increases the heart rate in both the mother and baby, reducing the supply of oxygen and blood to the baby. This means that the baby is likely to be small and to grow slowly. Some research indicates that children of mothers who use cocaine during pregnancy may experience long-term mental or physical effects.
Breastfeeding and drug use
Withdrawal in the baby
What you can do...
Effects on fertility
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See ‘Synthetic drugs’ on page 25 to learn about synthetic cocaine.
Amphetamines Amphetamines and methamphetamines (also known as speed or ice) belong to a group of drugs called psychostimulants. Amphetamines stimulate the central nervous system and speed up the messages going to and from the brain and the body. For medical
Stimulants Stimulants
Depressants
Hallucinogens
purposes, amphetamines may be prescribed to treat narcolepsy (uncontrollable urge to sleep) and attention-deficit hyperactivity disorder (ADHD).
Effects on fertility See Effects on fertility under Cocaine.
Effects of use during pregnancy Amphetamines in any form should not be used during pregnancy because they are associated with increased risk to the pregnancy and developing fetus. Using amphetamines in pregnancy may reduce blood flow and oxygen to the fetus from the narrowing of the blood vessels, and increase the risk of miscarriage, premature birth, bleeding from the site of the placenta, reduced growth of the fetus during pregnancy, and stillbirth.
Synthetic drugs
Medicines/ Safe sleeping with baby
Due to the reduced blood flow when amphetamines are used there may be an increased risk of the following abnormalities of the fetus: smaller head size, weight and height; eye problems, delayed motor development, changes to the brain which may cause bleeding, behavioural problems, and poor academic outcomes.
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In the short term, cocaine can result in decreased feelings of hunger, which in the long term can lead to malnutrition and weight loss. Excessive weight loss, emotional stress or overexercising can disrupt production of the female sex hormones and the ovulation cycle and cause amenorrhoea (the absence of menstrual periods).
Important
Most amphetamines are produced in backyard laboratories and sold illegally. They are often mixed with other substances that can have unpleasant, unpredictable or harmful effects.
Alcohol, other drugs, pregnancy and the law
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Ecstasy
Effects of use during pregnancy
Effects on fertility
Ecstasy is a street term for a range of drugs that are similar in structure to MDMA (methylenedioxymethamphetamine).
Like most drugs, ecstasy can cross the placenta and therefore have some effect on the fetus. There is limited research on the specific effects of using ecstasy during pregnancy but some studies show a baby’s development is delayed in general at four months of age. It is possible that ecstasy can also cause miscarriage.
Regular khat chewers experience a number of health problems including sleeping problems, nightmares, impotence, problems with the gastrointestinal tract such as constipation, inflammation of the mouth, mouth cancer, depression, anxiety and irritation. In the short term, these health problems may have an effect on fertility. It is not known whether there are long-term effects of khat use on fertility.
Its structure and effects are similar to amphetamines and (in high doses) to hallucinogens.
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Sometimes other drugs such as PMA, MDA and new synthetic drugs (see page 25) are sold as ecstasy, and the effects of these other substances vary considerably.
Effects on fertility There is limited research on the effects of ecstasy on fertility; however, some of the effects of mild ecstasy use include increased sexual drive and temporary impotence.
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Common words used in this booklet
Introduction
Drug types and effects
Khat The fresh and dried leaves and buds of the khat plant are chewed for their energising and stimulant effects. Some of the immediate effects of chewing khat include increased heart rate, breathing rate, body temperature and blood pressure. People may also feel excited, have more energy, be more talkative and have a decreased appetite.
Planning your pregnancy
Managing your pregnancy and drug use
Effects of use during pregnancy Recent evidence indicates that babies of mothers who chewed khat during pregnancy had a significant decrease in birth weight, length and head circumference in comparison with those of mothers who did not chew khat during pregnancy. Using khat can also affect fetal growth and may induce some chemical changes in the development of fetal organs such as the liver, heart and kidneys.
Breastfeeding and drug use
Withdrawal in the baby
What you can do...
Depressants Depressants slow down the messages travelling between the brain and the body. Although a depressant drug slows down, or depresses, the central nervous system it doesn’t necessarily make you feel depressed. There are two types of depressant drugs: opioids and non-opioids.
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Non-opioids
realised you were pregnant and then stopped drinking, the risk of harm to your baby is small.
Alcohol The Australian alcohol guidelines, which were introduced in in 2009, recommend that not drinking is the safest option during pregnancy. If you are pregnant, or planning to become pregnant: ❋❋ You should consider not drinking at all. ❋❋ You should note that the risk from heavy or binge drinking is highest in the earlier stages of pregnancy, including from the time of conception to the first missed period. If you have had a couple of drinks before you
Stimulants
Depressants Depressants
Hallucinogens
❋❋ Most importantly, you should never become intoxicated, binge drink or drink every day.
Long-term effects of heavy drinking on fertility For women, drinking heavily brings a greater risk of gynaecological problems. Women who are dependent on alcohol often experience menstrual irregularities, failure to ovulate and early menopause. For men, the long-term effects of heavy alcohol use can include impotence, shrinking of the testicles and damaged or reduced sperm production.
Synthetic drugs
Medicines/ Safe sleeping with baby
Effects of use during pregnancy Alcohol can cause problems in pregnancy such as bleeding, miscarriage, stillbirth and premature birth. Alcohol crosses the placenta to the baby. There is evidence to suggest that if a woman drinks two or more standard drinks a day the baby can be affected and grow slowly. For women who are pregnant or planning a pregnancy, not drinking is the safest option.
Fetal alcohol spectrum disorder Fetal alcohol spectrum disorder (FASD) is an umbrella term that describes the range of effects that can occur in a baby or infant whose mother drank alcohol during pregnancy. These effects may include physical, mental, behavioural and/or learning disabilities, with possible lifelong implications.
Alcohol, other drugs, pregnancy and the law
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The umbrella of FASD can include diagnoses such as: ❋❋ Fetal alcohol syndrome (FAS) ❋❋ Alcohol related neurodevelopmental disorders (ARND) ❋❋ Alcohol related birth defects (ARBD) ❋❋ Partial fetal alcohol syndrome (PFAS).
FASD is not a medical diagnosis but it refers to a variety of conditions that can occur in children born to mothers who drank alcohol while pregnant. Each of the FASD conditions is a lifetime disability that affects each child differently.
Fetal alcohol syndrome Heavy drinking during pregnancy can cause FAS. Alcohol can be particularly harmful to the developing baby. Babies with fetal alcohol syndrome may be born with facial defects and neurological difficulties.
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Common words used in this booklet
Introduction
Drug types and effects
Cannabis Cannabis is a depressant that can also have mild hallucinogenic effects.
Effects of regular use on fertility Cannabis can reduce fertility in both men and women, making it difficult to conceive. Men who smoke cannabis regularly are likely to produce less of the male hormone testosterone and have lower sperm counts. Women who smoke cannabis regularly may have impaired ovulation, as cannabis can suppress the hormones that regulate ovulation each month.
Effects of use during pregnancy While in itself cannabis is not associated with major birth abnormalities, prematurity,
Planning your pregnancy
Managing your pregnancy and drug use
miscarriage or birth complications, cannabis use during pregnancy is not recommended as it can lead to some issues for children later on. There is some evidence that children born to mothers who use cannabis during their pregnancy maybe at risk of: ❋❋ development problems ❋❋ trouble sleeping (at 3 years of age) ❋❋ memory problems ❋❋ reduced height (at 6 years of age) ❋❋ increased hyperactivity ❋❋ difficulty concentrating ❋❋ lower attention span. Cannabis is often taken mixed with tobacco, and the harms associated with tobacco in pregnancy are considerable, including an increased risk of SIDS.
Breastfeeding and drug use
Withdrawal in the baby
What you can do...
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Stimulants
There are also no recognised withdrawal symptoms from using cannabis by itself, but if it’s used with tobacco/nicotine there can be significant withdrawal symptoms and it can be more difficult to quit. It is best to seek medical advice if you are using both cannabis and tobacco and would like to stop or reduce use before or during pregnancy.
Benzodiazepines
Effects of use during pregnancy
Benzodiazepines, also known as minor tranquillisers, are depressants. Drugs in this group include: diazepam (Valium®, Ducene®), oxazepam (Serepax®, Murelax®), temazepam (Normison®, Euhypnos®) and clonazepam (Rivotril®).
The health risks of benzodiazepines in pregnancy have not been clearly established. The use of benzodiazepines on their own in pregnancy is not associated with any increase in the risk of abnormalities in your baby.
See ‘Synthetic drugs’ on page 25 to learn about synthetic cannabis.
Not much is known about the effects of benzodiazepines on fertility, but long-term use is not recommended as this may cause drowsiness, lack of motivation, difficulty thinking clearly, memory difficulties, anxiety, irritability and aggression, nausea and headaches, difficulty sleeping, menstrual problems, sexual problems and weight gain.
Depressants Depressants
Hallucinogens
Effects on fertility
Synthetic drugs
Medicines/ Safe sleeping with baby
Benzodiazepines can pass through the placenta to your baby. If you are taking more than a prescribed dose of benzodiazepines, it is possible that your baby will be lethargic and quite floppy when born. This effect will wear off over a day or two. Some babies will experience symptoms of withdrawal over the next several days. These symptoms can include excessive irritability, poor feeding or extreme sleepiness. Withdrawal appears to be a problem if you are taking other drugs in addition to benzodiazepines. Sometimes the withdrawal is severe enough to require medication to settle your baby.
Alcohol, other drugs, pregnancy and the law
Futher information/ Websites
Referrals
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Effects of use during pregnancy
Gamma-hydroxybutyrate (GHB) is a depressant drug. GHB was previously used as a general anaesthetic but was withdrawn from use in most countries, including Australia, due to unwanted side effects.
Little is known about GHB use during pregnancy. However, as is the case with many other legal and illegal drugs, GHB use during pregnancy is not recommended. In general, drug use during pregnancy can increase the risk of premature labour and a low birth weight baby.
Effects on fertility
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GHB
The effects of GHB are similar to alcohol, in that small amounts can cause a lack of inhibition, relaxation, and increased sex drive. However, due to a lack of research, the health and social consequences of long-term use are largely unknown.
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Common words used in this booklet
Introduction
Drug types and effects
Inhalants These are a range of products that produce vapours which, when inhaled, may cause a person to feel intoxicated or ‘high’. Inhalants include the organic solvents present in many domestic and industrial products (such as glue, aerosol, paints, industrial solvents, lacquer thinners, gasoline or petrol, and cleaning fluids) and the aliphatic nitrites such as amyl nitrite.
Planning your pregnancy
Managing your pregnancy and drug use
There are toxic substances in inhalants which are harmful to both you and your baby. It is believed that nearly all inhalants cross the placenta and enter the baby’s bloodstream. For this reason, it is important you stop using inhalants during pregnancy.
Effects on fertility There is limited available evidence on the effects of long-term use of inhalants. Some of the chemicals in inhalants may build up in the body, and some inhalant substances can cause permanent damage, including brain damage. However, adverse effects on fertility have not yet been documented.
Breastfeeding and drug use
Withdrawal in the baby
What you can do...
Effects of use during pregnancy
Opioids
Some of the known effects on the baby are premature birth, breathing problems and an increased risk of infection. The unborn baby may experience periods of reduced oxygen, which can affect brain development. This has the potential to affect a child’s lifelong learning ability.
Opioids, or opiates, are a group of natural and synthetic substances with chemical structures and effects similar to the drug morphine. Heroin, morphine and other prescription opiates are also classified as depressant drugs.
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Effects of use during pregnancy
There is also an increased risk of birth defects, seizures, miscarriage and SIDS. There is evidence that babies whose mothers frequently used toluene (found in paint products and glue) while pregnant are born with defects that are similar to those born to women who drink alcohol heavily.
Heroin Heroin is part of a group of drugs known as opiates. It is a depressant which slows down the activity of the central nervous system. Repeated use of heroin causes physical and psychological dependence.
Using heroin while pregnant can affect fetal development. Heroin use has been associated with an increased risk of miscarriage and premature birth, and babies may be born smaller than average and may be prone to illness. The substances that heroin is ‘cut’ with may also cause problems during the pregnancy and affect the developing fetus. Methadone substitution treatment has been shown to be the safest management for heroin in pregnancy and breastfeeding (refer to the section on page 22).
Effects on fertility The effects of long-term use of heroin may result in menstrual irregularities and poor fertility in women and a loss of sex drive in men.
Stimulants
Depressants Depressants
Hallucinogens
Synthetic drugs
Medicines/ Safe sleeping with baby
Alcohol, other drugs, pregnancy and the law
Futher information/ Websites
Referrals
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Effects of use during pregnancy
Brand names of this drug include Subutex® and Suboxone®. Buprenorphine is used to suppress withdrawal symptoms when stopping opiate use such as heroin or methadone.
Buprenorphine appears safe to use in pregnancy. Babies born to mothers dependent on buprenorphine can experience withdrawal symptoms following birth although this is not related to the amount of buprenorphine they are on.
Effects on fertility Buprenorphine, like other opiates, may reduce the desire to have sex and women may experience irregular periods; however it does not appear to have any effect on fertility.
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Common words used in this booklet
Introduction
Drug types and effects
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Buprenorphine
Before prescribing buprenorphine in pregnancy, your prescriber should discuss what is known and what is not known about buprenorphine and your treatment options. This provides you with the opportunity to give ‘informed consent’. If you use buprenorphine during pregnancy your health provider will need to increase the dose if you experience withdrawal symptoms. This happens as the pregnancy progresses because of the increased volume of fluid in your body, the increased work by your kidneys and the increase in metabolic rate.
Planning your pregnancy
Managing your pregnancy and drug use
Methadone Methadone is commonly used to suppress withdrawal symptoms when stopping use of opiates such as heroin.
Effects on fertility Methadone can reduce the desire to have sex, and for men it can affect the ability to obtain and maintain an erection. There is currently no evidence to indicate that methadone affects fertility in women, although women may experience changes such as reduced or absent menstrual periods.
Effects of use during pregnancy Methadone maintenance treatment (MMT) is the safest management option for heroin or other opiate use in pregnancy. Most babies born exposed to methadone experience some withdrawal symptoms and medication is required in around
Breastfeeding and drug use
Withdrawal in the baby
What you can do...
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60% of babies to help the baby stay comfortable. Whether your baby withdraws or not is NOT related to the dose of methadone you are on. During pregnancy your midwife will prepare you to help your baby with withdrawal after birth. If you stop using opiates suddenly you could miscarry or go into premature labour, so it’s important to take your prescribed dose of methadone every day. Opiates such as oxycodone may be prescribed for chronic pain. When used in pregnancy, babies may experience withdrawal symptoms similar to those exposed to other opiates. Discuss pain management in pregnancy with your doctor or health professional.
Stimulants
Depressants Depressants
Hallucinogens
Naltrexone Naltrexone (brand name Revia®) is usually prescribed to help treat alcohol and opioid dependence.
Effects on fertility There is currently no evidence to suggest that naltrexone affects fertility in women or men. However, there is a small chance that some men may experience delayed ejaculation and sexual problems.
Effects of use during pregnancy Naltrexone use in pregnancy is not advised and alternative treatment should be discussed with your doctor.
Synthetic drugs
Medicines/ Safe sleeping with baby
Alcohol, other drugs, pregnancy and the law
Futher information/ Websites
Referrals
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Hallucinogens These drugs often have some of the same effects as the other two categories of drugs, causing different levels of depression or stimulation. A specific function of hallucinogens is to distort perception. Cannabis and ecstasy taken in large amounts can produce hallucinogenic effects. Common hallucinogens include:
Effects of use on pregnancy
❋❋ LSD (lysergic acid diethylamide)
Although the effects from using hallucinogens during pregnancy have not been clearly shown, use is not recommended as they may be harmful to the baby. Pregnant women who use LSD may have an increased risk of miscarriage or birth complications. There may also be a higher incidence of birth defects among babies born to women using LSD.
❋❋ ketamine ❋❋ magic mushrooms (psilocybin) ❋❋ mescaline (peyote cactus) ❋❋ PCP (phencyclidine) ❋❋ Datura ❋❋ NBOMe (N-methoxybenzyl).
Effects of use on fertility It is not known whether there are any long-term effects of hallucinogen use on fertility.
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Common words used in this booklet
Introduction
Drug types and effects
See ‘Synthetic drugs’ on page 25 to learn about new hallucinogens.
Planning your pregnancy
Managing your pregnancy and drug use
Breastfeeding and drug use
Withdrawal in the baby
What you can do...
Synthetic drugs Synthetic drugs is a general term for substances that are designed to produce similar effects to illegal drugs such as cannabis, cocaine, ecstasy and LSD. They are also known as new psychoactive substances, legal highs, herbal highs, party pills, bath salts, plant fertilisers, herbal incense, aphrodisiac teas, social tonics and research chemicals. These products can sometimes be marked ‘not for human consumption’. They may also be found in some ecstasy pills. Manufacturers of these drugs use new chemicals to replace those that
Stimulants
Depressants
Hallucinogens Hallucinogens
Synthetic Synthetic drugs
Medicines/ Safe sleeping with baby
are banned. They are constantly changing the chemical structure of the drugs to try to stay ahead of the law. The effects of these drugs are therefore more unpredictable and potentially more serious than common illicit drugs. It is difficult to know the potential risks of taking synthetic drugs during pregnancy because the risks will vary depending on the chemical structure of the drug.
Alcohol, other drugs, pregnancy and the law
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Medicines There is limited information about the use of over-the-counter and complementary medicines during pregnancy and breastfeeding. Before using any over-the-counter or complementary medicines during pregnancy it is best to talk with your doctor or other health professional. Some medications can affect the fetus at any stage of the pregnancy. Of most concern are medicines that are taken within the first three months of pregnancy, due to possible interference with the baby’s organ development.
Therefore, it is best to discuss with your doctor, pharmacist or other health professional any medications that you are taking or intend to take.
Safe sleeping with baby It is recommended that people never sleep in the same bed or on the couch with their baby as this significantly increases the risk of SIDS. If you use any medications, drugs or alcohol which affect your state of alertness, and sleep with your baby, the risk of SIDS increases
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Common words used in this booklet
Introduction
Drug types and effects
Planning your pregnancy
Managing your pregnancy and drug use
around 90 times compared to babies who are sleeping in their own cot. Refer to SIDS guidelines: www.sidsandkids.org/safe-sleeping
Breastfeeding and drug use
Withdrawal in the baby
What you can do...
Alcohol, other drugs, pregnancy and the law All states and territories have specific legislation on child protection. Although drug and alcohol use may not warrant a report or notification to child protection, child protection can be a consideration in all dependent drug and alcohol interventions for pregnant women when there is thought to be a risk of harm or neglect to the fetus or newborn.
Further information Australian Drug Foundation (ADF) How drugs affect you series (regularly updated), Melbourne: ADF. Available at shop.adf.org.au Better Health Channel Birth defects—drugs and medications. Retrieved from betterhealth.vic.gov. au/bhcv2/bhcarticles.nsf/pages/ Birth_defects_and_drugs Better Health Channel Premature babies. Retrieved from betterhealth.vic.gov.au/bhcv2/ bhcarticles.nsf/pages/Premature_ babies Better Health Channel Conceiving a baby. Retrieved from betterhealth.vic.gov.au/bhcv2/ bhcarticles.nsf/pages/Conceiving _a_baby
Stimulants
Depressants
Hallucinogens
Australian Drug Foundation Druginfo. Pregnancy and alcohol. Retrieved from druginfo.adf.org.au/ fact-sheets/pregnancy-and-alcoholweb-fact-sheet National Health and Medical Research Council Australian guidelines to reduce health risks from drinking alcohol. Retrieved from nhmrc.gov.au/guidelines/ publications/ds10 The Royal Women’s Hospital Pregnancy, drugs & alcohol. Retrieved from thewomens.org.au/healthinformation/pregnancy-and-birth/ pregnancy-drugs-alcohol
Synthetic drugs
Medicines/ Medicines/ Safe sleeping sleeping Safe with baby baby with
Websites
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❋❋ Australian Drug Foundation DrugInfo: druginfo.adf.org.au
❋❋ Pregnancy, Birth & Beyond: pregnancy.com.au ❋❋ Women’s Alcohol & Drug Service (The Royal Women’s Hospital): thewomens.org.au/patientsvisitors/clinics-and-services/ pregnancy-birth/womensalcohol-drug-service ❋❋ Quitnow: quitnow.gov.au
Alcohol, other other Alcohol, drugs, pregnancy pregnancy drugs, and the the law and law
Futher Futher information/ information/ Websites Websites
Referrals
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Referrals ACT
Alcohol & Drug Information Service
(02) 6207 9977: 24-hour counselling, information & referral
NSW
Alcohol & Drug Information Service
(02) 9361 8000. Regional: 1800 422 599
NT
Alcohol & Drug Information Service
1800 131 350: 24-hour counselling, information & referral
QLD
Alcohol & Drug Information Service
1800 177 833: 24-hour counselling, information & referral
SA
Alcohol & Drug Information Service
1300 131 340: 24-hour counselling, information & referral
TAS
Alcohol & Drug Information Service
1800 811 994: 24-hour counselling, information & referral
WA
Alcohol & Drug Information Service
(08) 9442 5000: 24-hour counselling & referral. Regional: 1800 198 024
VIC
• Australian Drug Foundation DrugInfo • DirectLine • Women’s Alcohol & Drug Service, The Royal Women’s Hospital • Reconnexion (tranquilliser dependency)
1300 85 85 84: information 1800 888 236: counselling & referral (03) 8345 3931
Quitline
13 7848
National
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Common words used in this booklet
Introduction
Drug types and effects
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Planning your pregnancy
Managing your pregnancy and drug use
Breastfeeding and drug use
Withdrawal in the baby
What you can do...
Published by
Level 12, 607 Bourke Street, Melbourne VIC 3001 PO Box 818, North Melbourne VIC 3051 Telephone (03) 9611 6100 Fax (03) 8672 5983 Website www.adf.org.au 3rd ed. © Australian Drug Foundation 2014 ISBN 9780858090856 All rights reserved. Except for the purposes of study or review, as provided for in the Copyright Act of Australia 1968 and subsequent amendments, no part of this publication may be reproduced, stored in a retrieval system or transmitted in any form by any means whatsoever, without the prior written permission of the copyright owner. Apply in writing to the publishers. Text and research by the Australian Drug Foundation and the Women’s Alcohol & Drug Service, The Royal Women’s Hospital Design and illustrations by Linda McLaughlan Printed in Melbourne by L&R Print Services Acknowledgements The Australian Drug Foundation would like to acknowledge the work of Ms Debra Holmes, TRANX (Tranquilliser Recovery and New Existence) and colleagues, whose earlier booklet Alcohol, other drugs and pregnancy (1998) provided the inspiration for the development of the current booklet.
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Alcohol, other drugs, pregnancy and the law
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