USE OF MDMA (ECSTASY) IN PREGNANCY

3,4-methylenedioxymethamphetamine (MDMA) or “ecstasy” is an illicit hallucinogenic amphetamine with strong central nervous system stimulant properties and high abuse potential. MDMA acts to increase the synaptic cleft concentration of catecholamines through inhibition of reuptake.

MDMA is known to act as a vasoconstrictor. Theoretical concerns about increased malformation risk following gestational MDMA exposure are based on the possibility that placental and embryo-fetal perfusion may be compromised during maternal use, thereby increasing the risk of structural anomalies associated with vascular impairment.

The available data concerning fetal outcome following MDMA exposure in pregnancy are limited to two small, uncontrolled prospective case series.  Although an increased overall risk of congenital malformation was suggested in one, the analytical techniques employed are outdated and application of newer methodologies to the data suggest that major malformation rates within this cohort do not significantly exceed those in the general population. Furthermore, no clear malformation pattern was identified and possible confounding as a consequence of underlying maternal illness and concomitant drug use mean that a causal association with MDMA exposure cannot be assumed. One case-control study identified a possible association between use of vasoconstrictive recreational drugs in early pregnancy and increased risk of gastroschisis in the infant; however studies to assess MDMA exposure specifically are required.

Prenatal MDMA exposure has been correlated with poorer motor development in infants up to two years of age. Data regarding other pregnancy and infant outcomes are lacking or too limited to quantify the potential risk that in utero MDMA exposure may pose to the developing fetus.

The need for additional fetal assessment will depend on individual circumstances but should be considered where prolonged or high dose MDMA exposure has occurred.