USE OF RECREATIONAL DRUGS IN PREGNANCY

Recreational drugs derive from several classes and most commonly include cannabis, cocaine, opioids, amphetamines, MDMA, LSD, khat, synthetic cathinones, synthetic cannabinoids, kratom, ketamine, GHB, and nitrous oxide. Numerous prescription drugs are also used recreationally, such as benzodiazepines, some opioid painkillers, and gabapentinoids.

Recreational drug use should be avoided during pregnancy due to the largely unknown effects on fetal development and wellbeing, as well as childhood neurodevelopment.

It is not uncommon for women to report recreational drug use that occurred prior to recognition of pregnancy. Occasional recreational drug users are advised to avoid further exposure and to seek advice from a healthcare professional regarding the possible need for additional fetal monitoring. Pregnant women with chronic drug exposure or substance use disorder require careful specialist management which may include a supervised withdrawal programme.

Data on fetal and childhood outcomes following prenatal recreational drug exposure are confounded by numerous factors that are more prevalent among recreational drug users and that can independently increase the risk of adverse pregnancy outcome. These may include co-exposure to other substances (in particular, alcohol and tobacco), socioeconomic factors, and particularly with heavy drug use, health problems, including vitamin deficiencies, malnutrition, blood borne viruses and mental health conditions. Assessment of outcomes is also complicated by the fact that street drugs are commonly mixed with other substances and/or are not the substance that the user believes they are consuming.

Exposure to any centrally acting substance around the time of delivery can cause neonatal withdrawal symptoms and/or neonatal toxicity. Infants perinatally exposed to recreational drugs should be delivered in a hospital with facilities for neonatal monitoring and supportive treatment as required.

Exposure to recreational drugs may be an indication for additional fetal monitoring depending on the substance involved, the timing and duration of use, and the pregnant woman’s general health. Other risk factors which could independently increase the risk of adverse pregnancy outcome may also be present in individual cases and are important to consider when performing a risk assessment.