World Health Organization

Pregnancy FDA, NRT, SHS, World Health Organization

Effects of Smoking While Pregnant

Smoking increases the risks of prenatal issues, complicated birth, and a number of peripartum and newborn health issues.

In the U.S., there are an estimated 42 million people (nearly 18% of the total population) who currently smoke ¹. Tobacco use is the leading cause of preventable disease, disability and death in the U.S. In fact, smoking accounts for nearly 1 in every 5 deaths each year ².

Effects of Smoking on a Baby

Cigarette smoke contains thousands of harmful chemicals. When a woman smokes during pregnancy, these toxic chemicals enter her bloodstream and increase the risk of fetal injury. The nicotine and carbon monoxide in cigarettes are especially harmful because they can damage a baby’s developing brain and make it difficult for a baby to get enough oxygen. Nicotine narrows the blood vessels in the umbilical cord, which can result in inadequate levels of oxygen exchange for the developing baby.

Smoking increases the risks of prenatal issues, complicated birth, and a number of peripartum and newborn health issues. Risks include ^3,4,5 :

Roughly 1 in 10 women report that they smoked during the last 3 months of their pregnancy⁶.
Approximately 50-60% of women who quit during pregnancy will start again within 1 year after the birth of their child⁷.

Miscarriage.
Low-birth weight.
Premature birth.
Stillbirth.
Ectopic pregnancy.
Spontaneous abortion.
Placenta previa.
Placental abruption.
Sudden infant death syndrome (SIDS).

When babies are born too early, they are deprived of the safe environment and regular developmental duration they would have otherwise experienced in the womb. The earlier a baby is born, the greater the chance that they will experience health issues. In some cases, premature birth can result in infant death.

Premature babies may experience ^8,9:

Problems with feeding.
Respiratory distress.
Cerebral palsy.
Delays in development.
Problems with hearing or eyesight.

If a baby is born prematurely, they will often need to be hospitalized for days or even months so that doctors and nurses can safely monitor their progress.

The harmful effects of prenatal exposure to smoking are not limited to childhood. Negative effects can last throughout a child’s lifetime. Studies have found that children who are exposed to tobacco in utero have significantly higher odds of having a learning disability later on ¹⁰. Children born to mothers who smoked a pack or more a day during pregnancy are also significantly more likely to be smokers themselves when they grow up ¹¹.

E-cigarettes

Electronic cigarettes (also referred to as e-cigarettes) are hand-held battery-operated devices that people use to smoke a liquid that is made of nicotine, flavoring, and other chemicals. The battery in the device heats the liquid nicotine to create an aerosol that the smoker then inhales ¹².

The use of e-cigarettes has become increasingly popular. According to Forbes, e-cigarette sales generate over $1 billion every year.

People often think that they are safer than tobacco cigarettes, which may lead them to smoke more freely during pregnancy ¹³. For pregnant women, the chemicals in e-cigarettes can cause adverse effects to their baby.

E-cigarettes contain nicotine—a potent teratogen or, in other words, an agent that can be profoundly harmful to prenatal development ¹³. Nicotine crosses the placental barrier and studies have found that it can cause a significant amount of damage to the development and well-being of a fetus.

In animal studies, nicotine has been found to cause ^14,15:

Respiratory problems, including impaired lung function and decreased lung size. (This may affect both first- and second-generation offspring.)
Reduced fertility for female offspring.

Some people turn to e-cigarettes to help them stop smoking tobacco. However, there is no evidence that e-cigarettes are a safe alternative to cigarettes. In fact, to date, no e-cigarette is approved by the FDA for smoking cessation purposes ¹⁶. This is due in part to the fact that e-cigarettes are currently unregulated and contain nicotine at varying levels.

If you are pregnant and currently smoking e-cigarettes, talk to your doctor about the risks and benefits of exposing your baby to nicotine during pregnancy.

Dangers of Secondhand Smoke

Secondhand smoke (SHS) refers to the potentially inhaled smoke resulting from another person’s doing it. Just like immediately inhaled cigarette smoke, SHS is a human carcinogen – which means it contains chemicals that cause cancer ¹⁷. SHS can cause a number of negative health problems in children and adults.

Exposure to SHS during pregnancy is associated with an increased risk of ^18,19:

Low birth weight.
Preterm delivery.
SIDS.

Babies who are exposed to SHS after they are born are more likely to die from SIDS compared to babies who are not exposed to cigarette smoke ¹⁹.

Babies exposed to SHS also have weaker lungs than other babies, which can increase their risk for other chronic health problems such as asthma, ear infections, bronchitis, and pneumonia ¹⁹.

Credit: American Medical Association

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Below are some interesting facts and statistics about smoking during pregnancy:

Smoking reduces a woman’s chances of getting pregnant ^20,21,22. Approximately 15% of couples have trouble getting pregnant. One of the causes for this is female infertility. Smoking and secondhand inhalation are risk factors for decreased female fertility ²³. In a study on infertile couples, males who smoked had significantly lower sperm quality. Cigarette smoking was associated with reduced sperm density and sperm count ²⁴.
Smoking during pregnancy can increase the risk of tissue damage in an unborn baby: Studies show that maternal smoking can cause tissue damage in the baby’s lungs, brain, and increase the risk of the baby having a cleft lip ^25,26.
Nicotine passes freely into breast milk: The amount of nicotine transferred through breast milk is more than double the amount transferred through placenta ²⁷. However, breastfeeding is beneficial to a baby’s health and even if a woman smokes, she will be encouraged to breastfeed vs. use formula, as evidence shows the milk itself still provides protection against respiratory illness ²⁷.

Quitting Smoking While Pregnant

Quitting smoking during pregnancy is one of the most important steps a woman can take to improve her health. It will help you feel better and provide a healthier environment for your baby.

Keep in mind that many people try to quit multiple times before they are successful. It is difficult to quit smoking, and you are not a failure if you “slip.” The important thing is to keep trying.

Benefits of Quitting for Mothers

Mothers who quit smoking will get numerous health benefits. If you quit smoking, you’re likely to experience ¹⁷:

Reduced likelihood of developing heart disease, stroke, lung cancer, chronic lung disease, and other smoke-related diseases.
Increased levels energy.
Increased ease of breathing.
Better financial prospects, as money previously put toward cigarettes will be available for other expenses.
A sense of peace about the choices you made for yourself and your baby.

If you are in the process of quitting smoking, below are some useful strategies to help you handle cravings and avoid triggers ²⁸.

Engage in physical activity, such as walking, jogging, running, swimming, or dancing.
Practice deep breathing at least once a day. Take long, slow breaths to center yourself.
Talk to friends and loved ones.
Write down your thoughts and feelings in a journal or blog.
Remind yourself that you are not a smoker—identity is powerful, and identifying yourself as a nonsmoker can help you quit and stay tobacco-free.
Spend time with people who don’t smoke.
Ask others not to do it in front of you.
Establish a “smoke-free” zone in the car or house.
Identify triggers, such as people or stressful situations that cause you to want to smoke. Avoiding these triggers can help you stay drug-free.
Redirect your focus and attention when a trigger makes you want to smoke: immediately go for a walk, listen to music, call a friend, or brush your teeth.
Reduce stress in your life, such as work stress or personal stress.
Eat a healthy diet, drink plenty of water, and get at least 8 hours of sleep each night.

When you stop smoking, your baby will be able to get more oxygen. Quitting will also reduce the risk that your baby is born prematurely.

Some women may feel guilty or ashamed about their smoking. But every mother wants the best for her child. Try not to let fear stand in the way of getting help. There are numerous resources available for individuals looking to quit. For example, this virtual clinic is free for those looking for help to stop smoking. You can also call 1-800-44U-QUIT, a national quitline for pregnant women seeking to end their tobacco use.

If you are abusing any other substances like alcohol that may also cause potential harm during your pregnancy, reach out to us today at 1-800-980-3927Who Answers?. You and your baby deserve to be healthy.

Are Nicotine Replacement Therapies Safe During Pregnancy?

While nicotine replacement therapy (NRT) is shown to be highly effective in non-pregnant individuals, there is not evidence to determine whether or not NRT is safe and effective for use among pregnant smokers ²⁹. More data is needed to determine whether or not NRT is safe to use during pregnancy given that there is conflicting and inconclusive evidence in the research community regarding its use ³⁰.

Gynecologists may recommend nicotine replacement therapy only after a woman has tried behavioral therapy interventions and they have failed ³¹. A doctor should first discuss the risks and benefits of nicotine replacement therapy before prescribing it to a pregnant patient.

Below are a few facts about these medications ^30,31:

Varenicline acts on the brain’s nicotine receptors.
Bupropion is an antidepressant.
Both of these medications are transferred through breast milk.
The U.S. Food and Drug Administration recently added warnings on these products because they increase the risk of psychiatric symptoms and suicide.

There is currently not enough evidence to conclude whether any of these medications are safe to use during pregnancy.

Mothers can breastfeed while being on nicotine replacement therapy as long as the dose is less than the number of cigarettes usually smoked. Women should first consult their doctor before breastfeeding and using nicotine replacement therapy, since a baby can be exposed to nicotine through a mother’s breast milk. Additionally, the FDA discourages lactating women from using other smoking cessation pharmacotherapies such as bupropion or varenicline ³².

Handling Nicotine Withdrawal

An addiction to tobacco can have both physiologic and psychological components, potentially compounding the difficulty in quitting.

In order to quit smoking, a physician may recommend any of the following cessation techniques ³³:

Counselling.
Cognitive and behavioral therapy.
Motivational interviewing and talk therapy.
Alternative or nontraditional treatments and therapies like hypnosis, meditation, and acupuncture.
Pharmacologic therapy.

The acute nicotine withdrawal syndrome has a number of unpleasant associated symptoms. These are normal and will last a few days to a few weeks.

Symptoms of withdrawal may include ¹⁰:

Negative moods.
Urges to smoke.
Difficulty concentrating.

Women who smoke during pregnancy are encouraged to stop smoking and seek help. Although physicians recommend quitting smoking before 15 weeks of gestation for the greatest benefits to the baby and the mother, quitting at any point is beneficial ³⁴.

Additional Resources to Help You Quit

If you are addicted to smoking and looking for ways to quit, below are a few resources designed to help you.

Additionally, extra cessation therapy is offered to pregnant women under the Affordable Care Act, or ObamaCare.³⁵. This includes free counseling and medication – as approved by a doctor ³⁶.

Quitting smoking can be challenging. But there are more resources than ever to help you quit.

If you’re struggling with substance addiction, don’t wait to get help. Our treatment placement specialists at 1-800-980-3927Who Answers? can help you find the care you need to quit today and become as healthy as possible for yourself and your child.

References:

¹ Jamal, A., Agaku, I. T., O’Connor, E., King, B. A., Kenemer, J. B., & Neff, L. (2014). Current cigarette smoking among adults—United States, 2005–2013. MMWR Morb Mortal Wkly Rep, 63(47), 1108-1112.

² Centers for Disease Control and Prevention. (2016). Current Cigarette Smoking Among Adults in the United States.

³ Pineles, B. L., Park, E., & Samet, J. M. (2014). Systematic review and meta-analysis of miscarriage and maternal exposure to tobacco smoke during pregnancy. American journal of epidemiology, 179(7), 807-823.

⁴ Centers for Disease and Control. (2015). Highlights: Impact on Unborn Babies, Infants, Children, and Adolescents.

⁵ Cnattingius, S. (2004). The epidemiology of smoking during pregnancy: smoking prevalence, maternal characteristics, and pregnancy outcomes.Nicotine & Tobacco Research, 6(Suppl 2), S125-S140.

⁶ Centers for Disease Control and Prevention (2016). How Does Smoking During Pregnancy Harm My Health and My Baby?

⁷ American College of Obstetricians and Gynecologists. (2015). Smoking Cessation During Pregnancy: Committee Opinion.

⁸ Centers for Disease Control and Prevention. (2015). Preterm Birth.

⁹ Been JV, Lugtenberg MJ, Smets E, van Schayck CP, Kramer BW, Mommers M, Sheikh A. (2014). Preterm Birth and Childhood Wheezing Disorders: A Systematic Review and Meta-Analysis. PLOS Medicine.

¹⁰ Anderko, L., Braun, J., & Auinger, P. (2010). Contribution of tobacco smoke exposure to learning disabilities. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 39(1), 111-117.

¹¹ Buka, S. L., Shenassa, E. D., & Niaura, R. (2003). Elevated risk of tobacco dependence among offspring of mothers who smoked during pregnancy: a 30-year prospective study. American Journal of Psychiatry, 160(11), 1978-1984.

¹² Centers for Disease Control and Prevention (2016). E-Cigarettes and Pregnancy.

¹³ Baeza-Loya, S., Viswanath, H., Carter, A., Molfese, D. L., Velasquez, K. M., Baldwin, P. R., … & De La Garza, R. (2014). Perceptions about e-cigarette safety may lead to e-smoking during pregnancy. Bulletin of the Menninger Clinic, 78(3), 243.

¹⁴ England, L. J., Bunnell, R. E., Pechacek, T. F., Tong, V. T., & McAfee, T. A. (2015). Nicotine and the developing human: a neglected element in the electronic cigarette debate. American journal of preventive medicine, 49(2), 286-293.

¹⁵ Petrik, J. J., Gerstein, H. C., Cesta, C. E., Kellenberger, L. D., Alfaidy, N., & Holloway, A. C. (2009). Effects of rosiglitazone on ovarian function and fertility in animals with reduced fertility following fetal and neonatal exposure to nicotine. Endocrine, 36(2), 281-290.

¹⁶ Siu, A. L. (2015). Behavioral and pharmacotherapy interventions for tobacco smoking cessation in adults, including pregnant women: US Preventive Services Task Force Recommendation Statement. Annals of internal medicine, 163(8), 622-634.

¹⁷ World Health Organization, & International Agency for Research on Cancer. (2004). Tobacco smoke and involuntary smoking(Vol. 83). Iarc.

¹⁸ Khader, Y. S., Al-Akour, N., AlZubi, I. M., & Lataifeh, I. (2011). The association between second hand smoke and low birth weight and preterm delivery. Maternal and child health journal, 15(4), 453-459.

¹⁹ Centers for Disease Control and Prevention. (2016). Health Effects of Secondhand Smoke.

²⁰ US Department of Health and Human Services. (2006). The health consequences of involuntary exposure to tobacco smoke: a report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 709.

²¹ U.S. Department of Health and Human Services. (2010). A Report of the Surgeon General: Highlights: Overview of Finding Regarding Reproductive Health.

²² Meeker, J. D., & Benedict, M. D. (2013). Infertility, pregnancy loss and adverse birth outcomes in relation to maternal secondhand tobacco smoke exposure. Current women’s health reviews, 9(1), 41-49.

²³ Hyland, A., Piazza, K., Hovey, K. M., Tindle, H. A., Manson, J. E., Messina, C., … & Wactawski-Wende, J. (2015). Associations between lifetime tobacco exposure with infertility and age at natural menopause: the Women’s Health Initiative Observational Study. Tobacco control, tobaccocontrol-2015.

²⁴ Künzle, R., Mueller, M. D., Hänggi, W., Birkhäuser, M. H., Drescher, H., & Bersinger, N. A. (2003). Semen quality of male smokers and nonsmokers in infertile couples. Fertility and sterility, 79(2), 287-291.

²⁵ Leslie, E. J., & Marazita, M. L. (2013). Genetics of cleft lip and cleft palate. In American Journal of Medical Genetics Part C: Seminars in Medical Genetics (Vol. 163, No. 4, pp. 246-258).

²⁶ Centers for Disease Control and Prevention. (2016). Smoking During Pregnancy.

²⁷ Massachusetts General Hospital. (2007). Smoking While Breastfeeding: What Are the Risks.

²⁸ American College of Obstetricians and Gynecologists. (2011). Smoking Cessation During Pregnancy.

²⁹ Pollak, K. I., Oncken, C. A., Lipkus, I. M., Lyna, P., Swamy, G. K., Pletsch, P. K., … & Myers, E. R. (2007). Nicotine replacement and behavioral therapy for smoking cessation in pregnancy. American journal of preventive medicine,33(4), 297-305.

³⁰ Pfizer Labs. (2010). Chantix® (varenicline) tablets: highlights of prescribing information.

³¹ American College of Obstetricians and Gynecologists. (2008). Use of psychiatric medications during pregnancy and lactation. Obstet Gynecol,111(4), 1001-1020.

³² Sachs, H. C., Frattarelli, D. A., Galinkin, J. L., Green, T. P., Johnson, T., Neville, K., … & Van den Anker, J. (2013). The transfer of drugs and therapeutics into human breast milk: an update on selected topics. Pediatrics,132(3), e796-e809.

³³ American College of Obstetricians and Gynecologists. (2015). Smoking Cessation During Pregnancy: Committee Opinion.

³⁴ England, L. J., Kendrick, J. S., Wilson, H. G., Merritt, R. K., Gargiullo, P. M., & Zahniser, S. C. (2001). Effects of smoking reduction during pregnancy on the birth weight of term infants. American Journal of Epidemiology, 154(8), 694-701.

³⁵ ObamaCare. (n.d.). ObamaCare and Smokers.

³⁶ Substance Abuse and Mental Health Services Administration. (n.d.). How the Affordable Care Act Affects Tobacco Use and Control.

Pregnancy HIV, NAS, SMA, World Health Organization

Heroin’s Effects on Pregnancy

Heroin is an illegal and highly addictive substance that may be injected, smoked, or snorted. This powerful opiate drug can easily harm any user, and it can cause numerous problems for a pregnant mother and her developing baby. Unfortunately, heroin use is all too prevalent; the 2015 National Survey on Drug Use and Health report showed that 329,000 people in the US reported using heroin in the past month ¹. This includes women of childbearing age. The survey found that approximately 79,000 women aged 15-44 in the US reported using heroin in the past month. ¹.

Because unintended pregnancies are common in the United States, women may be using heroin and other substances without realizing that they are pregnant ². Heroin can cause serious harm to a woman’s body, and it can also significantly harm her baby.

If you are a woman of reproductive age and you are either pregnant or not actively preventing pregnancy through birth control and using heroin, consider getting help. You deserve to be healthy and so does your child. Call 1-800-980-3927

Effects of Heroin Use on the Mother

Heroin use during pregnancy is a major public health concern, with the potential to result in serious maternal and neonatal health issues. Using a drug like heroin can eventually compel a person to prioritize the drug over important issues like hygiene and proper nutrition, which can give rise to numerous issues during pregnancy.

Heroin-addicted mothers also tend to have poor attendance rates at prenatal visits ⁸. Prenatal care is vital for any expectant mother, and may be even more essential for women using heroin due to the high risk for pregnancy complications, such as ^{3 4 5}:

Antepartum hemorrhage (bleeding).
Low birth weight.
Higher neonatal mortality.
Hepatitis.
HIV.
Sexually transmitted infections (STIs).
Respiratory failure.
Preeclampsia.

Additionally, heroin is a dangerous drug because it is associated with serious physical, mental and social repercussions that negatively impact the mother and, consequently, the fetus or developing child. These include ³:

Malnutrition.
Poor dental hygiene.
Infections, such as HIV and hepatitis viruses.
Depression.
Self-harm.
Relationship problems.
Domestic violence.
Criminal activity.

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Effects of Heroin on a Developing Fetus

Heroin can easily cross the placental barrier. This means that when a woman injects, inhales, or smokes heroin, the drug is passed along to the baby, presenting numerous risks and the strong possibility the baby will become dependent on the drug.

Taking drugs such as heroin can lead to a number of health issues related to pregnancy, including but not limited to ⁶:

Problems with the placenta: The placenta is an important part of pregnancy since it provides a steady supply of blood through the umbilical cord—rich in oxygen and nutrients. When a woman has problems with her placenta, her baby may become oxygen- or nutrient-deprived. Placental abruption, or the separation of the placenta from the uterus, can be can be very serious for both the mother and the baby.
Increased risk of preterm birth: “Preterm” is a term used to define babies who are born before 37 weeks of pregnancy are completed. There are categories of preterm birth, including extremely preterm (<28 weeks), very preterm (28 to <32 weeks), and moderate to late preterm (32 to 37 weeks) ⁷.
Low birth weight: Low birth weight is defined by the World Health Organization (WHO) as weight at birth less than 2,500 grams or 5.5 lbs. Low birth weight is associated with neonatal mortality, inhibited cognitive development, and chronic disease as the child grows up ¹⁰.

Heroin use can also be deadly to the developing fetus or the newborn baby. Aside from increased miscarriage risk due to complications like placental abruption, illicit drug use during pregnancy increases the risk of stillbirth (death of a baby in the womb after 20 weeks of pregnancy) by 2 to 3 times ¹³.

Illicit drug use also increases the chances of sudden infant death syndrome (SIDS, or crib death) ^6,13. This refers to the unexplained death of a baby who is younger than 1 year old 11.

Neonatal Abstinence Syndrome (NAS)

When a woman uses an opioid like heroin during pregnancy it can cause her baby to develop neonatal abstinence syndrome (NAS). NAS is a set of behavioral and physical signs in the newborn that result from abruptly cutting off a baby’s opioid supply once the child is born. Studies show that anywhere from 48-94% of babies exposed in utero to heroin will experience withdrawal at birth ³.

How much heroin the mother used.
How well her body clears the drug from her system.
How long she used heroin.
Whether the baby was born full-term or premature.

Symptoms of NAS

Symptoms of NAS usually occur within the first 1-3 days after birth; however, they may appear up to a week after birth ¹².

Characteristics of NAS include but are not limited to ¹²:

Excessive crying.
Mottled (blotchy) skin.
Fever.
High-pitched cry.
Irritability.
Slow weight gain.
Poor ability to breastfeed.
Tremors.
Diarrhea.
Vomiting.

In the most severe cases, NAS can cause seizures and death. When a baby is born with NAS, they will usually need to be hospitalized and treated with medication (typically, another opioid medication like morphine or methadone) to relieve the withdrawal symptoms ¹³. The medication is gradually tapered as the baby adjusts to not having heroin in their system.

Although the effects of heroin use in utero have been well documented, less is known about the long-term effects on the developing child. However, some studies show that exposure to heroin in utero is associated with the following characteristics later in life ^{14 15 16}:

Behavioral disorders.
Difficulties with concentration and attention.
Hyperactivity.
Aggressiveness.
Lack of social inhibition.

If you are pregnant and use heroin, call your doctor to find out the best way to keep you and your baby safe. If you are interested in treating your substance use disorder, give us a call 1-800-980-3927 and a rehab placement specialist can help you.

Quitting Heroin While Pregnant

When a woman quits opiates cold turkey while pregnant, her fetus goes through a period of withdrawal. The fetus is not able to tolerate the effects of withdrawal as well as the mother and this may result in the death of the fetus ¹⁷. Because of this risk, it is important to talk to your doctor before attempting to quit using heroin on your own.

Pregnancy offers a window of opportunity to enter treatment and live drug-free. Data collected by the Substance Abuse and Mental Health Services Administration (SAMHSA) found that pregnant women use lower amounts of drugs, such as heroin, during the third trimester than they do the first and second trimesters (2.4 percent vs. 9.0 and 4.8 percent) ¹. This data suggests that by their last trimester, more women have stopped using harmful substances.

While therapeutic options may vary on an individual basis, many women quit using heroin during pregnancy through a combination of medication-assisted treatment and counseling.

Medication-Assisted Treatment During Pregnancy

Used since the 1970s, methadone is a time-tested method of medication-assisted treatment during pregnancy. Although methadone is the standard of care in most of the world and most doctors will prescribe it to women who are using heroin during pregnancy, it is important to note that methadone is still an opioid, and there are risks of using methadone when pregnant.

Credit: National Institute on Drug Abuse

Methadone can easily cross the placenta and enter the baby’s bloodstream, increasing the risk that the baby will be born with neonatal abstinence syndrome. Researchers are investigating the potential to use buprenorphine and naloxone (i.e., Suboxone) instead of methadone ^{18 19}. Research is still emerging, and one study found that babies born to mothers who were treated with buprenorphine and naloxone had less incidence of NAS and shorter hospital stays²⁰.

It is important to talk to your health care provider about your options for treatment. Give us a call today at 1-800-980-3927 to speak with a rehab treatment specialist and learn more about your options.

References:

Substance Abuse and Mental Health Services Administration. (2015). Results from the 2015 National Survey on Drug Use and Health: Detailed Tables (HHS Publication No. SMA 16-4984, NSDUH Series H-51).
Centers for Disease Control and Prevention. (2015). Unintended Pregnancy Prevention.
Namboodiri, V., George, S., Boulay, S., & Fair, M. (2010). Pregnant heroin addict: what about the baby?. BMJ case reports, 2010, bcr0920092246.
Giordano, R., Cacciatore, A., Cignini, P., Vigna, R., & Romano, M. (2010). Antepartum Haemorrhage. Journal of Prenatal Medicine, 4(1), 12–16.
Semba, R. D. (2010). Psychiatric Disorders in Pregnancy and the Postpartum: Principles and. Humana.
March of Dimes. (2015). Heroin and pregnancy.
World Health Organization. (2015). Preterm birth.
World Health Organization. (2001). WHO Regional Strategy on Sexual and Reproductive Health.
March of Dimes. (2015). Stillbirth.
World Health Organization. (2004). Low birth weight.
March of Dimes. (2015). Sudden Death Syndrome.
National Institutes of Health. (2015). Neonatal abstinence syndrome.
National Institute on Drug Abuse. (2015). Substance Use While Pregnant and Breastfeeding.
Ornoy, A., Michailevskaya, V., Lukashov, I., Bar-Hamburger, R., & Harel, S. (1996). The developmental outcome of children born to heroin-dependent mothers, raised at home or adopted. Child abuse & neglect, 20(5), 385-396.
Ornoy, A., Segal, J., Bar‐Hamburger, R., & Greenbaum, C. (2001). Developmental outcome of school‐age children born to mothers with heroin dependency: Importance of environmental factors. Developmental Medicine & Child Neurology, 43(10), 668-675.
Messinger, D. S., Bauer, C. R., Das, A., Seifer, R., Lester, B. M., Lagasse, L. L., … & Langer, J. C. (2004). The maternal lifestyle study: cognitive, motor, and behavioral outcomes of cocaine-exposed and opiate-exposed infants through three years of age. Pediatrics, 113(6), 1677-1685.
Chasnoff, I. J. (Ed.). (2012). Drug use in pregnancy: Mother and child. Springer Science & Business Media.
Lund, I. O., Fischer, G., Welle-Strand, G. K., O’grady, K. E., Debelak, K., Morrone, W. R., & Jones, H. E. (2013). A comparison of buprenorphine+ naloxone to buprenorphine and methadone in the treatment of opioid dependence during pregnancy: maternal and neonatal outcomes. Substance abuse: research and treatment, 7, 61.
Kraft, W. K., Dysart, K., Greenspan, J. S., Gibson, E., Kaltenbach, K., & Ehrlich, M. E. (2011). Revised dose schema of sublingual buprenorphine in the treatment of the neonatal opioid abstinence syndrome. Addiction, 106(3), 574-580.
Wiegand, S., Stringer, E., Seashore, C., Garcia, K., Jones, H., Stuebe, A., & Thorp, J. (2014). 750: Buprenorphine/naloxone (B/N) and methadone (M) maintenance during pregnancy: a chart review and comparison of maternal and neonatal outcomes. American Journal of Obstetrics & Gynecology,210(1), S368-S369.