MHLU - Health Status Resource

Prenatal Substance Exposure

Prenatal Substance Exposure

Key Findings: 

Smoking

The percent of women who reported smoking cigarettes during pregnancy was significantly higher in Middlesex-London compared to Ontario from 2013 to 2017. In 2017, 10.1% of women in Middlesex-London reported smoking during pregnancy compared to 7.0% in Ontario (Fig. 11.3.1).

The two age groups with the highest percent of smoking during pregnancy in Middlesex-London from 2013 to 2017 were women under the age of 20 and those aged 20 to 24. The percent of smoking among these two age groups were significantly higher than all other age groups (Fig. 11.3.2).

The percent of women who reported smoking during pregnancy was significantly higher among the urban population of Middlesex-London compared to the rural population from 2013 to 2017 (Fig. 11.3.3).

Interpretive notes:

Smoking cigarettes during pregnancy can cause health problems for both the mother and baby.1 Cigarettes contain chemicals such as nicotine, carbon monoxide, and tar that are passed to the baby through the placenta.2

For the mother, smoking increases the risk of having a miscarriage3 and an ectopic pregnancy4 (a condition in which the fertilized egg implants and grows outside of the uterus).

For the baby, maternal smoking increases the risk of being born prematurely, small for gestational age, and a low birth weight5; all of which can increase the risk of health problems for the baby.

Alcohol and other drugs

The percent of women in Middlesex-London who reported using alcohol during pregnancy was 3.5% in 2017. The percent in 2017 was significantly higher compared to Ontario (2.4%). The percent increased over time in Middlesex-London from 2013 to 2017 (Fig. 11.3.4).

There was no significant difference in the percent of women who reported using alcohol during pregnancy among the urban and rural population of Middlesex-London from 2014 to 2017 (not shown).

While the percent of women reporting alcohol use during pregnancy increased in Middlesex-London from 2013 to 2017, much of the increase was due to more women reporting alcohol use prior to the pregnancy being confirmed. The percent of women reporting alcohol use after the pregnancy was confirmed decreased from 2013 to 2017 (Fig. 11.3.5).

The percent of women in Middlesex-London who reported using drugs other than alcohol during pregnancy was 4.9% in 2017, a percentage significantly higher compared to Ontario (2.3%). The percentage increased over time for Middlesex-London, Ontario and the Peer Group from 2013 to 2017 (Fig. 11.3.6).

The percent of women who reported any drug use other than alcohol during pregnancy was higher among the urban population of Middlesex-London compared to the rural population, but the difference was not statistically significant (not shown).

Women under the age of 20 was the age group with the highest reported drug use (other than alcohol) during pregnancy in Middlesex-London from 2013 to 2017. The percent among this age group also increased over time from 2013 to 2017 (Fig. 11.3.7).

The percent of women reporting cannabis use during pregnancy was significantly higher in Middlesex-London compared to Ontario from 2013 to 2017. The percent of women reporting cannabis use increased over time for both Middlesex-London and Ontario during this period (Fig. 11.3.8).

Women under the age of 20 was the age group with the highest percent of reported cannabis use during pregnancy in Middlesex-London from 2013 to 2017. The percent among this age group also increased significantly over time from 2013 to 2017 (Fig. 11.3.9).

The percent of women in Middlesex-London who reported using any alcohol or other drug during pregnancy was 6.9% in 2016. This percent was significantly higher compared to Ontario (4.3%) and the Peer Group (5.0%). The percent in Middlesex-London increased over time from 4.2% in 2013 to 7.3% in 2017 (Fig 11.3.10).

Interpretive notes

When a pregnant woman drinks alcohol, the alcohol passes through the mother’s bloodstream into the baby’s blood.6 Babies exposed to alcohol in the womb can develop fetal alcohol spectrum disorder (FASD). FASD is an umbrella term used to describe a range of effects which can appear at anytime during childhood, including: restricted growth, facial abnormalities, learning disabilities, and behavioural problems.7 FASD is the leading known cause of preventable development disability in Canada.8

While cannabis is used to help treat a small number of diseases (e.g., glaucoma) or alleviate symptoms (e.g., chronic pain, nausea and vomiting due to chemotherapy)9, it is not recommended to treat morning sickness or for medical purposes during pregnancy.10 THC (delta-9-tetrahydrocannabinol), the main psychoactive ingredient in cannabis, can be passed to the baby through the placenta and can also accumulate in the mother’s breast milk.11 Women who use cannabis during pregnancy have an increased odds of developing anemia (low iron levels in the blood) and of having a baby with a low birth weight.12 The use of cannabis during pregnancy can also affect the baby’s brain development13, possibly causing long-term effects in the child.

Using illicit drugs during pregnancy, such as cocaine, crystal meth, and opioids (e.g., heroin, hydromorph, fentanyl), increases the risk of pregnancy complications such as miscarriage, preeclampsia (high blood pressure), placental abruption (placenta detaches from the uterine wall too early), and premature labour.14 It can also affect the development of the baby, leading to longer term effects that can carry into early childhood and beyond, such as behaviour problems, poor sustained attention, and language delays.15

Ontario Public Health Standard: 

Healthy Growth and Development Guideline, 2018

Ontario Public Health Standards: Requirements for Programs, Services, and Accountability


References:

1.      Cui Y, Shooshtari S, Forget EL, Clara I, Cheung KF. Smoking During Pregnancy: Findings from the 2009-2010 Canadian Community Health Survey. PloS One [Internet]. 2014 [cited 2018 Nov 13];9(1):e84640. Available from: https://www.ncbi.nlm.nih.gov/pmc/PMC3885577/ DOI: 10.1371/journal.pone.0084640

2.      Samet JM, Yoon S-Y, World Health Organization. Pregnancy and Postpartum Smoking Cessation. In: Samet JM, Yoon S-Y, editors. Gender, Women, and the Tobacco Epidemic. Geneva: World Health Organization; 2010. p. 175-88.

3.      Pineles BL, Park E, Samet JM. Systematic Review and Meta-Analysis of Miscarriage and Maternal Exposure to Tobacco Smoke During Pregnancy. Am J Epidemiol [Internet]. 2014 [cited 2018 Nov 13];179(7):807-23. Available from: https://www.ncbi.nlm.nih.gov/pmc/PMC3969532/ DOI: 10.1093/aje/kwt334

4.      Horne AW, Brown JK, Nio-Kobayashi J, Abidin HBZ, Adin ZEHA, Boswell L, et al. The Association between Smoking and Ectopic Pregnancy: Why Nicotine Is Bad for Your Fallopian Tube. PLoS One [Internet]. 2014 [cited 2018 Nov 13];9(2):e89400. Available from: https://doi.org/10.1371/journal.pone.0089400 DOI: 10.1371/journal.pone.0089400

5.      Ko T-J, Tsai L-Y, Chu L-C, Yeh S-J, Leung C, Chen C-Y, et al. Parental Smoking During Pregnancy and Its Association with Low Birth Weight, Small for Gestational Age, and Preterm Birth Offspring: A Birth Cohort Study. Pediatr Neonatol [Internet]. 2014 [cited 2018 Nov 13];55(1):20-7. Available from: http://www.sciencedirect.com/science/article/pii/S1875957213001058 DOI: https://doi.org/10.1016/j.pedneo.2013.05.005

6.      Canadian Paediatric Society. Fetal Alcohol Syndrome: What You Should Know About Drinking During Pregnancy. Paediatr Child Health [Internet]. 2002 [cited 2018 Dec 2];7(3):177-200. Available from: https://www.ncbi.nlm.nih.gov/pmc/PMC2794811/

7.      National Institute on Alcohol Abuse and Alcoholism. Fetal Alcohol Exposure [Internet]. 2015 [cited 2018 Dec 2]. Available from: https://pubs.niaaa.nih.gov/publications/FASDFactsheet/FASD.pdf

8.      Public Health Agency of Canada. About Fetal Alcohol Spectrum Disorder (FASD) [Internet]. 2017 [cited 2018 Dec 1]. Available from: https://www.canada.ca/en/public-health/services/diseases/fetal-alcohol-spectrum-disorder/about.html

9.      Whiting PF, Wolff RF, Deshpande S, Di Nisio M, Duffy S, Hernandez AV, et al. Cannabinoids for Medical Use: A Systematic Review and Meta-Analysis. JAMA [Internet]. 2015 [cited 2018 Dec 1];313(24):2456-73. Available from: http://dx.doi.org/10.1001/jama.2015.6358 DOI: 10.1001/jama.2015.6358

10.    Public Health Agency of Canada. Thinking About Using Cannabis before or During Pregnancy? [Internet]. 2018 [cited 2018 Dec 1]. Available from: https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/health-effects/before-during-pregnancy.html

11.    American College of Obstetricians and Gynecologists Committee on Obstetric Practice. Committee Opinion No. 637: Marijuana Use During Pregnancy and Lactation. Obstet Gynecol [Internet]. 2015 [cited 2018 Dec 1];126(1):234-8. Available from: https://www.acog.org/-/media/Committee-Opinions/Committee-on-Obstetric-Practice/co722.pdf?dmc=1&ts=20181202T0448174087 DOI: 10.1097/01.AOG.0000467192.89321.a6

12.    Gunn JKL, Rosales CB, Center KE, Nuñez A, Gibson SJ, Christ C, et al. Prenatal Exposure to Cannabis and Maternal and Child Health Outcomes: A Systematic Review and Meta-Analysis. BMJ Open [Internet]. 2016 [cited 2018 Nov 13];6(4):e009986. Available from: http://bmjopen.bmj.com/content/6/4/e009986.abstract DOI: 10.1136/bmjopen-2015-009986

13.    El Marroun H, Tiemeier H, Franken IHA, Jaddoe VWV, van der Lugt A, Verhulst FC, et al. Prenatal Cannabis and Tobacco Exposure in Relation to Brain Morphology: A Prospective Neuroimaging Study in Young Children. Biol Psychiatry [Internet]. 2016 [cited 2018 Dec 1];79(12):971-79. Available from: http://www.sciencedirect.com/science/article/pii/S0006322315006927 DOI: https://doi.org/10.1016/j.biopsych.2015.08.024

14.    Finnegan L. Substance Abuse in Canada: Licit and Illicit Drug Use During Pregnancy: Maternal, Neonatal and Early Childhood Consequences [Internet]. Ottawa, ON: Canadian Centre on Substance Abuse, 2013 [cited 2018 Dec 2]. Available from: http://www.ccsa.ca/Resource%20Library/CCSA-Drug-Use-during-Pregnancy-Report-2013-en.pdf

15.    Lester BM, Lagasse LL. Children of Addicted Women. J Addict Dis [Internet]. 2010 [cited 2018 Dec 2];29(2):259-76. Available from: https://www.ncbi.nlm.nih.gov/pmc/PMC4451952/ DOI: 10.1080/10550881003684921

16.    The American College of Obstetricians and Gynecologists. Preeclampsia and High Blood Pressure During Pregnancy [Internet]. 2018 [cited 2018 Nov 15]. Available from: https://www.acog.org/-/media/For-Patients/faq034.pdf?dmc=1&ts=20181115T1957255816

Last modified on: January 24, 2019

Jargon Explained

Maternal smoking during pregnancy
The percentage of women who gave birth (live or still) who reported any smoking of cigarettes at admission for birth.

Cannabis
A product derived from the Cannabis sativa plant. Cannabis products come in different forms, including: dried flowers and leaves, extract dissolved in oil, edibles, hashish, and topical skin products such as creams and salves.

Preeclampsia
A pregnancy disorder characterized by high blood pressure (hypertension) and one or more signs that the woman’s organ systems are not functioning normally (e.g., abnormal amount of protein in the urine, low number of platelets in the blood). It usually occurs after 20 weeks of pregnancy.16

Alcohol use during pregnancy
The percentage of women who gave birth (live or still) who reported any alcohol exposure during pregnancy.

Drug use during pregnancy
The percentage of women who gave birth (live or still) who reported any drug exposure, other than alcohol, during pregnancy.

Any alcohol or drug use during pregnancy
The percentage of women who gave birth (live or still) who reported any alcohol or drug exposure during pregnancy.

Cannabis use during pregnancy
The percentage of women who gave birth (live or still) who reported any cannabis exposure during pregnancy