2. Malformation of Extremities Malformation of Extremities

3. Child with Meningomyelocele at thoracic spine Twins with deformities of faces, clip lips and palates

4. Spina bifida has been linked to antidepressants.

5. Pregnancy with Drugs Kris Trairatana trairatana@hotmail.com

6. Pregnancy with Drugs More than 90% of pregnant women take prescription or nonprescription (over-the- counter) drugs or use social drugs, such as tobacco and alcohol, or illicit drugs at some time during pregnancy. In general, drugs, unless absolutely necessary, should not be used during pregnancy, because many can harm the fetus. About 2 to 3% of all birth defects result from the use of drugs.

7. Drugs taken by a pregnant woman reach the fetus primarily by crossing the placenta, the same route taken by oxygen and nutrients, which are needed for the fetus's growth and development. Drugs can affect the fetus in several ways: act directly on the fetus, causing damage, abnormal development (leading to birth defects), or death. act directly on the fetus, causing damage, abnormal development (leading to birth defects), or death. alter the function of the placenta, usually by reducing the supply of oxygen and nutrients to the fetus thus resulting in an underweight and underdeveloped baby. alter the function of the placenta, usually by reducing the supply of oxygen and nutrients to the fetus thus resulting in an underweight and underdeveloped baby. cause the muscles of the uterus to contract forcefully, thus injuring the fetus by reducing its blood supply or triggering preterm labor and delivery. cause the muscles of the uterus to contract forcefully, thus injuring the fetus by reducing its blood supply or triggering preterm labor and delivery.

8. How Drugs Cross the Placenta

9. Key Points No OTC (over-the- counter) drugs should be taken without doctor’s permission. No OTC (over-the- counter) drugs should be taken without doctor’s permission. The drug addiction can be passed on to baby and baby must go through painful withdrawal period after birth The drug addiction can be passed on to baby and baby must go through painful withdrawal period after birth

10. Caffeine: harms the fetus is unclear. It is a stimulant that readily crosses the placenta to the fetus. Thus, it may stimulate the fetus, increasing the heart and breathing rates. Caffeine also may decrease blood flow across the placenta and decreases the absorption of iron (possibly increasing the risk of anemia). Caffeine: harms the fetus is unclear. It is a stimulant that readily crosses the placenta to the fetus. Thus, it may stimulate the fetus, increasing the heart and breathing rates. Caffeine also may decrease blood flow across the placenta and decreases the absorption of iron (possibly increasing the risk of anemia). Drinking 7-8 cups or more/day increases the risk of having a stillbirth, premature birth, low-birth-weight baby, or miscarriage is also unclear. Drinking 7-8 cups or more/day increases the risk of having a stillbirth, premature birth, low-birth-weight baby, or miscarriage is also unclear.

11. Cocaine: Cocaine readily crosses the placenta and affects the fetus. It constricts blood vessels, reducing blood flow (and the oxygen supply) to the fetus, particularly of the bones and the intestine. Rarely, use of cocaine results in birth defects of the brain, eyes, kidneys, and genital organs. Cocaine: Cocaine readily crosses the placenta and affects the fetus. It constricts blood vessels, reducing blood flow (and the oxygen supply) to the fetus, particularly of the bones and the intestine. Rarely, use of cocaine results in birth defects of the brain, eyes, kidneys, and genital organs. Use of cocaine during pregnancy can also cause complications during pregnancy, about 31% have a preterm delivery and 15% have premature detachment of the placenta (placental abruption). Use of cocaine during pregnancy can also cause complications during pregnancy, about 31% have a preterm delivery and 15% have premature detachment of the placenta (placental abruption). Newborns may have withdrawal symptoms. Their behavior is also affected. Newborns interact less with other people. Babies of cocaine users may be hyperactive, tremble uncontrollably, and have difficulty learning (which may continue through age 5 years or even longer). Newborns may have withdrawal symptoms. Their behavior is also affected. Newborns interact less with other people. Babies of cocaine users may be hyperactive, tremble uncontrollably, and have difficulty learning (which may continue through age 5 years or even longer).

12. Opioids: such as heroin, methadone, and morphine, readily cross the placenta. Consequently, the fetus may become addicted to them and may have withdrawal symptoms 6 hours to 8 days after birth. However, use of opioids rarely results in birth defects and increases the risk of complications, such as miscarriage, abnormal presentation of the baby, and congenital heart problems. Babies of heroin users are more likely to be small. Opioids: such as heroin, methadone, and morphine, readily cross the placenta. Consequently, the fetus may become addicted to them and may have withdrawal symptoms 6 hours to 8 days after birth. However, use of opioids rarely results in birth defects and increases the risk of complications, such as miscarriage, abnormal presentation of the baby, and congenital heart problems. Babies of heroin users are more likely to be small.

13. Amphetamines: Use of amphetamines during pregnancy may result in birth defects, especially of the heart. Amphetamines: Use of amphetamines during pregnancy may result in birth defects, especially of the heart. Marijuana: harm the fetus is unclear. The main ingredient of marijuana, tetrahydrocannabinol, can cross the placenta and thus may affect the fetus. If marijuana is used heavily during pregnancy, newborns may have behavioral problems. Marijuana: harm the fetus is unclear. The main ingredient of marijuana, tetrahydrocannabinol, can cross the placenta and thus may affect the fetus. If marijuana is used heavily during pregnancy, newborns may have behavioral problems.

14. Conclusion Try to avoid any kind of drugs before, during, and after pregnancy Try to avoid any kind of drugs before, during, and after pregnancy If necessarily use, under the prescription and strictly follow doctor’s direction If necessarily use, under the prescription and strictly follow doctor’s direction No self-medication No self-medication Provide sufficient and healthy food Provide sufficient and healthy food Follow up doctor’s appointment Follow up doctor’s appointment The best choice of addictive pregnancy, consult your doctor, counseling center, AA, NA, and other services The best choice of addictive pregnancy, consult your doctor, counseling center, AA, NA, and other services Participate with every teaching classes Participate with every teaching classes Enjoy life, have fun, and prepare for a new member Enjoy life, have fun, and prepare for a new member

15. References Drug use during pregnancy, The MERCK manual of medical information-second home edition, online version, http://www.merck.com/mmhe/index.html Drug use during pregnancy, The MERCK manual of medical information-second home edition, online version, http://www.merck.com/mmhe/index.html http://www.merck.com/mmhe/index.html Teenage pregnancy and drug abuse, Teenage pregnancy and drug abuse, Illicit drug use in pregnancy, http://www.marchofdimes.com/professionals/14332_116 9.as/ Illicit drug use in pregnancy, http://www.marchofdimes.com/professionals/14332_116 9.as/ http://www.marchofdimes.com/professionals/14332_116 9.as/ http://www.marchofdimes.com/professionals/14332_116 9.as/ Drug abuse and treatment, National Women's Health Information Center, http://www.4woman.gov/ Drug abuse and treatment, National Women's Health Information Center, http://www.4woman.gov/http://www.4woman.gov/ Alcohol research group, National research center, Public Heath Institute, http://www.arg.org/studies.html Alcohol research group, National research center, Public Heath Institute, http://www.arg.org/studies.htmlhttp://www.arg.org/studies.html

16. Thank You Thank You