1300 THE INCIDENCE OF CONGENITAL ANOMALIES AMDNG INFANTS OF DEPENDENT PREGNNANT MEN

Abstract

There is concern about infants born to drug-dependent women with regard to whether illicit drug use during pregnancy adversely affects structural fetal development. To assess the risk of fetal exposure to psychoactive drugs in-utero, a study of infants born to drug-dependent women enrolled in Family Center, a program providing prenatal care, counseling and methadone maintenance for these women, was conducted. From 1979 through 1983, 201 infants were examined for evidence of congenital anomalies. One-hundred and twelve of the infants (56%) were treated for neonatal abstinence; 89 infants (44%) required no treatment. Overall, the incidence of congenital anomalies in both groups fell within that of the general population (2-3%), suggesting that methadone maintenance, with or without accompanying illicit drug use during pregnancy, does not place the fetus at higher risk for anatomic defects. Of the anomalies seen, the cardiovascular system was most frequently affected. Structural congenital heart disease was found in 3.4% of the infants, (four times the incidence reported in the general population-.6%-.8%). Septal defects and pulmonic stenosis were the lesions identified. No explanation is available at present for these findings; however, the following should be considered: 1) Cardiac development occurs between weeks 2 and 8 of gestation, 2) The drug seeking behaviors of the addicted pregnant woman place her at risk for early intrauterine infection, 3) Exposure to viral teratogens (primarily coxsackie and rubella) has been implicated in abnormal cardiac development. These data suggest that, although the drug-dependent women may experience greater exposure to environmental teratogens early in pregnancy, the incidence of congenital malformations are not increased over that expected in the general population. However, the fetal cardiovascular system does appear more sensitive to environmental stressors in a pregnancy complicated by drug-dependency.

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