The developing fetus, when exposed to exogenous chemicals and drugs, is vulnerable, plastic in its remodeling, and is incredibly resilient. Compounds that fetuses are exposed to include licit and illicit drugs, which alter neurotransmitter levels or directly bind to and activate or inhibit specific receptor systems (1). Such influences can alter neuronal division, rates of apoptosis, axonal growth, and synaptic plasticity.

The scope of compounds that fetuses are exposed to is quite broad, including alcohol, cannabis, and nicotine; food and beverage additives such as caffeine; illicit drugs such as opioids, cocaine, amphetamines, and their derivatives; and prescription medications such as anticonvulsants, opioid treatment medications, and antidepressants (1). The important question—what are the long-term consequences of these exposures?—is complex and evolving in its answers.

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