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Pregnant women's usage of alcohol and illicit substances has significantly increased during the past several decades. Maintaining an ideal environment for foetal development requires a suitable nutritional status in the mother. However, the potential teratogenic consequences of alcohol and drugs of abuse rise if these substances are used and interfere with the intake of nutrients. Drinking alcohol or using drugs can affect how well nutrients are absorbed, reducing the amount and quality of appropriate dietary intake as well as calorie intake, which can lead to malnutrition, particularly in micronutrients (vitamins, omega-3–3, folic acid, zinc, choline, iron, copper, selenium). The foetus may not have access to vital nutrients when the mother's nutritional state is impaired by alcoholism or drug dependency; this can lead to foetal abnormalities such as Foetal Alcohol Spectrum Disorder (FASD) or Intrauterine Growth Restriction (IUGR). Finding a way to lessen the physical and neurological damage that foetal alcohol and drug misuse exposure during pregnancy causes, in addition to inadequate maternal nutrition, is crucial. Target treatment and prenatal dietary interventions are necessary to stop these disorders' development potentially.
Pregnant women's usage of alcohol and illicit substances has significantly increased during the past several decades. Exposure to alcohol during pregnancy is seen as a significant public health concern. The five nations with the highest estimated prevalence of alcohol use during pregnancy were Ireland (60.4%), Belarus (46.6%), Denmark (45.8%), the United Kingdom (41.3%), and Russia (36.5%), according to the most recent published systematic review on the prevalence of foetal alcohol syndrome (FAS), which is the characteristics of growth retardation, facial malformations, and impairment of the central nervous system. The Eastern Mediterranean Region had the lowest average prevalence of alcohol usage during pregnancy (0.2%). In comparison, the European region had the most significant average prevalence (25.2%).
According to the research, South Africa (58.5 per 1000), Croatia (11.5 per 1000), Ireland (8.9 per 1000), Italy (8. per 1000), and Belarus (6.9 per 1000) are the five nations with the highest frequency of FAS. About 25% of pregnant women in Europe consume alcohol, and the prevalence of FAS in the general population is estimated to be 1.4 per 1000 worldwide. Although FAS is avoidable, its frequency may rise globally in the coming years. Many young women worldwide are drinking more alcohol on average, binge drinking, and drinking while pregnant. In addition, many pregnancies, both in developed and developing nations, are unplanned, increasing the risk of the embryo being unintentionally exposed to alcohol during the earliest stages of pregnancy, when the embryo's developing brain is more susceptible to the effects of alcohol. About 60% of pregnant women in Spain had alcohol in their system when their hair was analysed at birth. Pregnant women continue to binge drink (more than five drinks in one sitting) or drink often (more than seven drinks per week) despite ongoing government and media campaigns warning against the harmful consequences of alcohol use during pregnancy.
According to recent studies, between 3% to 16% of pregnant women in the US use cannabis. According to the National Survey on Drug Use and Health's population-based surveillance statistics, the percentage of US pregnant women who use cannabis rose to 62% between 2002 and 2014. Since the 1970s, there has been a six- to seven-fold increase in cannabis usage. Prenatal cannabis usage is on the rise as a result of growing access to the substance, perceptions of its medicinal value, and its innocuous nature. The National Surveys on Drug Use and Health, conducted from 2007 to 2012, provided data on pregnant and nonpregnant women aged 18 to 44. The survey was cross-sectional and nationally representative, and the results showed that 10.9% of pregnant and 14.0% of nonpregnant US women of reproductive age used marijuana in the previous year, with 3.9% of pregnant women and 7.6% of nonpregnant women using it in the last month.
Furthermore, the prevalence of abuse and dependency was found in 18.1% of pregnant women and 11.4% of nonpregnant women. 1.2% of French women said they had smoked cannabis while they were pregnant. According to a recent self-reporting study conducted by The National Survey on Drug Use and Health from 2002–2003, 4.3% of pregnant women between the ages of 15 and 44 reported using illegal drugs.
Cocaine is a stimulating stimulant that is typically misused intranasally. At the same time, it may also be injected or smoked (it's sometimes referred to as crack cocaine). The majority of the world's crack users are found in Latin American nations, with Brazil having the highest rate of use at over 0.81%. According to population surveys conducted in the United States, 1.1% of youth utilise cocaine. Nonetheless, screening American neonates for cocaine using hair and meconium revealed that the prevalence of cocaine exposure during pregnancy may be over ten times greater. Comparable outcomes have been found when screening newborns in Canada and Europe. The National Women's Hospital of New Zealand's Alcohol, substance and Pregnancy Team (ADAPT) has reported a sharp rise in the number of pregnant women who have used the substance methamphetamine (MA). 10% (6/60) of the ADAPT referrals in 2001 were related to methamphetamine use and related issues. In 2003, this increased to 59% (34/58).
The usage of opioids during pregnancy has also skyrocketed in the last several years. Between 2000 and 2010, the proportion of Medicaid-enrolled women who filled at least one prescription for an opioid during their pregnancy rose by 23%, from 18.5% to 22.8%. Between 1998 and 2011, there was a rise in the frequency of opiate misuse or dependency among pregnant women, with an increase from 1.7 to 3.9 per 1000 delivery admissions. According to data from the 2010 South African Community Epidemiology Network on Drug Use (SACENDU), between 5 and 20% of patients in South African (SA) specialised treatment facilities use heroin as their primary illicit substance of choice. In South Africa, heroin is mainly used by people between the ages of 22 and 30. Women make up 20 to 40 per cent of those receiving treatment for heroin misuse, which is greater than the figure for the majority of other illegal drugs.
A proper nutritional state is essential for generating healthy progeny. When a mother's nutritional quality is compromised by the harmful effects of alcohol or drug abuse, the growing foetus cannot receive the vital nutrients it needs to grow properly, which leads to less-than-ideal health consequences.
There is a shortage of contemporary data about the nutritional state of drug abusers during pregnancy, despite the focus of recent material on maternal nutritional status and alcohol addiction in pregnancy. Furthermore, drug users are more likely to abuse multiple substances and engage in behaviours that compromise their nutritional status, such as sharing needles, having unprotected sex, and having multiple partners. These factors put drug users at the highest risk of contracting HIV, so the mother's altered nutrition is complex and not solely dependent on the substance used.
Alcohol is a psychotropic drug that can lead to dependency. According to WHO alcohol guidelines, the amount, pattern, and, occasionally, the quality of alcohol ingested all influence the risk of alcohol-related damage. Consuming 60 grammes or more of pure alcohol (more than six standard drinks in most countries) on at least one occasion, at least once a month, is known as heavy episodic drinking (HED). A pattern of alcohol use that is endangering one's bodily or mental well-being is referred to as harmful alcohol use. Strong desires to drink, trouble managing one's use, continuing to use alcohol despite adverse effects, increasing tolerance, and occasionally a physiological withdrawal state are all signs of alcohol dependency. The Pattern of Drinking Score (PDS) is a tool used to measure alcohol consumption patterns. It takes into account various drinking attributes such as the typical amount of alcohol consumed on a given occasion, festive drinking, the percentage of drinking events where drinkers get intoxicated, the percentage of drinkers who drink regularly or almost daily, drinking with meals, and drinking in public places.
The severity of the different symptoms of Foetal Alcohol Spectrum Disorder (FASD) is correlated with the frequency, pattern, and duration of alcohol intake during foetal development.
Acute, moderate alcohol intake is far less harmful to the foetus than chronic, everyday high alcohol usage or frequent, intermittent alcohol use. Studies have shown that chronically consuming more than six drinks each day poses a severe risk to the developing foetus. "Binge drinking," or consuming large quantities of alcohol often during one drinking session, may also raise blood alcohol concentrations and have teratogenic effects. The evaluation of the data about alcohol's possible adverse effects on the growing foetus forms the basis of international guidelines for alcohol intake during pregnancy.
Recent guidelines from Australia, Canada, Denmark, France, and the USA state that while high and frequent maternal alcohol consumption during the first trimester increases the risk of congenital disabilities, alcohol exposure at any point during pregnancy, including before conception, can have adverse effects on the development of the foetal brain. It's unclear how the dosage of alcohol affects the consequences and whether there's a threshold beyond which adverse effects start to manifest. The most significant danger comes from excessive drinking, and when one drinks, it is crucial. However, not all "heavy" drinkers will have a kid who is impacted. Most organs expand rapidly after fertilisation during the early weeks of pregnancy while the embryo is still developing and growing until the baby is born. Most organs expand rapidly after fertilisation during the early weeks of pregnancy while the embryo is still developing and growing until the baby is born. Alcohol has more harmful teratogenic effects during embryogenesis when development can be disturbed, particularly in the first trimester.
Nonetheless, several rules highlight the lack of a defined safe threshold and determine that abstaining from alcohol is the most secure course of action. According to WHO standards, women who are dependent on drugs should not use drugs. At the same time, pregnant women should participate in detoxification programmes.
Alcohol toxicity and nutrition are related, and this relationship may increase or mitigate the teratogenic effects of alcohol. Drinking alcohol can harm both the quantity and quality of a healthy diet and energy intake before pregnancy. Drinkers who consume significant quantities less frequently have the lowest quality diets. In contrast, those who eat modest quantities more regularly have the best. Alcohol affects a drinker's nutritional condition when it is ingested in excess, and many alcoholics also don't eat a balanced diet. Light to moderate drinkers who have one to two glasses of alcohol or less a day see such drinks as a typical part of their diet and get a specific amount of calories from them. Abuse of alcohol in excess can affect how different nutrients are absorbed by the body and used. As a result, many alcoholics—heavy drinkers in particular—can have varying degrees of malnourishment. When alcohol takes the place of other nutrients in the diet and reduces the intake of nutrients overall, primary malnutrition ensues. When a drinker eats enough nutrients, but alcohol prevents those nutrients from being absorbed from the gut, the body is unable to use them, leading to secondary malnutrition. Alcohol can obstruct the absorption of vital amino acids and vitamins, including folic acid, vitamins A and C, B1 (thiamine), B2 (riboflavin), and B6 (pyridoxine).
The three illegal substances that are most often used while pregnant are marijuana, cocaine, and methamphetamine (MA). The use of illicit substances generally results in considerable weight loss due to altered intake behaviours and tastes, which causes many nutritional deficiencies and malnutrition. Being undernourished is the most prevalent cause of immunodeficiency and might compromise immunity. These medications promote appetite suppression and alter eating patterns, which makes drug abusers want "empty-energy," perhaps nutrient-deficient meals that result in micronutrient deficiencies.
Methamphetamine (MA): MA are powerful Central Nervous System (CNS) stimulants that are highly addictive and have a significant alertness and focus-boosting effect. Increased release of dopamine, serotonin, and norepinephrine from brain neurons is the primary mechanism of action. Amphetamines prevent these neurotransmitters from being reabsorbed at the exact moment. Even though MA inhibits these neurotransmitter transporters, which have detrimental effects on foetal circulation, its usage seems to rise, especially among young pregnant patients. Because MA users frequently take other illegal substances while pregnant, it is challenging to distinguish the effects of MA from those of other illicit drugs in studies on MA use during the preconception period and throughout pregnancy. Poor maternal weight increase and nutritional condition were linked to MA abuse. Addict women typically use a variety of drugs, most of which have appetite-suppressing solid effects.
Furthermore, undernutrition is made worse by psychological risk factors such as poverty and a high prevalence of psychopathology. Managing poor maternal nutrition can be challenging because it isn't often easy to modify ingrained maternal behaviours regarding food. Pregnant patients who abuse substances sometimes have severely underweight or low body mass; both of these disorders point to inadequate nutritional status generally, and overeating is frequently a result of stopping MA addiction. Pregnant MA addicts had much lower body fat percentages and smaller biceps skinfold thickness.
Cocaine: Human research indicates that malnutrition in cocaine dependencies may be complex, involving altered metabolic and gastrointestinal processes, reduced caloric intake, and other harmful drug side effects. Because of its anorexigenic effects, cocaine suppresses hunger and tends to cause weight loss. Brazil's cocaine-addicted population was found to have haemoglobin and hematocrit levels below average, which were linked to a diet deficient in macronutrients—particularly protein—and micronutrients, such as iron. They also showed reduced percentages of glucose change and dysregulation of lipid metabolism, defined by low levels of HDL cholesterol and high levels of triglycerides, LDL cholesterol, and total cholesterol.
Numerous harmful outcomes in humans, such as low maternal weight gain, spontaneous miscarriage, placental abruption, early and abrupt labour, foetal distress, intrauterine growth restriction (IUGR), multiple birth abnormalities, and neurobehavioral problems in newborns, have been linked to prenatal cocaine consumption. Low birth weight and low cranial circumference were observed in the foetuses of pregnant cocaine addicts; however, when pre-pregnancy weight and maternal weight gain were taken into account during the analysis, the birth weight deficit did not reach significance. Significant reductions in birth length and head circumference persisted. Therefore, these findings imply that dietary variables may mitigate the relationship between cocaine use and development retardation, but not entirely. Particular claimed detrimental effects may have been muddled by other variables, such as alcohol intake, cigarette smoking, and other drug addiction, which were not taken into account in all the research. It would be challenging to separate the impact of cocaine from different variables, though, as cocaine use is frequently linked to drug misuse and other lifestyle choices that might be harmful to the developing foetus.
In conclusion
A person's diet can help prevent the teratogenicity of alcohol and drug misuse. FASD, developmental abnormalities, and cognitive delays can occur when the nutritional quality of the mother is changed, vital nutrients are unavailable for the foetus, and the toxic damage of alcohol and substances of abuse rises. For these reasons, current research is concentrating on nutritional intervention to counteract the adverse effects of alcohol and drug addiction on the mother's nutritional condition and the resulting impairment of the fetus's development. The harmful effects of alcohol and drug addiction on foetal brain development would likely be partially reversed by micronutrient supplementation, albeit it can be challenging to determine the ideal range of micronutrients throughout pregnancy. Furthermore, each woman's dietary needs might differ due to genetic variations. Even though there is no known blood level of choline shortage, choline and its metabolite, betaine, are two of the most investigated micronutrients for their significance in cognitive and memory function. In Ukraine, a prospective clinical experiment was carried out to compare a cohort of pregnant women who drank moderately to heavily with low- or unexposed control pregnant women. Of the three groups administered different multivitamin supplements, the group supplemented with choline positively impacted neurological outcomes such as essential learning and memory throughout the first year of life and on foetal development.
Reference
Sebastiani, G., Borrás-Novell, C., Casanova, M. A., Pascual Tutusaus, M., Ferrero Martínez, S., Gómez Roig, M. D., & García-Algar, O. (2018). The effects of alcohol and drugs of abuse on maternal nutritional profile during pregnancy. Nutrients, 10(8), 1008.
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Nwabekee
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