MAMa FAQ's #5

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More information can be found in Crystal Meth: They Call it Ice.

I've adopted a child who was exposed to methamphetamine in utero. What problems can I expect as a result of that exposure?

Most of this section is taken from my book: Crystal Meth: They Call it Ice

I get calls occasionally from grandparents, adoptive, and foster parents inquiring about the effects of methamphetamine on the child exposed to the drug in utero. They have real concerns about the future of their child. How will he be affected by the mother's use of methamphetamine? Will the baby be brain damaged? Will he have learning disabilities?

Some birth defects, like heart defects, cleft lip and palate, limb reduction anomalies [a baby with no arms], anencephaly [a baby with no brain], and anophthamlia [a baby with no eyes] have been associated with methamphetamine, but reports are sporadic and no recognized syndrome has emerged.

Methamphetamine use during pregnancy is associated with prematurity and low birth weight in term infants; a four pound baby at full term is not unusual. There is a high risk of brain damage from oxygen deprivation during labor. An inadequate placenta causes in- utero asphyxia [oxygen deprivation], and placental abruption [where the placenta separates from the uterus and hemorrhages]. Together with the chaotic lifestyle, profound malnutrition, sexually transmitted diseases, and lack of prenatal care typical of meth addicts, it's a wonder some of these children even survive. Many of them have cerebral palsy from the chronic oxygen deprivation during pregnancy.

Methamphetamine does cross the placenta, and animal studies have shown that fetal brain tissue levels are about 1/5 of maternal levels one hour post injection, with the heaviest concentration in the fetal midbrain, frontal lobe, and brainstem. Withdrawal symptoms are seen in about 40% of exposed newborns, including excessive crying and tremors lasting for weeks. They don't feed well, don't sleep well, and don't gain weight. We call that 'failure to thrive.' They have rapid heart rates, and some are in heart failure at birth, though they usually recover with no permanent heart damage.

The risk to the baby's brain is obvious. The early studies on this subject were grim and suggested permanent neurological impairment in the children exposed. An early ultrasound study showed detectable abnormalities in the brains of 35% of drug exposed neonates compared to 5.3% of unexposed babies. Lesions included interventricular hemorrhage, echodensities associated with cell death, and cavitary lesions especially in the midbrain, frontal lobes, and brainstem. The injuries were consistent with those seen in adult abusers.

As these children have matured, the effects seem to have lessened. A human brain continues to develop until the age of twenty-two. Much of the early damage appears to be compensated for by the growing brain. Methamphetamine exposed school aged children were studied by MRI and 1H MRS, and showed decreased size of some areas of the brain dealing with language development, attention and learning. Another study showed that methamphetamine exposed children were three times more likely to be a year or more behind in school.

The fetal sequelae of methamphetamine use by the mother appear to be limited to learning disability and hyperactivity, which can be severe. Language development is delayed and impaired, but intelligence appears to be normal. There does appear to be a lasting susceptibility to the addictive and toxic effects of meth in the adult survivor of prenatal drug exposure, especially in the male. Adult male rats exposed to meth in utero were more susceptible to neurotoxicity if re-exposed to crystal as adults. The adult children of alcoholic parents are known to have a genetic predisposition to addiction, but children of methamphetamine addicts will have the additional burden of a biochemical susceptibility to addiction.

Prenatal exposure to methamphetamine is invariably associated with exposure to alcohol and nicotine, and smoking during pregnancy is linked to low birth weight and increased risk of ADHD in susceptible families. Fetal alcohol syndrome is also a concern, with consequent brain damage and other anomalies. Seventy-five percent of pregnant drug addicts use two or more substances during their pregnancy, making it difficult to distinguish the influences of each drug upon the baby.

Proper care of the infant exposed to methamphetamine is essential for the long term mental health of the child. Learning disabilities need to be identified and treated with appropriate special education. The child may have ADHD and require pharmacological treatment and special attention. A coordinated effort involving your pediatrician, schools and counselors can improve a child's chances for a normal healthy life.

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