Drugs, alcohol, and pregnant women: Anesthetic implications for mother and newborn

The prevalence of substance abuse among young adults has increased markedly over the last 20 years. Since nearly 90% of drug-abusing women are of childbearing age, it is likely that the clinician will encounter pregnant women who abuse illicit drugs [1]. As many case reports confirm, life-threatening complications may result when the physiologic changes of pregnancy are combined with the adverse effects of drug abuse [2]. Anesthesiologists are likely to meet the drug-abusing parturient first in an acute setting either when labor analgesia is requested or in an emergency situation such as fetal distress, placental abruption, uterine rupture, or sudden onset of life-threatening maternal dysrhythmias. Risk factors suggesting drug abuse in pregnancy include lack of prenatal care, history of premature labor, and cigarette smoking [3]. The most common illicit substances encountered are alcohol, cocaine, amphetamines, opioids, marijuana, and tobacco.