Fetal narcotic syndrome refers to the effects on the fetus and newborn of exposure to illicit substances--particularly cocaine, crack cocaine, and heroin--during pregnancy. Narcotic use during pregnancy poses risks to both the woman and the fetus, including miscarriage, poor fetal growth, placental problems, premature delivery, low birth weight, and stillbirth. In addition, infants born after exposure to drugs may develop symptoms of withdrawal, including excessive crying, irritability, trembling, and breathing or gastrointestinal problems. These symptoms, known as "neonatal abstinence syndrome," are short-lived. National surveys find that about 4 percent of pregnant women in the United States report using illicit drugs. In contrast, about 18 percent of pregnant women report smoking cigarettes. Women ages 15 to 25 are substantially more likely than women ages 26 to 44 to use illicit drugs during pregnancy.

The mass media, health care workers, and legislators became particularly concerned about the consequences of prenatal drug use during the crack cocaine epidemic in the 1980s. Initial reports suggested that infants born after prenatal exposure to crack cocaine, labeled "crack babies" by the media, suffered permanent brain damage and lifelong behavioral problems, raising fears of a generation of unteachable children in the inner cities. However, more thorough epidemiological research later established that children exposed to cocaine and other drugs in utero do not suffer lasting cognitive deficits. Moreover, many pregnant women who use illicit substances also use alcohol and tobacco and may experience extremely poor nutrition, sexual abuse, domestic violence, and homelessness. These factors make it difficult to discern the effect of narcotics alone on fetal development and birth outcomes.

The policy response to prenatal drug use has been mainly punitive. In the past 2 decades, more than 200 women in 34 states have been prosecuted in criminal courts for substance use during pregnancy. Many others have been jailed, faced charges of child endangerment or neglect in civil proceedings, or had their children removed from their care because they tested positive for drugs at the time of the birth. Some women have been prosecuted for murder after their babies were stillborn. The majority of women targeted by these policies are poor and nonwhite. Many child advocacy, public health, and medical organizations--including the March of Dimes, the American Public Health Association, the American Academy of Pediatrics, and the American College of Obstetricians and Gynecologists--oppose this criminal justice approach, arguing that it scares women away from prenatal care and other needed services.

Bibliography:

1) Frank, Deborah A., Marilyn Augustyn, Wanda Grant Knight, Tripler Pell, and Barry Zuckerman. 2001. "Growth, Development and Behavior in Early Childhood following Prenatal Cocaine Exposure: A Systematic Review." JAMA 285(12):1626-28.

2) Gomez, Laura E. 1997. Misconceiving Mothers: Legislators, Prosecutors, and the Politics of Prenatal Drug Exposure. Philadelphia: Temple University Press.

3) Substance Abuse and Mental Health Administration (SAMHSA). 2005. "Substance Use during Pregnancy: 2002 and 2003 Update." The NSDUH Report, June 2. Research Triangle Park, NC: Office of Applied Studies, SAMHSA, and RTI International.

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