![]() Hyperactivity, crying, irritability, poor suck, tremors, seizures onset of signs at birth, poor sleeping pattern, hyperphagia, diaphoresis ![]() Phendimetrazine (Adipost, Bontril, Prelu-2) ![]() Oxycodone (Percodan, OxyIR, Percolone, Roxicodone, Percocet, Ox圜ontin) Solvents and aerosols (glues, gasoline, paint thinner, cleaning solutions, nail polish remover, Freon) Phenylisopropylamines (MDA, MMDA, MDMA, MDEA) Indolealkylamines (LSD, psilocin, psilocybin, DMT, DET) In a recent report, chronic use of narcotic prescriptions (use for ≥1 intrapartum month) among pregnant women cared for at a single clinic increased fivefold from 1998 to 2008, and 5.6% of infants delivered to these women manifested signs of neonatal withdrawal. An indeterminate part of these observed increases has resulted from more liberal use of prescription opiates in pregnant women to palliate a wide variety of etiologies of acute or chronic pain. In Florida, the number of newborns discharged with ICD-9 code 779.5 climbed by more than 10-fold, from 0.4 to 4.4 discharges per 1000 live births, from 1995 to 2009. Nationally, the number of infants coded at discharge with neonatal withdrawal increased from 7653 in 1995 to 11 937 in 2008. 4 Data compiled by the Agency for Healthcare Research and Quality and by the Florida Department of Health attest to an increased incidence and/or recognition of neonatal withdrawal syndrome (ICD-9 code 779.5). For infants, the use of International Classification of Diseases, Ninth Revision ( ICD-9)-based hospital discharge databases to determine the incidence of neonatal drug withdrawal secondary to intrauterine exposure has in the past underestimated the incidence of this condition. The reported rates of illicit drug use most likely underestimate true rates, because the percentage of pregnant women who report the recent use of illicit drugs on screening interviews can be substantially lower than that determined by drug screening using biological samples. In the latter age group, the rates of illicit drug use and smoking were higher among those who were pregnant compared with those who were not pregnant (15.8% vs 13.0% and 20.6% vs 13.9%, respectively). Rates of recent illicit drug use and smoking were lower among pregnant compared with nonpregnant women across all age groups, except for those 15 to 17 years of age. Binge or heavy drinking in the first trimester was reported by 11.9%, and recent tobacco use was reported by 15.3%. 3 With the use of computer-assisted interviewing techniques that preserved confidentiality, the 2009 National Survey on Drug Use and Health noted that 4.5% of pregnant women 15 to 44 years of age reported recent use of illicit drugs (eg, marijuana, cocaine, hallucinogens, heroin, methamphetamines, and nonmedical use of prescription drugs). 2 Fetal exposure to marijuana, the illicit drug most commonly used by pregnant women, does not cause clinically important neonatal withdrawal signs but may have subtle effects on long-term neurobehavioral outcomes. Intrauterine exposure to certain drugs may cause congenital anomalies and/or fetal growth restriction, increase the risk of preterm birth, produce signs of withdrawal or toxicity in the neonate, or impair normal neurodevelopment. 1 Numerous case reports have documented the use of a variety of drugs by women of childbearing age ( Table 1). The 2009 National Survey on Drug Use and Health reported that recent (within the past month) use of illicit drugs, binge or heavy alcohol ingestion, and use of tobacco products occurred in 8.7%, 23.7%, and 27.7%, respectively, of the population 12 years or older. Use and abuse of drugs, alcohol, and tobacco contribute significantly to the health burden of society.
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