The Effects of Alcohol and Drugs of Abuse on Maternal Nutritional Profile during Pregnancy

The consumption of alcohol and drugs of abuse among pregnant women has experienced a significant increase in the last decades. Suitable maternal nutritional status is crucial to maintain the optimal environment for fetal development but if consumption of alcohol or drugs of abuse disrupt the intake of nutrients, the potential teratogenic effects of these substances increase. Despite evidence of the importance of nutrition in addicted pregnant women, there is a lack of information on the effects of alcohol and drugs of abuse on maternal nutritional status; so, the focus of this review was to provide an overview on the nutritional status of addicted mothers and fetuses. Alcohol and drugs consumption can interfere with the absorption of nutrients, impairing the quality and quantity of proper nutrient and energy intake, resulting in malnutrition especially of micronutrients (vitamins, omega–3, folic acid, zinc, choline, iron, copper, selenium). When maternal nutritional status is compromised by alcohol and drugs of abuse the supply of essential nutrients are not available for the fetus; this can result in fetal abnormalities like Intrauterine Growth Restriction (IUGR) or Fetal Alcohol Spectrum Disorder (FASD). It is critical to find a strategy to reduce fetal physical and neurological impairment as a result of prenatal alcohol and drugs of abuse exposure combined with poor maternal nutrition. Prenatal nutrition interventions and target therapy are required that may reverse the development of such abnormalities.


Very heavy drinkers had:
-higher iron depletion -not anemia Drink pattern was not related to iron status except very heavy drinkers (> 8 drinks per day) Streissguth et al. 198 Intake of micronutrients in nonpregnant alcohol abusers Population research Non-pregnant alcohol abusers had low intake vitamin A, B1,B2,B6, C, D, calcium, selenium, folic acid Maternal alcohol use and nutrition during pregnancy Case-control -Alcohol was related to higher intake of phosphorus, choline and vitamin B12 -Drinking frequency was associated with lower intake of vitamin C and occasional drink with more intake of vitamin D -Alcohol was not related to anthropometric features -All women gained less weight in pregnancy ->85% of both group of pregnant women had insufficient intake for 10 of 22 key nutrients and >50% for additional 3 nutrients Carter et al. 2016

Addiction in Pregnancy Review
-Abuse have all been associated with poor maternal weight gain and nutritional status -These substances are mixed, with powerful appetite suppressant properties.
MA use was associated to: -Poor maternal nutritional status -Fetal growth insufficiency Keegan DO, et al.
-Sometimes little can be done to change established maternal behaviours in regard to nutrition -Fetal growth insufficiency has been associated with MA use in pregnancy. It is unclear if this is related to a direct effect of the agent on the placenta or fetus or whether this represents a nutritional problem in patients who use MA Effects of prenatal MA during gestation Animal Study -Anorexia and blood pressure are increased by misuse of MA in mother -MA abuse can decrease food intake and appetite -Fetus and placenta weight decreased

Cocaine Studies
Maternal nutrition profile and daily cocaine administration Animal Study Cocaine administration was associated to: -Less weight gain during pregnancy -Weight recovery after parturition -High risk of mother and fetus mortality at 60mg/kg/day cocaine.
-Less weight gain during pregnancy related to dosage.
-Pronounced lag in weight recovery after parturition Wiggins et al. 1990 Serum illicit drug concentrations and maternal nutritional status Population research Addicted subjects had: -lower serum folate and ferritine -higher leukocyte levels -Subjects whose serum values were above the ADAMHA/NIDA ranges for marijuana, PCP and cocaine had concentrations of folate and ferritin that were significantly lower than those of subjects with lower serum drugs levels. -High maternal serum concentration of illicit drugs were accompanied by a significant increase in leukocyte count -The level of maternal cocaine during the third trimester was inversely correlated with birth weight and head circumference Knight et al. 1994 Maternal and fetal body composition related to cocaine Animal studies -Maternal weight gain and food consumption showed dose-dependent decreases -Maternal weight gain and food consumption showed dosedependent decreases -Maternal water consumption, by contrast, was significantly increased -Undernutrition was a sufficient cause of fetal weight reduction at dose of 50mg/kg/day

Cannabis studies
Effects of marihuana on the solution of anagrams, memory and appetite Experimental study Marihuana smokers consumed significantly more marshmallows Subjects who smoked marihuana recalled significantly fewer items than the control subjects and there were significantly more erroneous recalls Abel EL, 1971 Interactive effects of nutrition and cannabis upon rat perinatal Clinical trial Animal models Female Wistar rats were exposed to cannabis smoke, placebo smoke, or no smoke while concurrently -12 variables affected by the low-protein diet, 8 were significantly potentiated when under nutrition was combined with cannabis Charlebois AT and Fried PA, 1980 development consuming 1 of 3 diets differing in protein concentration (8%, 24%, 64%) treatment -these included a lengthened gestation period, an increase in occurrence of stillbirths and litter destruction, and decreased activity in the rat pups An investigation of prenatal cannabis exposure and minor physical anomalies in a low risk population Case-control None of the anomalies noted occurred more frequently among the offspring of cannabis users O'Connell CM and Fried PA, 1984 Effects of maternal marijuana and cocaine use on fetal growth Case-control -Infants whose mothers had positive urine assays for marijuana, as compared with the infants whose mothers were negative according to both interviews and urine assays, had a 79-g decrease in birth weight and a 0.5-cm decrement in length -Women who had positive assays for cocaine, as compared with nonusers, had infants with a 93-g decrease in birth weight (a 0.7cm decrement in length and a 0.43-cm-smaller head circumference Zuckerman B et al. 1989 Relationships of serum illicit drug concentrations during pregnancy to maternal nutritional status Case-control study Fasting blood samples, drawn during each trimester of pregnancy and at delivery, were screened for concentrations of cocaine, phencyclidine and marijuana Serum folate, vitamin B12, ferritin and ascorbic acid -Subjects whose serum values were above the ADAMHA/NIDA ranges for marijuana, phencyclidine and cocaine had concentrations of folate and ferritin that were significantly less than those of subjects with lower serum drug levels Knight EM et al. 1994 Characteristics of pregnant illicit drug users and associations between cannabis use and perinatal outcome in a population-based study Population-based study -Women who reported use of any illicit drug were less likely to have used folic acid in the periconception period -Users were also more often underweight (BMI<18.5kg/m2) than women who did not report use of illicit drugs during pregnancy -Cannabis users were more likely than nonusers to have excessive weight gain during pregnancy Van Gelder MM et al. 2010 Marijuana Use and Maternal Experiences of Severe Nausea During Pregnancy in Hawai'i Descriptive study -6.0% reported using marijuana in the month before pregnancy -2.6% reported using marijuana during pregnancy -21.2% reported severe nausea during pregnancy -Women who reported severe nausea during pregnancy were significantly more likely to report marijuana use during pregnancy (3.7% vs 2.3%)

Heroine studies
Burden and nutritional deficiencies in Opiate addicted Review -Unhealthy eating behaviors due to lack of nutritional knowledge, food preparation skills, and environments.
-During withdrawal from heroin, weight gain or loss occurs which is caused by major changes in food intake selection. -Nutrition is related with conditions and diseases, such as diabetes which decreases sensitivity to dependence on morphine and vitamin D deficiency hat slows down morphine dependency as well as protein deprivation which generates preferential fat intake with low cocaine use.