The effects of alcohol and illicit drugs on the human embryo and fetus.

Women at childbearing age often use alcohol and various illicit drugs such as cocaine and heroin. These agents pass through the human placenta and may affect the developing embryo and fetus. Indeed, large amounts of alcohol ingested by the pregnant woman may produce a specific syndrome manifested by prenatal and postnatal growth retardation, a variety of facial dysmorphic features and mental retardation. Ingestion of smaller amounts of alcohol will produce the fetal alcohol effects with only few and minor dysmorphic features but with developmental delay and some degree of intellectual impairment. Cocaine use during pregnancy may apparently result in an increase in the rate of congenital anomalies, of stillbirth and of intrauterine growth retardation. The use of heroin and opiates does not seem to increase the rate of major congenital anomalies, but it reduces fetal growth and increases the rate of intrauterine fetal death. Studies on the developmental outcome of children born to cocaine or heroin dependent mothers seem all to show psychomotor developmental delay at a young age. At school age these children have intellectual impairment and a very high rate of inattention and/or hyperactivity. We should therefore address our efforts in improving the environment of these children and in treating the early symptoms of inattention and hyperactivity, even before the child reaches school.