Marijuana (cannabis, Indian hemp, hashish), along with alcohol, nicotine, and ecstasy, is among the drugs most commonly used during pregnancy. The carbon monoxide concentration in the blood caused by marijuana is thought to be five times higher than that caused by tobacco, and the coal tar content in the blood is three times higher. Tetrahydrocannabinol, the active ingredient in marijuana, crosses the placenta and can lead to a decline in the baby's heart frequency. The rate of birth defects is not increased after using marijuana during pregnancy, but perinatal morbidity probably is. One long-term study found that speech and thought capabilities at the age of 4 years were significantly affected in children whose mother*-had consumed marijuana regularly - i.e. ranging from several time; a week to daily - during the pregnancy (Fried 1990). This study alst found a significantly smaller head circumference in the older children although the difference at birth had not been noticeable (Fried 1999) A meta-analysis on the effect on the birth weight did not give am conclusive indication that it was lower, at least when the cannabi: use was moderate or only occasional (English 1997). There is, as yet no indication that the chromosome breaks attributed to marijuani in earlier animal studies have any clinical relevance.
Recommendation. Pregnant women should avoid using marijuana in all circumstances. However, if it has been consumed, this does not justify interruption of the pregnancy, and neither does sporadic use justify any additional diagnostic procedures.
Lysergic acid diethylamide (LSD)
No specific cmbryotoxic effects have been proven in humans afte using the hallucinogen LSD. Epidemiologic studies have not beer performed. Thus, published data on LSD use during pregnancy an insufficient for a detailed risk assessment. The accumulated reports according to the Reprotox database of abnormal human births tha included the ingestion of LSD early in gestation, involve defects o the limbs (Lilienfeld 1970, Zellweger 1967, Carakushansky 1969) eyes (Margolis 1980, Chan 1978, Apple 1974, Boddanof 1972), am central nervous system (Jacobsen 1972). Some small prospective stud ies have reported normal births following first-trimester use of LSI (Chan 1978, Aase 1970), but a possible increase in spontaneous abor tions has been suggested (Jacobsen 1972, McGlothlin 1970). A smal number of patients who received LSD therapeutically did not have ai increased incidence of abnormal or low birth weight babies (Cohei 1968). People who use LSD as a recreational drug during pregnane; are likely to use other drugs as well (e.g. cannabis, alcohol, tobacco (McGlothlin 1970, Cohen 1968), and to engage in a variety of activi ties that may compromise their reproductive health. Therefore, ¡den tifying specific reproductive effects of this or any recreational dru is difficult. Available reports do not suggest there are persistent repro ductive effects from LSD used in the past. There have been report of chromosome breaks (Cohen 1968).
Recommendation. Pregnant women should avoid LSD under all circumstances. However, if it has been used, this does not justify interruption of the pregnancy. When there has been repeated exposure during the first trimester, detailed ultrasound should be carried out to confirm the normal development of the fetus.
Phencyclidine piperidine (PCP, Angel dust) is an arylcyclohcxy-lamine, and is one of the hallucinogens. It was introduced in 1957 as an intravenously administered anesthetic, but was then removed from the market because of undesirable side effects. Until 1979 it was available as a veterinary drug, which was also used in the drug scene, Phencyclidine is easily produced and is a cheap extender for other drugs (LSD. mescaline, cocaine). Phencyclidine is taken by mouth or smoked, mixed with marijuana, tobacco, and orcgano.
Phencyclidine inhibits the reuptake of dopamine, noradrenaline, and serotonin in the central nervous system, and blocks postsynaptic acetylcholine. Depending on the dose and the site of action, phencyclidine can act either as a stimulant or as a depressant. With severe intoxication, sympathomimetic action and depression of the central nervous system are the most prominent symptoms.
After oral intake, phencyclidine is quickly absorbed in the small intestine and, following excretion, reabsorbed in the stomach. The effects arc noticed 15 minutes after oral intake, or within 2-5 minutes after smoking. Lipophylic characteristics encourage accumulation in the fatty tissue and in the central nervous system. For this reason, the effects last for 4-6 hours despite a plasma half-life of only I hour.
In case reports, a connection has been noted between phencyclidine abuse and microcephaly, as well as facial asymmetry and a complex intra- and extracranial birth defect syndrome. A causal relationship has not yet been proven. Intrauterine growth restriction and postnatal interaction deficits, as well as other neurological deviations and opiate-like withdrawal symptoms, have been reported (Wachsmann 1989). Follow-up studies at 1 year on 62 children exposed in utero did not reveal anything remarkable compared with a control group (Wachsmann 1989). Animal experiments indicate that it may causc degeneration of fetal cortex neurons (surveyed in Schardein 2000).
Recommendation. Pregnant women should avoid the use of phencyclidine under all circumstances. However, its use does not justify interruption of pregnancy interruption. A detailed ultrasound should be performed to confirm normal fetal development.
Mescaline is a hallucinogen made from Mexican cacti. Animal studies on the teratogenic potential of mescaline are contradictory (Hirsch 1981, Gebcr 1967). There is insufficient experience on prenatal toxicity in humans. Chromosome anomalies were not observed in one study (Dorrance 1975).
Recommendation. Pregnant women should avoid mescaline under all circumstances. However, its use does not justify an interruption of pregnancy. If there has been repeated exposure during the first trimester, detailed ultrasound should be performed to confirm norma! fetal development.
Psiiocybin is a hallucinogen made from mushrooms ("magic mushrooms"). There is insufficient experience in humans to allow a risk assessment on its use in pregnancy.
Recommendation. Pregnant women should avoid psiiocybin under all circumstances. However, its use does not justify interruption of the pregnancy. If there has been repeated use in the first trimester, detailed ultrasound should be carried out to confirm normal fetal development.
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