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Understanding Prenatal Drug and Alcohol Exposure

Understanding Prenatal Drug and Alcohol

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In Canada 10% of women reported using alcohol during their pregnancies (Taylor, 2016) and 17% reported smoking (Statistics Canada, 2006). This section will try to explain some background on Prenatal Exposure to drugs and alcohol and its effects on a fetus, as well as offer some strategies for parents raising children who may have been prenatally exposed.

Alcohol continues to be the second most commonly used psychoactive drug, only behind caffeine (Taylor, 2016). When coupled with the fact that 50% of pregnancies are unplanned, prenatal alcohol exposure continues to effect children being born. It is also important to note that in this article “substances” includes both illegal narcotics, alcohol and prescription medications, like anti-depressants and anti-seizure medication (Dondertman, 2007).

Prenatal Drug and Alcohol Exposure is when a substance taken by a pregnant women moves across the placenta and enters into the blood stream of the fetus (Nelson, Bhaghat, Browning & Mills, 2011). Many factors are involved with how prenatal exposure will present in a child and some of those factors are tied to a child’s early life experiences. While it can be tempting to look for a clear-cut connection between a specific substance and childhood development, it is nearly impossible to achieve when discussing prenatal drug and alcohol exposure.

Effects of Substances

Prenatal Drug and Alcohol Exposure is not a hard and fast diagnosis in the same way that Fetal Alcohol Spectrum Disorder is (Cowan, 2003). There is no one set of symptoms or behaviours that can be attributed to the use of one substance prenatally. Rather, Prenatal Drug and Alcohol Exposure is a term used to describe a spectrum of children’s diagnoses and disabilities. Substances that reach the fetal blood stream then have the possibility of effecting the way a child’s cells and brain develops (Ross, Graham, Money & Stanwood, 2015), leading to possible effects later in life.

The effects of substances on a fetus can be influenced by many factors including the types of substances used, the amount of substances used and the timing (Minnes, Lang & Singer, 2011). The earlier on in the pregnancy the substance is used and the higher the amounts of substances used, increases the possibility of developmental issues in a child (Behnke & Smith, 2013) because of the effect is tied to the fetus’s developing brain. In addition, there is a possibility that substances will not be used in isolation. If a pregnant women’s substance of choice is opiates and she is unable to find opiates, it is probable that she could use another substance until she is able to find her substance of choice or she may use different substances simultaneously. This makes attaching a behaviour or diagnosis a child exhibits later in life to one specific substance much more difficult (Cowan, 2003).

What a family might see when a child has been prenatally exposed is that infants tend to have a lower birth weight and a higher probability of being born prematurely (Minnes et al. 2011). This does not mean that every baby who was born with a low birth weight or prematurely was prenatally exposed, but rather that a when low birth weight has been noticed, prenatal exposure may be suspected. Newborns who have been prenatally exposed to substances excluding alcohol can also experience withdrawal-like symptoms from certain substances (like opiates or some prescriptions), which will end within the first few days of being born (Nelson et al. 2011).  

Infants who have been prenatally exposed to drugs can also show effects of withdrawal four to 12 months after birth (Nelson et al. 2011). Most of these effects are connected to the nervous system, which is affected in its development by substances (Ross et al. 2015). These signs can include poor feeding or poor sleep patterns, irritability, a high-pitched cry, problems with digestion and stiff or floppy muscles (Nelson et al. 2011). Later on in life, some substances (such as alcohol) are also tied to developmental needs or learning needs (Hughes, La Greca, & Conoley, 2001). In the chart below, some common effects are listed that have been observed in infants exposed to various substances:

Source: Institute of Medicine 1996, Report to Congress: created by Lauren Ireland M.A., BCBA 

It is important to remember that a child’s early environment can also affect how the effects of prenatal exposure are going to present themselves (Cowan, 2003). A child growing up in a stressful environment with few consistent caregivers can develop behaviors that will then interact with their experiences of prenatal exposure (Cowan, 2003). This is key to remember when adopting child, as they may have had different adverse childhood experiences. It is crucial not to attribute every behavior a child exhibits to a possible prenatal exposure and instead view prenatal exposure as one experience that has interacted with a variety of factors to shape the child into who they are.

Barriers to Establishing Prevalence

Currently, there are two ways of determining whether a woman has used substances during her pregnancy: self-reporting or biological samples (Behnke & Smith, 2013). There is still a heavy amount of stigma, shame and fear around substance abuse, especially related to pregnant women who use substances (Nelson, et. al, 2011). This can make the prevalence of prenatal exposure hard to track (Behnke & Smith, 2013). Whether adopting privately, through a local Children’s Aid Society or internationally, it is important to ask about what information is available on a child’s prenatal experiences.

Myths About Prenatal Exposure

Babies who have been prenatally exposed to cocaine are severely damaged, and will need many resources and support into adulthood.

Although cocaine exposure may effect a baby as they continue to grow, the effects appear to be less severe that the effects of alcohol (Dondertman, 2007).

Babies born prenatally exposed are at a higher risk of drug use themselves.

Prenatal exposure has not been tied concretely to any substance use later in life. It is also important to take into account a child’s early life experiences. Exposure to an individual who uses substances could be a larger factor in future substance use than a prenatal exposure experience.

Strategies for Parents

  • Be patient: Children who are suspected of being prenatally exposed to substances require patience and understanding from the adults in their lives. As children will have their prenatal exposure manifest uniquely, it is important that there is ongoing monitoring of the child’s development throughout their childhood. If a child comes into your care later in life, you can ask if this monitoring has already been done or if there are any developmental assessments in the child’s past
  • Be informed: Parenting a child who has experienced prenatal exposure means parents will need to learn more about child development and how they can best support their children as they grow. Children’s development can be uneven or inconsistent, so learning the basics is a good place to start!
  • Put prenatal exposure in context: It is also important to not place too much of an emphasis on a child’s prenatal exposure history or to tie too many behaviours to a potential exposure. Rather, it is important to look at the behaviours as a result of the entire life experiences of the child, such as grief and loss or trauma, including their prenatal exposures and everything that has occurred after their birth (Oregon Post-Adoption Resource Centre, 2006).
  • Build a support system: This support system can include various health professionals (Oregon Post-Adoption Resource Centre, 2006) like a pediatrician, occupational therapist and/or other professionals at your child’s school to assist with developing appropriate supports. Other parents who have adopted children with prenatal exposure experiences are also a great resource, as they have experience navigating services for their children.
  • Build a routine for daily life: Another good idea is to implement a structured and consistent routine in a child’s life. Children who have had unpredictable or unstable past experiences thrive in environments with predictable and stable routines (Oregon Post-Adoption Resource Centre, 2006). Routines help a child reduce stress and anxiety about what will come next, allowing them to relax in their environments and attach to the people around them.
  • Be open to the unknowns: An important strategy for parents is to be prepared for the wide range of possibilities that come with prenatal exposure (Oregon Post-Adoption Resource Centre, 2006). As stated previously, the effects of prenatal exposure can be difficult to ascertain and nearly impossible to trace back to one specific substance.
  • Be ready to advocate: Reaching out for help for a child can also include working with a child’s school, daycare and service providers to identify a child’s strengths and needs. Navigating these systems and advocating for a child to receive services are an integral part of supporting a prenatally exposed child’s development.

While there are few concrete answers when discussing how prenatal exposure affects children, it does not mean that children will always struggle or have identical experiences. Like many childhood experiences, prenatal exposure exists on a spectrum and will present individually. By approaching each child’s situation differently and focusing on a child’s individual behaviours, parents can best support their children as they grow.

Helpful Links and Resources

Baby Steps: Caring for Children with Prenatal Substance Exposure:

A guide written by the British Columbia Ministry of Children and Family Development for caring for babies who have experienced prenatal exposure. 

Living with Prenatal Drug Exposure - A Guide for Parents:

A book that focuses on the behaviours that children who have experienced prenatal exposure can show, along with a workbook for parents that assists with recognizing behaviour patterns.

Panorama - The Truth about Pills and Pregnancy:

A documentary focusing on the possible effects of prescription medications (like those prescribed for epilepsy of depression) on developing fetus’s by profiling some of the more extreme cases of the possible effects.


Behnke, M. & Smith, V.C. (2013) Prenatal Substance abuse: Short and long term effects on exposed fetus. Pediatrics, 131(3) pg. 1009-1024

Cowan, L. (2003). Living with prenatal drug exposure: A guide for parents. Vancouver, BC: Ben Simon Press

Dondertman, B. (2007) Exposure to psychotropic medications and other substances during pregnancy and lactation. Toronto, ON: Centre for Addiction and Mental Health

Hughes, J.N., La Greca, A. M. & Conoley, J. C. (2001) Handbook of Psychological Services of Children and Adults. Oxford, UK: Oxford University Press.

Kuhn, C., Swartzwelder, S. & Wilson, W. (2003) Buzzed: The straight facts about the most used and abused drugs from alcohol to ecstasy. New York, NY: W.W. Norton & Company Inc.

Minnes, S., Lang, A. & Singer, L. (2011) Prenatal tobacco, marijuana, stimulant and opiate exposure: Outcomes and practice implications. Addiction Science & Clinical Practice, 6(1) pg. 57-70

Nelson, C., Bhagat, R., Browning, K. & Mills, L. (2011) Baby steps: Caring for children with prenatal substance exposure. Vancouver, BC: Ministry of Children and Family Development

Oregon Post-Adoption Resource Centre (2006) Parenting Children who have been exposed to methamphetamines. [Brochure] Portland, Oregon

Ross, E.J., Graham, D.L., Money, K. M & Stanwood, G. D (2015) Developmental consequences of fetal exposure to drugs: What we know what and we now we still must learn. Neuropsychopharmacology, 40 (1) pg. 61-87

Taylor, G. (2016) Alcohol consumption in Canada. The Chief Public Health Officer’s Report on the State of Public Health in Canada 2015. Retrieved from:

Special Thanks

A special thanks to Shelia Burns for her assistance and insight during the writing process of this section. More information about Shelia and her work can be found at