• Nearly any psychoactive licit or illicit substance consumed by the pregnant woman is likely to result in enhanced risk of medical, developmental, and emotional/behavioral disability in the developing infant/child. These risks can be compounded by biologic and psychosocial factors associated with maternal addiction. • Drug-dependent women do not use substances in isolation and they cannot escape the myriad complications of their internal and external environments and the attendant risks to the developing fetus and infant. • The developmental trajectories of fetuses exposed to psychoactive substances may be altered by many factors, including disruption to neuroendocrine and neurotransmitter system development and fetal programming via stress hormone changes, resulting in altered set points for physiologic, metabolic, and behavioral outcomes. (69) • Epigenetic models of developmental theory examining the intersecting influences of genes, physiology, and behavior with the physical, cultural, and social environment as well as other mechanisms have been implicated in the alteration of developmental trajectories. (5) • These effects occur through the programming of cell fate and differentiation, in defining ultimate activity levels of specific functional systems, and in mediating environmental modulation of genetically based developmental programs. In this context, maternal substance use during gestation may directly or indirectly derail normal development by adversely modifying fetal/neonatal gene expression, resulting in disruption in brain development. • The consequences of drug exposure can be seen at birth but sometimes do not emerge until later in life and may be produced at doses that are relatively harmless for adults. • The role for all clinicians in the comprehensive care of the substance-exposed neonate should include thorough, comprehensive, and individual evaluation of the infant, the mother, and their interaction. Only through a willingness to understand and treat the mother who has drug addiction and the exposed infant as a pair, which may involve the extension of the boundaries of pediatric care, can we provide optimal care for substance-exposed infants, perhaps the most poorly understood, marginalized, and vulnerable segment of the pediatric population.
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health