Don’t Judge Pregnant Women Based on Junk Science


Recently, National Advocates for Pregnant Women, the Drug Policy Alliance and the Southern Poverty Law Center filed an amicus brief on behalf of leading public health professional and advocacy organizations in support of an Alabama mother who was convicted of “chemically endangering” her “unborn” child. The state claimed that the newborn she had carried for twenty-five weeks and undergone cesarean surgery to deliver, died because she used a controlled substance while pregnant.

Reactions to another blog about the same case reveal that some people believe such convictions are justified because a pregnant woman who uses an illegal drug will cause her child  “all sorts of brain damage, stunt its development and even kill it.” While such beliefs are widely held, experts tell us that they are far from accurate.

We should pause here to say that if what you want to do is judge pregnant women, then you probably should stop reading now. But, if you actually care about babies you might want to find out what the experts have to say.

What you will find out is that scientific and medical research does not always conform to our beliefs. Sometimes it does not even match what the media told us were “expert” views.

This is especially true when it comes to pregnant drug using women. For nearly two decades popular media claimed that any illegal drugs used by pregnant women would inevitably and significantly damage their babies.

The actual scientific research contradicts this assumption. Carefully constructed, unbiased scientific research has not found that prenatal exposure to any of the illegal drugs causes unique or even inevitable harm. This research is so clear that that courts and leading federal agencies have concluded that what most people heard was “essentially a myth.” As the National Institute for Drug Abuse explains, “babies born to mothers who used crack cocaine while pregnant, were at one time written off by many as a lost generation. . . .  It was later found that this was a gross exaggeration.”

Leading researchers, publishing in the most highly regarded, peer reviewed journals, warned about a rush to judgment. And when research results started to come in, they found that the harmful effects of illegal drugs, when they could identify any, are less severe than those of alcohol and are comparable to those of tobacco:  two legal substances used much more often by pregnant women, despite health warnings. By the way, here is what a citation to a responsible medical research article looks like: Deborah A. Frank et al., Growth, Development, and Behavior in Early Childhood Following Prenatal Cocaine Exposure: A Systematic Review, 285 JAMA 1613 (2001)

Yes, marijuana, cocaine, and methamphetamine are illegal, but not because our legislators determined that these drugs pose unique risks to fetuses. (To find out why some drugs are regulated by the FDA and others by the police, read  Drug Crazy).   

Fortunately, some people are beginning to listen. For example judges on South Carolina’s Supreme Court listened. As a result, they unanimously overturned the conviction of a woman who’s drug use allegedly caused a stillbirth.  The judges agreed that the research the prosecutor relied on was “outdated” and that counsel failed to call experts who would have testified about “recent studies showing that cocaine is no more harmful to a fetus than nicotine use, poor nutrition, lack of prenatal care, or other conditions commonly associated with the urban poor.”

Even the popular press is catching up. For example, the Kansas City Star reported that “[a]fter monitoring these children into their teen years, researchers think cocaine exposure is less severe than alcohol and comparable to tobacco use during pregnancy. The Oklahoman, reported that “[d]eepening research shows babies who are exposed to cocaine or methamphetamine in the womb fare similarly to other babies as they age.” And the New York Times ran a story last year entitled: The Epidemic That Wasn’t.

Even if prosecutors don’t get it, many state legislators do—which is one reason why state legislatures in Alabama and across the country have refused to pass criminal laws specifically directed to pregnant drug using women.

They understand that ignoring current scientific research about drug use and pregnancy can also be dangerous to children. The assumption that every child prenatally exposed to a drug is damaged has led to kids being labeled and teased and to schools assuming such  kids cannot learn when in fact they may be high achievers. Such assumptions have even been used to distract from real instances of child abuse. For example, when New Jersey community members noticed that four adopted boys in a large family looked undernourished, the parents said “the four brothers had been born addicted to crack cocaine and had an eating disorder.” That was enough to stop the inquiries until the boys were near death because their adoptive parents were starving them.

So before you comment about pregnant women and drugs please look at the research.  And if you see a comment about this subject that sounds like it is based on an assumption, demand, for the sake of pregnant women and their babies, that the author provide support for the claim by posting this simple statement: “source and citation needed.”

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  • crowepps

    The assumption that every child prenatally exposed to a drug is damaged has led to kids being labeled and teased and to schools assuming such kids cannot learn when in fact they may be high achievers.

    It was my experience when my daughter was in school that the myth of drug use leading to prenatal damage was interpreted by some of the teachers to mean that even genetically linked problem like dyslexia implied that I must have used drugs or alcohol during my pregnancy.

     

    In other words, if children had learning disabilities the PRESUMPTION was that it was their mother’s fault.  This did not help in trying to get her services, since that presumption labeled me a criminal and/or neglectful parent at fault for ‘causing’ the problem.

     

    It’s ironic that at the same time people get all hysterical about this issue, they ignore the fact that just as much damage is caused to the fetus by poor nutrition and lack of prenatal care and insist pregnant girls and women shouldn’t be ‘rewarded for promiscuity’ through the provision of food or medical services.

     

    Ran across an article in England about how the stillbirth rate is higher in poor areas and the cause seems to be “interuterine growth restriction”, that the fetus doesn’t grow correctly.

    http://www.bbc.co.uk/news/health-10700910

  • faultroy

    You’re absolutely right that we should not convict women on junk science, but your comments regarding expert testimony implies that the State has no prevailing interest in doing everything it can to develop healthy thriving babies. Furthermore, the comments of “experts” seems to be taken totally out of context.  First of all if you read your own writing, experts say that cocaine and drug use is “no more harmful than alchohol or tobacco…”  That is not to say that ingesting crack and cocaine while pregnant causes no damage.  All these experts are saying is that it CAUSES NO MORE DAMAGE THAN ALCHOHOL AND TOBACCO.  And while the case you cite is certainly valid and accurate, the implication is that the courts are saying that one cannot convict a person just because they take crack and cocaine.   This is totally false.  What the court said was that if there is disputed expert testimony, you have to present the disputed evidence and let the jury (assuming it is a jury trial) render their verdict based ALL PREVAILING EVIDENCE.   In the case cited above, the prosecution presented outdated research data that clearly tied substance abuse with the death of the of the child–and used this data as the “smoking gun” as to why the child died.  However, current research does not draw that direct a conclusion.  We know from other research that there are many factors affecting fetal viability and its ability to thrive.  We also know that what we currently call IQ (intelligence quota) is substantially affected by what a mother ingests.  How fit she is and even her mental condition at time of pregnancy and birth.  In the above, we are talking about a felony charge.  Nor does your writings discuss the child rearing and safety concerns with someone completely devoid of reality when high.  The reality is far different from the scant very narrow evidence that “expert testimony ” wouldl imply.  The great societal shame is that we allow these addicted women to bear and rear children and receive state and federal  monies without detailed oversight.  We then have another generation of dysfunctional and impoverished children and finally adults that now repeat the cycle.  This should not and cannot be sustained.  We should judge these women as harshly and cruelly as society permits–and of course that includes alchohol abuse and tobacco abuse.  If you should have a right to choose your “reproductive rights,” you should also be required to take responsibility for you “reproductive decisions,” regardless as to how painful they may be.

    • bj-survivor

      And when research results started to come in, they found that the harmful effects of illegal drugs, when they could identify any, are less severe than those of alcohol and are comparable to those of tobacco:  two legal substances used much more often by pregnant women, despite health warnings.

       

      No, the research did not say “causes no more damage than alcohol and tobacco.” Nice try, though.

  • grayduck

    “For nearly two decades popular media claimed that any illegal drugs used by pregnant women would inevitably and significantly damage their babies. The actual scientific research contradicts this assumption. … the harmful effects of illegal drugs…are comparable to those of tobacco…”

     

    The sentences above show that the evidence presented by the authors does not justify their conclusion.

     

  • arekushieru

    Errr, sorry, no, it doesn’t.  If you could actually proVIDE the evidence I’m sure you would see that, too… perhaps….

  • rachel-larris

    I was thinking about this recently when I watched, of all things, the VH1 “Behind the Music” special about Courtney Love. Year ago there was a scandal when Courtney talked to a Vanity Fair reporter about possibly using drugs while pregnant (as well as smoking in front of her child). It became the basis for the L.A. Child Protective Services to come and remove her baby from the hospital right after she was born.

    When I was a kid and I heard this story I assumed the L.A. Child Protective Services was ABSOLUTELY CORRECT in their actions. Courtney “deserved it” in my opinion.

    It wasn’t until watching the show 20 years later talk about that incident when I realized I had come a complete 180 from my original position and realized what a huge injustice had been done to Courtney as a new mom. (Regardless of her current relationship with her daughter, that’s immaterial to her situation as a newborn). In fact had such actions happen to any other woman besides the infamous Courtney Love she might have gotten a lot of sympathy from the public. Instead the view was that she was the “bad mom” who deserved to have her baby taken away. It’s outrageous and shouldn’t have happened then, let alone NOW to anyone.

  • saltyc

     We should judge these women as harshly and cruelly as society permits

     

     

    And somehow punishing the mother will help the child……

    somehow. Hating, shaming, punishing, are always great ways to create thriving children.

     

    Sorry, but that’s 100% pure bullshit.

    I’ll tell you right now, I know someone very close to me, who was smoking crack …CRACK  when she found out she was pregnant. She quit crack after that, but still smoked a marijuana joint every few weeks or so. Her 5-yr-old child is now thriving, healthy, rambunctous, current on all cognitive, social and developmental marks.

    But I guess the real problem is, how do we as a society allow for such a nasty, dirty drug-using mother get away with the crime of using drugs while pregnant? Maybe the child would not be doing so well on emotional development with her mother a convicted felon who couldn’t get a job after doing time, but at least WE WOULDN”T BE LETTING HER GET AWAY WITH IT.

  • saltyc

    Thank you Rachel,

     

    The important thing is to keep sight of the goal, that children deserve to be with cherished, loved, and healthy. And that is with the mother who loves them and is able to take care of them.

  • saltyc

    The actual quote was “And when research results started to come in, they found that the harmful effects of illegal drugs, when they could identify any, are less severe than those of alcohol and are comparable to those of tobacco”

     

    I Italicized the key words you cut out.

    You would be surprised to learn how many more pregnant women are using illegal drugs than is known because they don’t generally tell you and you can’t tell from looking at the baby. The cases where the mother’s drug use is known are probably the most extreme cases where the mother was using large quantities, or where there were other social/economic disadvantages.

  • squirrely-girl

    …but still smoked a marijuana joint every few weeks or so. Her 5-yr-old child is now thriving, healthy, rambunctous, current on all cognitive, social and developmental marks.

     

    The marijuana/THC research is pretty well developed in other nations and the biggest negative for a pregnant woman (and everybody for that matter) is the actual smoking, which obviously exposes the mother and fetus to additional carcinogens and decreased oxygen. However, there are multiple ways to consume THC and eating it or vaporizing it are much more effective and safer. The research on THC consumption during pregnancy (and subsequent breastfeeding) has actually suggested more positive outcomes for those children than not – higher IQ in early childhood, more consistent newborn feeding patterns, etc. 

  • saltyc

    True, SquirrelyG

    And it was lucky that the child happens to be on target developmentally, because any problems would automatically be blamed on the mother’s habits, whether or not there was an actual causal connection. 

     

    Heck even taking a warm bath now is seen as jeopardizing the future child. Being stressed out is endangering your child, so is not keeping the house clean, making enough money or getting enough sleep.

     

    Wait. How about giving mothers a helping hand or doing some little thing to relieve their stress? Nah, let’s throw the book at ‘em, that always works.

  • saltyc

    When will people re-examine their need to punish women for being mothers?

     

    The more you look at it, it really is true, no matter what you do, just having functioning ovaries & uterus is original sin.

     

    It’s really sad that we need a group like Advocates for Pregnant Women. Of course they’re doing invaluable work, but you’d think that in a society that glamorizes celebrity motherhood, religious groups that promote motherhood, heroic stories of mothers’ sacrifice, etc, that pregnancy would be some kind of privilege rather than the liability it is.

  • squirrely-girl

    We also know that what we currently call IQ (intelligence quota) is substantially affected by what a mother ingests. 

    This is an entirely too simplistic way of looking at this. IQ is influenced by a variety of factors, but genetics and postnatal environment are FAR more influential than what a mother “ingests” at any given point during nine months. Much of this is because neural development continues long into early childhood. It’s incredibly important to also note that the effects of any teratogen will depend on the specific point and period of time during fetal development that the ZBEF and woman were exposed. Excessive or specific teratogenic exposure during the first trimester often results in miscarriage while second trimester exposure is more likely to result in structural deformities, depending on what was forming at the time (e.g., arms, legs, face). Exposure during the third trimester is generally associated with low birth weight, poor lung development, and early delivery. 

    How fit she is and even her mental condition at time of pregnancy and birth. 

    Way to sound like a scientologist :/ Are you a proponent of silent birthing as well? Women don’t magically transpose their mental state onto a child at delivery. Whether or not a woman is physically “fit” at birth is more likely to affect the actual birthing process itself, not the long term intellectual abilities of the child. Now whether a woman is mentally “fit” at childbirth is debatable. However, that would have a greater impact on her ability to provide appropriate care more than anything… which, over time could affect the child’s environment thus impacting potential IQ. 

  • squirrely-girl

    You bring up a great point about maternal stress. Stress raises cortisol levels which has all kinds of negative on the body when you’re not pregnant (e.g., weight gain, sleep disturbance, cognitive disturbance). The effects of maternal stress on pregnancy are rather well documented and most OB/GYNs actively encourage stress reduction (how practical this actually is has yet to be determined). This is one of the reasons many professionals recommend progressively reducing cigarette use rather than going cold turkey – the stress of quiting smoking can totally outweigh the potential benefits.

  • squirrely-girl

    … allows those individuals to ignore all of the other negative contributing problems and outcomes, such as poverty, sexism, racism, and lack of educational opportunity. In other words, it’s all HER fault so WE don’t have to help now. 

  • bornin1984

    If you decide to do hard drugs, it is your fault. Whatever happened to that choice mantra?

    • invalid-0

      yeah, and if you decide to be poor, “F*CK YOU, IM NOT HELPING YOU WITH *MY* TAXES. GO GET A JOB. OR GO TO SCHOOL TO GET A BETTER PAYING ONE.”

       

      if you are overweight, “F*CK YOU, YOU’RE THE ONE WHO ATE CHEESEBURGERS AND PIZZA EVERYDAY”

       

      your statement proves you have no empathy for anyone and lack the capacity to ever even imagine the circumstances under which someone would use drugs.  

       

       

  • arekushieru

    No, that’s the ProLife mantra.  If you decide to have sex, it’s your fault you got pregnant.  Therefore, if you decide to do hard drugs, it’s your fault the fetus was affected.  However, penalizing a woman for something incurred during pregnancy, penalizes a woman for a bodily function.  A bodily function whereby what she ingests may be passed on to a fetus through her uterus.

  • grayduck

    SaltyC on July 23, 2010 – 12:33pm: “Nice use of ellipses.”

     

    Removing the ellipses only serves to show how they needed to bury the most salient information amid obfuscation.

     

  • arekushieru

    Sure, much like your own ‘obfuscation’, GD….?

  • prowomen

    Other things that harm babies are the physical abuse and murders of pregnant women.  Homicide was the second most common cause of death among pregnant women in the United States between 1991 and 1999.  

    Also harmful to children are the 5 that die every day from child abuse, with most of them below age six.  In 2005, about 800,000 children were placed in foster homes because of abuse or neglect.

    Sperm is affected by drugs, alcohol, etc., so the sperm donor for the baby should, also, be prosecuted and put in prison for 15 years for his part in what may have been done to harm the baby.

    Legal drugs, also, may affect the development or health of a fetus.  Practically every prescribed or over-the-counter drug, and even herbs, include a warning to get physician approval if pregnant.  Aside from prescribed Thalidomide, which resulted in many children with parts of limbs missing, most side effects are unknown.

    The legal system generally doesn’t interfere in the lives of the wealthy and famous.  Being treated like an inhuman, mindless breeding machine is generally reserved for the poor and powerless, even though they deserve equal treatment under the law along with the males who impregnate them.

  • crowepps

    It would be interesting to see how the possibility of secondary effects has been adjusted in a study of the “damage” caused by tobacco, as well, since as I understand it the “damage” is smaller birth weight, which is more common in poor women, and smokers are disproportionately found among the poor.

     

    Noticed publicity recently on some studies talking about how being obese also causes small birth weight, and expect people to start objecting to pregnant women ‘deliberately’ choosing to be overweight while pregnant.  And again, obesity disproportionately is found among the poor.

     

    I suppose to be consistently Pro-Fetus there ought to be laws passed that criminalize women ‘having sex while poor’ just in case it has an impact on any potential zygotes that might be created.

     

    But then, that’s what ALL the anti-abortion rhetoric is about, isn’t it?  “How DARE you have sex when you don’t want to and are not fit to be a **MOTHER**”?