The Interfaces of Perinatal Addiction Ira J ChasnofT In the last few years, problems associated with drug use in pregnancy have become endemic. As cocaine has become the drug of choice for millions of Americans, including pregnant women, as AIDS has become more commonly recognized in women and infants, and as legal cases have begun to raise the question of fetal abuse, no professional group has come forward to serve as advocate for this special population of substance abusers. Meanwhile, however, physicians, nurses, social service agencies and public health officials have all been faced with increasing numbers of infants showing the detrimental effects of their mothers' drug use. Although problems of substance abuse in pregnancy have received increasing attention in the medical literature since the early 1970s, there has recently been a very rapid increase in the number of articles published related to this field. The reasons for this new interest are easily understood when current statistics from the National Institute on Drug Abuse are reviewed 1. Although patterns of abuse of alcohol, marijuana, heroin and other substances by women of childbearing age have changed very little over the last ten years, the incidence of cocaine use in this special population has been rising rapidly, a reflection of cocaine's increasing popularity among the general population of the United States.

The Interfaces of Perinatal Addiction Ira J ChasnofT In the last few years, problems associated with drug use in pregnancy have become endemic. As cocaine has become the drug of choice for millions of Americans, including pregnant women, as AIDS has become more commonly recognized in women and infants, and as legal cases have begun to raise the question of fetal abuse, no professional group has come forward to serve as advocate for this special population of substance abusers. Meanwhile, however, physicians, nurses, social service agencies and public health officials have all been faced with increasing numbers of infants showing the detrimental effects of their mothers' drug use. Although problems of substance abuse in pregnancy have received increasing attention in the medical literature since the early 1970s, there has recently been a very rapid increase in the number of articles published related to this field. The reasons for this new interest are easily understood when current statistics from the National Institute on Drug Abuse are reviewed 1. Although patterns of abuse of alcohol, marijuana, heroin and other substances by women of childbearing age have changed very little over the last ten years, the incidence of cocaine use in this special population has been rising rapidly, a reflection of cocaine's increasing popularity among the general population of the United States.

With the emergence of the biological sciences in the seventeenth and eighteenth centuries, some explanations of congenital malformations with a basis in scientific fact were formulated. It was not, however, until the thalidomide tragedy in 1961 that the necessity for further study of the effects of environmental factors on congenital malformations was recognized. By the early 1970s concentrated efforts had begun to be directed toward evaluating the effects on the unborn child of mood-altering drugs taken during pregnancy. Over the past decade, research and treatment programs have led to the recognition of a full range of psychoactive drugs that affect the developing fetus either somatically or behaviorally. Programs for the treatment of the pregnant drug addict have been developed which concentrate not only on the pharmacologic therapy of the woman but also on the social and psychologic characteristics that place her and her unborn child at risk. This book is an attempt to bring together clinicians and researchers who have been active in developing programs for the recognition and management of the chemically dependent pregnant woman and her newborn. The contributions of the multiple disciplines which the authors represent emphasize the need for a multifactorial approach to the problems of drug use and abuse during pregnancy. It is hoped that through this type of approach a better future for substance-exposed infants, innocent bystanders in the process of addiction, can be assured. Ira J. Chasnoff vii Contributing Authors I. J. CHASNOFF, MD W.