Understanding Complications in Drug-Exposed Infants

Substance exposed or Intrauterine Drug Exposed (IUDE) infants have been exposed to toxic substances while in the womb. The most common substance exposure is to alcohol or illicit drugs, such as methamphetamines, heroin, marijuana, or cocaine. This presents an added complication for an infant. How much it affects a child depends, in part, on whether the infant is born prematurely or not.

This article will give you an idea of how different substances affect an infant if they are exposed in utero.

Tobacco and Nicotine Exposure

Up to one out of five women use tobacco and nicotine during pregnancy.

An infant exposed to tobacco and nicotine is at greater risk for:

  • Low or Extremely low birth weight, head circumference, and length
  • Neurobehavioral effects, leading to poor cognitive, psychomotor, or language skills and general academic achievement
  • Sudden Infant Death Syndrome (SIDS)
  • Hospitalizations
  • Perinatal morbidity
  • Birth defects (a small increased risk)
  • Prematurity

Alcohol Exposure

Up to 12.4 percent of women ages 15–44 years use alcohol and 3.9 percent are binge drinkers during pregnancy.

An infant exposed to alcohol is at greater risk for:

  • Fetal Alcohol Syndrome (FAS), the leading – and only preventable – cause of mental retardation. Adverse effects of FAS may include:
  • Reduced growth
  • Behavioral or cognitive disabilities
  • Central nervous system abnormalities
  • Heart, bone, kidney, or eye defects
  • Hearing loss
  • Dysmorphic features

Withdrawal from alcohol during the first 12 hours after birth, which may include:

  • Tremors
  • Poor feeding patterns, including weak sucking or exaggerated mouthing
  • Poor sleeping
  • Excessive crying

Cocaine Exposure

An infant exposed to cocaine is at greater risk for:

Withdrawal from cocaine, which may cause:

  • Central nervous system (CNS) irritability including restlessness, irritability, tremors, and increased tone
  • Sleepiness and sluggishness, which may follow CNS irritability
  • Behavioral symptoms, which may include trouble responding to human faces or voices, alternating periods of sleep and agitation, overstimulation, difficulty being consoled, exaggerated startle response, or rapid state changes(for example, when the infant goes from a quiet alert state to crying or crying excessively to sleep)
  • Neuromotor problems such as high or low muscle tone, abnormal movements, or abnormal suck-swallow patterns

Amphetamine Exposure

One-and-a-half percent of Americans use amphetamines. Multiple drug use is high in those who use amphetamines.

An infant exposed to amphetamines is at greater risk for:

  • Decreased birth weight, head circumference, and length
  • Significant complications related to blood loss from placental abruption
  • Possible central nervous system or heart abnormalities

Withdrawal from amphetamines, which may cause:

  • Abnormal sleep patterns, poor feeding, tremors, abnormal weight gain, and state dysregulation
  • Agitation, vomiting, and profuse sweating
  • Frantic fist sucking, high-pitched crying, loose stools, fevers, yawning, and increased reflexes.

Marijuana Exposure

This is the most commonly used illicit drug during pregnancy. Overall use by expecting mothers in the U.S. population is between 4.8 percent and 5.4 percent.

Limited inconclusive studies have been done in this population, but some findings suggest an infant exposed to marijuana is at greater risk for:

Withdrawal from marijuana, which may include:

  • Tremors
  • High-pitched crying
  • Abnormal sleep patterns
  • Prolonged startle reflex

Narcotics and Opioids Exposure

Examples of narcotics and opioids are morphine, heroin, and methadone.

An infant exposed to narcotics and opioids is at greater risk for:


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Verklan, M. T. and Walden, M. (ed.) (2004) Core Curriculum for Neonatal Intensive Care Nursing, Third edition. St. Louis, MO: Elsevier Science.