Maternal Exposure and Neonatal Effects of Drugs of Abuse

Jessica M Barry, Angela K. Birnbaum, Lisa R. Jasin, Catherine M Sherwin

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


The public health crisis of pregnant women being exposed to drugs of abuse and of its impact on their unborn children continues to grow at an alarming rate globally. The state of pregnancy is unique, with physiological changes that can lead to changes in the way drugs are handled by the body in both pharmacokinetics and response. These changes place the pregnant woman, fetus, and newborn infant at risk, as many of these drugs can cross the placenta and into breast milk. The substances most commonly linked to harmful effects include alcohol, tobacco, cannabis, stimulants, and opioids. The pharmacological and toxicological changes caused by in utero exposure or breastfeeding exposure are difficult to study, and the full extent of the mechanisms involved are not fully understood. However, these changes can significantly affect the risks of substance abuse and influence optimal treatment of pregnant women with a substance use disorder. In addition, newborns who were exposed to drugs of abuse in utero can experience withdrawal syndromes. Pharmacological management in infants is used to guide and treat withdrawal symptoms, with the goal being to improve the infant's sleep, eating, and comfort. Several barriers may prevent pregnant women from seeking help for substance use, including stigma and interactions with the legal system. Understanding changes in pharmacology, including pharmacokinetic changes that happen during pregnancy, is essential for anticipating the extent of maternal exposure and neonatal adverse effects.

Original languageEnglish (US)
Pages (from-to)S142-S155
JournalJournal of Clinical Pharmacology
Volume61 Suppl 2
Issue numberS2
StatePublished - Aug 2021

Bibliographical note

Funding Information:
No funding was received for this work. We thank and acknowledge the help of Sandra Bowers, BA, Project Manager in the Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, for her assistance with EndNote and proofreading of this article.

Publisher Copyright:
© 2021, The American College of Clinical Pharmacology


  • drug abuse
  • drug withdrawal symptoms
  • neonatal abstinence syndrome
  • opioid use
  • pregnancy physiology
  • substance use in pregnancy


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