■ No evidence that lysergic acid diethylamide (LSD) or other hallucinogens cause chromosomal damage or other deleterious effects on human pregnancy

■ There have been no studies on the potential long-term effects on neonatal neurodevelopment.


Crystal methamphetamine ("ice," "blue ice"), a potent IV stimulant, has been associated with:

■ Decreased fetal head circumference

■ Placental abruption

■ Intrauterine growth retardation (IUGR)

■ Fetal death in utero

The anorectic properties of amphetamines may severely impair nutrition during pregnancy.

Exposure to Violence

■ Twenty percent of all pregnant women are battered during pregnancy.

■ For some women, the violence is initiated at the time of pregnancy.

■ One half of women who are physically abused prior to pregnancy continue to be battered during pregnancy.

■ Ask: "Are you in a relationship in which you are being hit, kicked, slapped, or threatened?"

■ All abused patients should be given information regarding their immediate safety and referrals for counseling and support.


Pulmonary hypertension:

■ Associated with a 50% maternal mortality rate and a > 40% fetal mortality rate

Eisenmenger's syndrome:


Nutritional Recommendations

■ Folic acid supplementation:

■ If previous pregnancies: 4 mg/day starting 4 weeks prior to conception, through T1

Physical Activity Recommendations

■ Women who exercise regularly before pregnancy are encouraged to continue.

■ For the normal healthy woman, a low-impact exercise regimen may be continued throughout pregnancy.

Folic acid supplementation reduces the risk of neural tube defects (NTDs).


Drug exposure is responsible for 2 to 3% of birth defects.

The placenta permits the passage of many drugs and dietary substances:

■ Lipid-soluble substances readily cross the placenta.

■ Water-soluble substances cross less well because of their larger molecular weight.

■ The greater degree to which a drug is bound to plasma protein, the less likely it is free to cross.

■ The minimal effective dose should be employed.

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