Substance abuse.

The potential for human developmental toxicity caused by chemical exposure was not generally recognized until the thalidomide tragedy of the early 1960s, at which time it was acknowledged that the placenta is not a barrier protecting the fetus. The focus of this chapter is to present the role of substance abuse screening in prenatal care, the gamut of drugs, and the clinical implications of the substances abused by pregnant women, as well as the legal and ethical considerations. Physiologic and care issues will be discussed. Legal substances discussed include the commonly used artificial sweeteners, caffeine, cigarette smoking, alcohol, and over-the-counter and prescription drugs. Illegal substances discussed include marijuana, phencyclidine, lysergic acid diethylamide, opiates, and cocaine.