Referrals, Matches, and Prenatal Drug or Alcohol Use

Answers to your most frequently asked questions about prenatal drug and alcohol use when considering an adoption referral.

A pregnant woman, thinking about prenatal drug and alcohol use

How much damage do prenatal drugs and alcohol do?

Experienced adoption pediatricians say they assume that any child placed for adoption may have been exposed to drugs, alcohol, and tobacco. Long-term effects depend on which substance, the degree and timing of the exposure, and on the mother’s own health. Before you choose your adoption path, talk to an adoption pediatrician about risk factors and complications.

  • Alcohol: Drinking during pregnancy results in a spectrum of results from fetal alcohol syndrome (FAS, which, in its most severe form, results in lifelong physical and mental handicaps) to fetal alcohol effect (FAE, which has implications for behavior and learning disabilities) to no discernible damage at all.
  • Marijuana: Heavy use is correlated with attention deficit disorders and learning disabilities.
  • Heroin: Babies exposed to heroin during pregnancy may need treatment for withdrawal, but there don’t seem to be long-term consequences.
  • Cocaine: Twenty-odd years ago, when crack cocaine was epidemic in U.S. inner cities, sociologists predicted a “lost generation” of crack babies with permanent, devastating brain damage. In fact, while cocaine is far from harmless, long-term studies of exposed children show very mild, if any, effects on behavior and learning.
  • Ecstasy (MDMA): Early research suggests that ecstasy used in the third trimester of pregnancy may produce learning disabilities, but no definite link has been made.
  • Methamphetamines: Researchers are still accumulating data on the long-term effects of meth use, but indications are that use in any stage of pregnancy may cause behavioral and learning disabilities.
  • Tobacco: Whether the birth mother smokes herself or is exposed to second-hand smoke, the risk is of low birth weight, with its attendant complications.
  • Prescription drugs: Adoptive parents focus on illegal drug use, but should be alert to use and abuse of prescription drugs as well. Some commonly used medications (like the acne drug Accutane) do more damage to a fetus than cocaine or heroin.
  • Environmental toxins: In international adoption, parents should learn about the environment where the birth mother lived during pregnancy, and where the child lived before adoption. In countries with no environmental protections (that is, virtually all sending countries), both may have been exposed to chemicals (through industrial pollution, for example) or other toxins at levels no longer seen in the U.S.

Dr. Jeri Jenista, a pediatrician and adoptive mother of four Indian-born daughters, says: “Early in your adoption process, think about the worst case you can accept. Then, when you are faced with a birth mother match or a child referral, remember — and stick to — your original decision.”

Drugs and alcohol can have a direct effect on the fetus, but they can also have the indirect effects of premature birth and low birth weight — the two most significant indicators for long term problems. The most important bits of information to get are: How long was the pregnancy, and what did the baby weigh?

Can I find a birth mother who definitely hasn’t used drugs or alcohol?

Some of our families have chosen to adopt from countries or communities with lower rates of drug and alcohol use. China, for example, was favored because young women, especially in rural areas, didn’t have easy access to alcohol. It’s certainly worth factoring this into your choice of country or community. (The Centers for Disease Control publishes state-by-state reports on the prevalence of drinking before and during pregnancy in the U.S. The World Health Organization publishes country-by-country reports on alcohol use in general.) However, statistics are always out of date (as China has become wealthier and more urban, alcohol use has risen dramatically), and, more importantly, they can’t tell you anything about an individual child.

Can’t we just test the birth mother — or the baby?

In domestic infant adoption, if the expectant mother is getting prenatal care, her doctor will order a panel of tests that may or may not include tests for substance abuse. (This will depend on state requirements and the doctor’s own practice.) Your social worker or attorney is required to tell you the results of those tests, if they are available — and to tell you if the birth mother refused testing. However, tests are of very limited use. Alcohol, for example, appears to do its greatest damage in the first eight weeks of pregnancy, when the mother may not even realize she is expecting. Testing a newborn will tell you only about drug or alcohol exposure during the past 72 hours, so while a positive result would be cause for alarm, a negative isn’t particularly useful.

In international adoption, you are unlikely to know much about the birth mother’s drug and alcohol use. Before you get a referral, find an adoption pediatrician experienced in evaluating signs of fetal alcohol syndrome, and make sure your agency knows how to get photographs and videos (full face, straight on, no distortion) for diagnosis.

Experienced social workers, doctors, and adoptive families don’t rely on tests, but on counseling for the expectant mother. A birth mother whose counselor is clearly working for her benefit, not for the adoptive parents, is far more likely to make an honest disclosure of her own history — and to follow her counselor’s advice for a healthy pregnancy. For this reason alone, adoptive parents should insist that a birth mother have independent counseling.

Is a child whose birth parents abused drugs and alcohol more likely to grow up to be an alcoholic or drug addict?

Not enough is known about the heredity of risk factors to make any assumptions. Psychologists warn, however, against creating a self-fulfilling prophecy. Parents and professionals should discuss drug abuse with adolescents, without suggesting that the child is more likely to abuse drugs because his or her birth parent did so. As an adolescent develops an identity, such suggestions may, in fact, increase a child’s interest in exploring illegal substances, rather than curtail the behavior. In open adoptions, adoptive parents need to promote abstinence but not offer criticism of the birth parents.

“Our adoption attorney arranged a meeting with a young prospective birth mother and her mother (whom I’ll call Jane). We began to chat animatedly about our family philosophies, history, and values. Jane mentioned that she had grown up in an acrimonious household with an alcoholic father. After we left the meeting, I said to my husband, “We can’t adopt this child … there is alcoholism in the family!” My husband shot me a curious look and said, “Uh, what about your brother? My sister?” Oh right, I thought. In my enthusiasm for screening the genetic problems of the child that would join our family, the skeletons in my own family closet … and there were many … had somehow dropped from my consciousness.” —AF reader

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