Transcript Document 7818588

Fetal Harm
James G. Anderson, Ph.D.
Purdue University
Problems for Newborns
• 11.0% exposed to illegal drugs
• 1.9 per 1,000 live births fetal alcohol syndrome
• 17% pregnant women smoke
Babies Harmed by Alcohol
Reported incidence rate of fetal alcohol syndrome by
year of birth (per 10,000 live births)
20
18
16
14
12
10
8
6
4
2
0
19
6.8
4
1.2
1.9
1980
1985
1990
1993
2005
Fetal Alcohol Syndrome by
Race/Ethnicity
Native
Americans
29.9
6
Blacks
Whites
0.9
Hispanics
0.8
Asians
0.3
0
Incidence per
10,000 births
10
20
30
40
Fetal Harm from Alcohol
• Growth Retardation
– Prenatal
– Postnatal
• Central Nervous System
– Neurological Abnormalities
– Behavioral Dysfunction
– Intellectual Impairment
•
Skull/Brain Malformations
– Short eye openings
– Flattened Midface
– Thin Upper Lip
Tobacco-Exposed Infants Exhibit
Significant Neurobehavioral Effects
NNNS Category
Handling
Excitability
Hypertonicity
Tobacco-Exposed
Infants (N=27)
0.57
3.08
0.37
Non-Exposed
Infants (N=29)
Measure Description, Number
of Items, and Range
0.44
Mean number of strategies used
to maintain infant's alert state (8
items, 0-1)
1.91
Sum of items measuring
excitable behavior(15 items, 015)
0.00
Sum of items measuring excess
muscle rigidity response (10
items, 0-10)
Total Stress/Abstinence
(Withdrawal)
0.12
0.05
Mean number of observed
stress/abstinence signs (50 items,
0-1)
Central Nervous
System Stress
0.16
0.09
Subscale of total stress/
abstinence score (range 0-1)
Gastrointestinal Stress
0.16
0.02
Subscale of total stress
/abstinence score(range 0-1)
Visual Stress
0.11
0.01
Subscale of total stress/
abstinence score (range 0-1)
Impact of Prenatal Drug Exposure
– Prenatal Effects
•
•
•
•
•
•
•
•
High blood pressure/preeclampsia
Stillbirth
Premature birth
Abnormally smaller birth weight
Increased risk of genital-urinary abnormalities
Skull malformations
Limb defects
Neural tube defects
Impact of Prenatal Drug Exposure
– Postnatal Effects
• Hypersensitive
• Irritable
• Altered sleep-wake cycles
– Infant/Toddler Effects
• Motor Disorders
• Expressive language difficulties
• Poor impulse control
Court Ordered Interventions
Court Ordered Contraception
• Buck vs. Bell. U.S. Supreme Court upheld the
sterilization of an alleged retarded woman.
• State courts in California, Ohio, and Florida mandated
the use of contraceptives as a condition of probation
• Darlene Johnson was offered a reduction in her prison
term by a California court if she agreed to the use of
Norplant. She had been convicted of abusing her two
children
• The Kansas State Legislature considered a proposal that
drug-abusing fertile women could be placed on probation
if they accepted the use of Norplant.
Court Ordered Medical Treatment
(Maternal-Fetal conflicts)
• Jessie Mae Jefferson refused a c-section on religious
grounds. Doctors felt the c-section necessary. Georgia
courts ordered a c-section
• Angela Carder, a pregnant woman dying of bone cancer.
The DC court ordered a c-section against the wishes of
Mrs. Carder, her family and physician
• 19 states invalidate a “right to die” living will for
woman if she gets pregnant; 11 other states invalidate a
living will if birth is possible
Prosecution
• Shannon Moss, a Georgia woman who gave births
to twins, one of which died after birth, was
charged with murder after she tested positive for
methamphetamines.
• Rebecca Corneau belongs to a sect that rejects
modern medicine. Her son died soon after birth
because he was not allowed to undergo a routine
medical procedure. When she became pregnant
again, a judge ordered her to be sent to a center for
pregnant inmates until she gave birth.
Prosecutions
• A Wisconsin court dismissed charges of
attempted murder against Deborah
Zimmerman who drank heavily during her 9
months of pregnancy. Her child was born
sickly but apparently recovered.
• A Utah woman snorted so much
methamphetamine that her fetus was born
stillborn.
Prosecution
• Pamela Rae Stewart gave birth to a brain damaged infant
who died at 6 weeks. While pregnant she had been warned
by her doctor to seek medical treatment, abstain from sex
with her husband, and not take any drugs. Mrs. Stewart was
prosecuted in California.
• Mothers in Illinois and Michigan were prosecuted for
involuntary manslaughter for causing the death of their
newborn babies by using cocaine during pregnancy.
• Since 1985 30 states have arrested and charged 200 women
for exposing fetuses to drugs and alcohol.
• From 1989 to 1994, South Carolina arrested 42 pregnant
women who refused treatment. .
Medical University of South
Carolina Hospital
• Routinely tested the urine of pregnant women for
drugs without their consent
• Women who tested positive for drugs were given a
choice: enter a drug rehabilitation program or be
prosecuted for illegal drug use and fetal harm
• Nine women were arrested and 2 were jailed.
• Cornelia Whitner was sentenced to eight years in
prison when her baby was born with cocaine
metabolites in his system
Medical University of South
Carolina Hospital
• She filed a petition for Post Conviction
Relief arguing that the state criminal neglect
statute covered children not fetuses and that
she had not been informed that the statute
might apply to prenatal drug abuse.
• After her petition was granted the state
appealed to the Supreme Court of South
Carolina.
Medical University of South Carolina
Court Decisions
• The Supreme Court of South Carolinas ruled that the
state legislature could impose additional criminal
penalties on pregnant women using drugs and that the
term “child” included fetuses.
• The 4th Circuit Court of Appeals ruled that searches
(drug testing) was reasonable under the U.S.
Constitution's 4th amendment which prohibits
unreasonable searches
• The U.S. Supreme Court ruled that the Medical College
of South Carolina’s policy of drug testing was
unconstitutional
Discussion Questions
• Is a fetus a person and does it have ‘rights’
independent of the mother? If so, what are
these rights?
• Is requiring screening for drugs a violation of a
woman’s constitutional rights?
• Will mandatory drug testing discourage poor
women from seeking prenatal care?
• Will some addicts seek late-term abortions
rather than deliver a baby with signs of drug
abuse?
Discussion Questions
• Can child endangerment statutes be
applied to fetuses before they are viable?
• Does a policy of drug testing pregnant
women who seek care in public hospitals
discriminate against the poor and
minorities?
Discussion Questions
• Does every action by a pregnant woman that
might endanger the fetus, legal or illegal,
constitute unlawful neglect? (e.g., smoking
drinking, working at hazardous jobs, etc.)
• What about actions of the male partner that
might endanger the fetus? (e.g., smoking, drug
use, etc.)
• Can a pregnant woman be forced to change her
behavior to safeguard the health of her fetus?
What behaviors?