Alcohol, drugs and medication in pregnancy: The long-term outcome for the child. Preece, P. & Riley, E. (2011).
Clinics in Developmental Medicine, No. 188. London: Mac Keith Press.
Many NICUs are reporting that infants experiencing prenatal exposure to alcohol and drugs (including tobacco and prescription medications) are a constant and growing sub-population within their units. The research in this area continues to move forward and it is important for practitioners to stay aware of advances related to not only neonatal care but also pre and postnatal support of women.
This book was written by an international team of contributors, including geneticists, pediatricians, neuropsychologists, occupational therapists, and social workers. The content is organized in four main sections: (1) epidemiology and pathology of neuroteratogenesis, (2) long term effects of major prescribed medications, (3) long term effects of drugs of abuse, and (4) intervention strategies to reduce the impact of drugs and alcohol in pregnancy.
The intervention chapters focus not only on interventions for the infant and child, but also for supporting the mother during pregnancy and early parenting. Chapters in the final section on interventions address some of the challenges of practice research and policy in this area – defining patterns of exposure, methodological challenges in conducting long-term research and delivering sustained interventions, addressing the ethical issue of balancing the rights of the child with that of the parents, determining appropriate use of child protection services, and the complexity of developing public health messaging.
A strength of the book is that the editors and authors acknowledge the complexity of the subject and the wide range of factors that influence long-term outcomes for this population of infants. They also promote actively exploring not only medical interventions, but also social interventions, as early as possible. A limitation of the book is that sometimes the challenges that mothers experience are often presented as lifestyle choices. Research is increasingly demonstrating that social determinants of health such as poverty, intergenerational impacts of trauma and violence, concurrent mental health challenges, and lack of access to health and social supports impact greatly on a women’s ability to have a healthy pregnancy and to parent successfully. Macrory and Murphy’s chapter is effective at highlighting the need for family-focused, harm reduction based services, and early connection to interventions, and Streissguth and Grant’s chapter highlights the effectiveness of intervention models such as the Parent-Child Assistance Program. A second limitation for neonatal readers is that the book does not include specific guidelines to support infants through withdrawal. For practitioners looking for more specific clinical guidelines supporting care of the infant during withdrawal, it is recommended that readers refer to local, regional and professional clinical guidelines for this specific information.
This book would be a useful adjunct text for practitioners to provide background on brain development, outcomes, and effective interventions to assist them with counselling parents and participating in multidisciplinary teams to organize both infant and family-focused services.
Lenora Marcellus, RN, MN, PhD
Assistant Professor, School of Nursing
University of Victoria
Victoria, British Columbia Canada