Alcohol, Smoking and Other Drugs: Why Ten Fingers Plus Ten Toes Doesn’t Always Equal the Whole Story

January 28, 2019

By Lauren Kozlowski, MSW, MPH, MotherToBaby Georgia

Carly called and I could hear the stress in her voice immediately. She had been smoking marijuana on weekends and having a glass of wine most evenings with her dinner.  She just found out she was pregnant with her fifth child.  Carly knew her baby could suffer if she did not change her use of alcohol and marijuana. Carly was scared, so she contacted MotherToBaby.  We were able to discuss what kinds of risk the substances she had used may have, and I shared information with her that she could talk to her doctor about. Carly’s story immediately came to mind when talking about Birth Defects Prevention Month’s Tip 5: Boost your health by avoiding harmful substances during pregnancy, such as alcohol, tobacco, marijuana and other drugs.


Alcohol is actively advertised as a way to relax after a hard day, and it’s almost always a part of celebrations.  Alcohol is legal to purchase in any amount for most adults 21 and older, making it very accessible.  Changing your lifestyle to not drink any alcohol during pregnancy may seem hard, but it is worth it for the health of your developing baby.  Though having one drink likely does not mean your baby will automatically have health problems, no amount of alcohol has been proven safe during pregnancy. This means that not drinking alcohol at all during pregnancy is your best bet.  Alcohol can cause a range of issues for the health of your child.  Some are physical birth defects, while others are related to controlling emotions effectively and learning abilities.  Some of these issues last long after birth and can have lifelong effects on your child.

Cigarettes  & e-cigarettes

Smoking and the use of tobacco products are activities that many associate with stress reduction and, like alcohol, can be hard to stop. Cigarette smoke contains more than 4,000 chemicals and toxins, including nicotine, tar, arsenic, lead, and carbon monoxide. Some of these chemicals cross the placenta and lower the amount of oxygen and food available for a developing baby. Babies born to mothers who smoke are at increased risk for being born too small (with low birthweight) and prematurely (before 37 weeks of pregnancy). Babies born too small and too early are more likely than other babies to have health complications and may need to stay in the hospital longer. Some studies suggest that babies born to moms who smoke are at risk of having an oral cleft, a birth defect where the lip or roof of the mouth does not fully close. Not smoking is best for you and your baby during pregnancy. Every little bit counts, so even reducing the amount can be helpful to your baby!

In comparison to traditional cigarettes, we know very little about the safety of e-cigarettes (or vaping) during pregnancy. This is because e-cigarettes are largely unregulated, and little research has been done on them. While some moms-to-be may view e-cigarettes as safer alternatives than traditional cigarettes, e-cigarette solutions contain several of the same reproductive or developmental toxins that are found in traditional cigarettes, like nicotine, cadmium and lead. So until more studies have been done on the safety/risk of e-cigarettes, it is best for moms-to-be not to use them.

Marijuana and other street drugs

Another way to boost your health during pregnancy is to not use harmful drugs. For example, women may think marijuana may help with nausea and vomiting (morning sickness).  Though we still need more research, studies in animals have shown that exposure to marijuana in the womb may harm a baby’s brain development.  Marijuana is unregulated in most places, so you don’t know what may be in it – certain chemicals, pesticides or other drugs may cross the placenta and impact your baby. In addition to smoking marijuana, using substances that include THC (the active ingredient in marijuana), such as edibles and oils, carries the same potential to affect a baby’s brain development. No amount of marijuana or THC has been proven safe to use during pregnancy.

Other street drugs, like cocaine, heroin, LSD, MDMA (ecstasy or Molly), and methamphetamine, also are harmful during pregnancy. Using these kinds of drugs during pregnancy increases a baby’s risk for miscarriage, preterm birth, birth defects and neonatal abstinence syndrome (NAS). NAS is a group of conditions caused when a baby withdraws from certain drugs she’s exposed to in the womb before birth. NAS is most often caused when a woman takes drugs called opioids during pregnancy.  Not a single one of these drugs has a beneficial effect on pregnancy or a developing baby – so for your baby’s sake as well as your own, a drug-free pregnancy is a healthier pregnancy.

It is important to realize that giving birth to a baby with ten fingers and ten toes – who looks healthy at birth - is not the end of the story.  Effects caused by the use of alcohol, tobacco and other drugs during pregnancy can take a while to show.  As a child develops and reaches or fails to reach developmental milestones, only then is it possible to evaluate the long-term effects of prenatal substance exposure on things like the ability to learn and manage emotions.  While every pregnancy carries some risk that is out of anyone’s control, we want to encourage women to focus on areas of their health that they do have some control over. Taking care of yourself and your health means a healthier baby.  Doing what you can to boost your health by avoiding harmful substances during pregnancy is a great place to start!

If you are struggling with substance addiction, talk to your health care provider. You can also find help and treatment referrals by visiting the Substance Abuse and Mental Health Services Administration (SAMSHA) website or by calling their national helpline, 1-800-662-HELP (4357).

This blog post is the fourth of a series of guest posts from MotherToBaby during this year’s National Birth Defects Prevention Month activities. This year’s theme is: Best for You, Best for Baby. 

Lauren Kozlowski, MSW, MPH is serving as the Program Coordinator for MotherToBaby Georgia. She graduated from Boston University with both a Masters of Social Work and a Masters of Public Health. She has experience working with families in both an educational setting, as well as in housing and health, allowing her to recognize the multiple factors contributing to the ability of women and children to thrive. She enjoys living in Atlanta and exploring what the city has to offer.

About  MotherToBaby

MotherToBabyis a service of the Organization of Teratology Information Specialists (OTIS), suggested resources by many agencies including the Centers for Disease Control and Prevention (CDC). If you have questions about exposures during pregnancy and breastfeeding, please call MotherToBaby toll-FREE at 866-626-6847 or try out MotherToBaby’s new text information service by texting questions to (855) 999-3525. You can also visit to browse a library of fact sheets about dozens of viruses, medications, vaccines, alcohol, diseases, or other exposures during pregnancy and breastfeeding or connect with all of our resources by downloading the new MotherToBaby free app, available on Android and iOS markets.