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 AlcoholReported incidence rate of fetal alcohol syndrome by

year of birth (per 10,000 live births)

1.2 1.9

4

6.8

19

0

2

46

8

10

1214

16

18

20

1980 1985 1990 1993 2005

Fetal Alcohol Syndrome by Race/Ethnicity

0.3

0.8

0.9

6

29.9

0 10 20 30 40

Asians

Hispanics

Whites

Blacks

NativeAmericans

Incidence per10,000 births

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 CategoryTobacco-Exposed

Infants (N=27)Non-Exposed

Infants (N=29)Measure Description, Number

of Items, and Range

Handling 0.57 0.44Mean number of strategies used to maintain infant's alert state (8

items, 0-1)

Excitability 3.08 1.91Sum of items measuring

excitable behavior(15 items, 0-15)

Hypertonicity 0.37 0.00Sum of items measuring excess

muscle rigidity response (10 items, 0-10)

Total Stress/Abstinence (Withdrawal)

0.12 0.05Mean number of observed

stress/abstinence signs (50 items, 0-1)

Central Nervous System Stress

0.16 0.09Subscale of total stress/

abstinence score (range 0-1)

Gastrointestinal Stress 0.16 0.02Subscale of total stress

/abstinence score(range 0-1)

Visual Stress 0.11 0.01Subscale 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 CarolinaCourt 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?