Illicit drug-use is not the only concern for pregnant women. Many doctors say substances that are legal can harm an unborn baby more than drugs that are illegal.
While methadone, alcohol and cheap cigarette online are legal, doctors say they fear the impact these substances can have on fetuses and newborn babies.

Dr. Stefan Maxwell, with Charleston Area Medical Center, says babies can suffer much damage from nicotine and alcohol, especially.

"It's not getting any better," Maxwell said. "There's a lot of damage. Nicotine and alcohol cause brain damage. Even though narcotics and opiates cause problems such as severe withdrawal symptoms, I don't know that it has long-term effects that nicotine and alcohol causes.

"In my opinion, if the state wanted to spend money to reduce incidence to improve health, they should focus on alcohol and nicotine use because those are legal, but it seems like no one cares," Maxwell added.

According to the March of Dimes, West Virginia has the highest rate in the nation of women who smoke cigarettes during pregnancy.

The West Virginia Perinatal Partnership's website defines the risk of prenatal exposure to cigarettes. The site states "the prospect of a good birth outcome for a pregnant smoker is much dimmer compared to that of a pregnant non-smoker."

The March of Dimes also reports that smoking cigarettes exposes babies to hazardous chemicals and can "lessen the amount of oxygen" that a baby would receive.

Other harmful effects smoking cigarettes can have include ectopic pregnancy, stillbirth, placental abruption and placenta previa. The March of Dimes also states that babies are more likely to be born prematurely, at a lower birth weight or with cleft palate.

As for second-hand smoke, the March of Dimes states that babies could be at risk for Sudden Infant Death Syndrome, asthma or other respiratory symptoms.

United Kingdom newspaper The Times, reported in a February 2008 article that smoking cigarettes during pregnancy is "far less damaging" to the unborn baby as once thought, however.

The article centers around a study conducted by the Centre for Economic Performance at London's School of Economics.

The article states that harm, which is presented in lower birth weight, is done later in a woman's pregnancy. Even with this effect on birth weight, the study states that the risk is "surprisingly small."

However, Maxwell said smoking cigarettes can be detrimental to unborn babies.

"Nicotine is tough because people come in with the mindset that 'my mother smoked, and I'm fine,'" Maxwell said. "So it's tough. The thing is it's legal. You don't get prosecuted for smoking cigarettes. I can't say how many people I've seen driving down the road with a kid in the car seat and the woman is very pregnant and puffing away on a cigarette."

Alcohol use during pregnancy also is very damaging, according to Maxwell. Not only could a baby suffer from birth defects, according to the March of Dimes, but Maxwell said babies also could develop neuro-developmental disorders or ARND. This syndrome, he said, is not easily identified and is associated with mental retardation.

The West Virginia Perinatal Partnership is conducting various pilot projects in the state and also is trying to raise money to create a program focusing on changing women's behavior.

The March of Dimes states that alcohol can also increase risk of learning and emotional problems, defects of the heart and other organs. The site also states that it can increase the risk of miscarriage and premature birth.

Although the March of Dimes states that binge drinking or drinking more than seven drinks per week is the most harmful, the site states that no amount of alcohol is safe during pregnancy.

Maxwell said he agreed with this principle and said the most dangerous time to drink would be in the first trimester because that's when the majority of the organ systems are developed.

"That can cause significant damage too because that's when organs are being developed. The most significant problems occur with the brain," Maxwell said.

"I think they should just stop," he added. "Unfortunately, there are those who don't know they're pregnant in the first trimester. It may take six to eight weeks and during that time, they could be drinking heavily."

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