“I’m going to have a baby.” The case of Natasha V. This case is a clear example of the dangers of substance abuse, especially during pregnancy, and most especially in the first eight weeks of...

“I’m going to have a baby.” The case of Natasha V.

This case is a clear example of the dangers of substance abuse, especially during pregnancy, and most especially in the first eight weeks of gestation when embryonic organs are forming. Natasha was intoxicated with alcohol at the time she appeared in the emergency room. Her medical record revealed a history of chronic alcohol and other drug abuse that made it likely she abused alcohol during the critical first eight weeks of gestation. Adding to the problem, she was also a smoker. Heavy cigarette smoking is also associated with fetal birth defects. That a previous pregnancy ended in a spontaneous abortion suggests that the aborted fetus may have been more adversely affected than the current one. Natasha’s infant was premature (36 weeks gestation). The lungs of premature infants typically lack enough surfactant to keep alveoli open and blood adequately oxygenated, so it is not surprising that he developed RDS. The infant’s low Apgar score (3 on a scale of 10) and unusually low birth weight (SGA) is consistent with his prematurity, fetal alcohol syndrome, and placental ischemia from maternal smoking. Mortality and the risk of severe neurologic morbidity are increased in infants with low scores. Finally, the infant’s failure to thrive, seizure disorder, and early death are proof positive of the devastating effects of maternal alcohol abuse and fetal alcohol syndrome.