Yes. Recent studies have shown that many illicit drugs can harm or even kill a fetus. What alarms us most now is cocaine, which can induce labor. Users' prematurity rate is triple the general population's. Cocaine can also cause abruptio placentae -- premature detachment of the placenta -- and retard fetal growth. And there have been several reports of fetal strokes linked to one-time use late in pregnancy.
We've found that infants exposed to cocaine in utero are less alert and more irritable as newborns. They have difficulty responding to their environment and caretaking. This hinders the bonding of mother and child and their ability to interact later on.
Cocaine users often abuse other drugs, too. Some problems may be caused by interactions of marijuana and cocaine, for example.
In the past, we may have overlooked prenatal effects, because we don't see gross malformations in infants of drug-abusing women. But we do see both physiological and behavioral abnormalities.
Doctors must start viewing drug abuse as a problem that endangers mother and fetus. They should think about detection and intervention.
When a woman comes in for prenatal care, her urine should be tested not only for diabetes and protein but also for substances of abuse -- with her consent. And when a general history is taken, any history of drug abuse should be recorded.
This is the only way to get at the problem on a mass scale. If abuse is confirmed, we should refer the woman to a drug-treatment program.
I agree with the right to privacy. But does it allow a woman to injure her baby? -- Dr. Ira J. Chasnoff Director, Perinatal Center for Chemical Dependence, Northwestern University
No. Drug testing is a search -- and an unwarranted invasion of women's privacy, especially when sample collection is observed.Urine tests have technological flaws. Passively inhaled marijuana smoke may make a test positive. Ibuprofen can be misread as marijuana and amoxicillin as cocaine.
If you subject an untargeted population to a test that at best has a 95 percent accuracy rate, you are going to get more false positives than true ones.
Such testing would squander money. Some 25 percent of American women of child-bearing age have no medical coverage at all. It's among them that you'll find most drug users -- not the more affluent who seek prenatal care.
Testing would discourage users from seeking prenatal care. We could end up losing even more babies.
And where would we draw the line? Alcohol, nicotine, too much coffee and obesity pose risks for the fetus. Viewing women as fetus receptacles could lead to arrests or forced abortions when they don't follow doctors' advice.
If a pregnant patient abuses drugs, a physician doing his job will spot it. But forcing her into a treatment program won't work. What does work is confronting her with some observable symptom, working with her to overcome denial, and helping her see she has a problem she must deal with.
No one wants women to harm their fetuses. But a better step would be to make prenatal care universally available and give pregnant drug users the chance to be treated in a nonpunitive setting.
There are pregnant teenage addicts in New York who want to kick their habit but can't get help. That's where we should focus our resources -- not on testing women who aren't likely to abuse drugs. -- Loren Siegel New York attorney; special assistant to the Executive Director, American Civil Liberties Union