As we dive headfirst into November, National Adoption Month, I’m reminded of how crucial it is we all remember the vast numbers of children without permanent homes for the holidays, as well as the barriers keeping many people from taking the leap of faith of welcoming a child into their families.
I am particularly reminded of a call I recently received from an anxious couple, Nick and Shae Boyd. They were in the process of adoption, opting to adopt domestically. They were lucky enough to be contacted by their adoption agency regarding a possible match! As a genetic counselor who works for a pregnancy riskline, I frequently talk with couples in all phases of the adoption process. Often these couples only have a day or so to make up their minds if they wish to be considered for a particular baby. Needless to say, they are happy, anxious and in a hurry for the information, all at the same time!
In this case, the baby girl was due in two weeks. The birth mother reported using methamphetamines a few times in the first trimester, and smoked half a pack of cigarettes per day throughout the pregnancy, but had reduced this amount recently. The birth daddy was reported to drink alcohol on weekends and did have some cocaine use. The Boyd’s were very worried and concerned about the possible risks to the baby girl from all of these exposures and were unsure about this possible match. What should they do? What if the baby had increased risks for birth defects and learning problems? If they said “no” to this match, would they get another chance?
I quickly told them they had called the right place. Anytime you have questions about exposures during pregnancy, it is best to ask a trained teratogen specialist as we answer questions like this every day. They had reached me through OTIS, the national Organization of Teratology Information Specialists, and had called our toll-free 866-626-6847 number.
I explained that the use of street drugs always sounds scary, but we need to look at which birth parent used the drug, when in the pregnancy the exposure occurred, and how much and often was the drug was used. When the birth dads are using drugs, our concern is really only at the time of conception. With exposures to the birth dads, we know that the number and quality of the sperm they produce can be reduced and/or damaged. This can lead to fertility issues. But in the case of a successful pregnancy, the studies have not shown any increased risk for birth defects and learning problems in the babies that are born. So Nick and Shae do not need to worry about any possible increased risks from the birth dad’s exposures.
Now what the birth mom uses throughout her pregnancy is a different story, as the pregnant woman shares a blood supply with the baby. So what the mom takes into her body, for the most part, does get to the baby to some degree. I explained that unfortunately the recreational use of methamphetamines these days is pretty common. The good news in this case is that the birth mom only used the drug a few times in the first trimester, and has not reported any drug use since that time. Even though we do know that heavy use of methamphetamines during the first trimester may have a small increased risk for birth defects over the back ground population risk of 3 to 5 per 100 births, this would not be a possible risk with such limited use. I also explained that there would not be a known increased risk for learning or behavior problems, or for withdrawal at birth, with only a few exposures in the first trimester. In cases of more heavy and/or prolonged use of methamphetamines, the risks can be higher.
As Shae and Nick breathed a sigh of relief, I went on to explain that smoking a one half of a pack of cigarettes per day is most likely not going to increase the background risk for birth defects either. Studies have shown that heavier smoking, more like one pack per day, does have a small one percent increased risk for oral clefting in the baby. The other risks that we often talk about with cigarette smoking, including an increased risk for a smaller baby who is born early, and an increased risk for asthma and allergies, are probably not significantly increased with exposure to 10 or fewer cigarettes per day, but could be there. Nick asked about SIDS and we talked about how this is more often seen when the babies go home to smoking households.
The Boyd’s told me they were very relieved! When their case worker had told them about this baby girl, there were very excited but really worried about the drug exposures. After talking with me, the Boyd’s did give their case worker the green light to submit their profile to the birth mom! If that little girl lands in the arms of such a caring and thoughtful couple, I know the phrase “home for the holidays” will have much greater meaning for them this year.
If you have any questions at all surrounding the adoption process and the risks to the baby of exposures during the pregnancy, please call OTIS’s specialists toll-free at (866) 626-OTIS (6847). Good luck in your adoption journey!

**Lori Wolfe, MS, is a board-certified genetic counselor and the past president of OTIS. She is also the director of OTIS’ Texas affiliate, the Texas Teratogen Information Service (TTIS), which she founded in 1991. Learn more about the TTIS by visiting http://www.ttis.unt.edu/. OTIS is a North American non-profit dedicated to providing accurate evidence-based information about exposures during pregnancy and breastfeeding.**