The nurse is teaching a prenatal class about the effects of substance abuse during pregnancy. What potential outcome(s) will the nurse include? (Select all that apply).

Choice A rationale Decreased maternal weight gain is a frequent consequence of substance abuse during pregnancy. Many substances, particularly stimulants like cocaine or nicotine, act as appetite suppressants, leading to poor nutritional intake. Additionally, the lifestyle associated with substance use disorders often involves neglect of self-care and prenatal nutrition. Insufficient weight gain negatively impacts the mother's health and reduces the availability of essential nutrients required for the developing fetus to grow appropriately. Choice B rationale Intrauterine growth restriction occurs because many substances cause vasoconstriction, which impairs placental perfusion. When the flow of oxygen and nutrients through the placenta is reduced, the fetus cannot meet its biological growth potential. This leads to infants who are small for gestational age and have increased risks for neonatal morbidity. Chronic exposure to toxins further disrupts cellular division and metabolic processes, resulting in long-term developmental and physical delays for the infant. Choice C rationale Increased neonatal pain tolerance is not a typical outcome of maternal substance abuse. In fact, neonates born to mothers who used substances like opioids often experience neonatal abstinence syndrome, which is characterized by hyperirritability and an exaggerated response to stimuli. These infants are typically more sensitive to pain and environmental stressors, requiring specialized pharmacological and non-pharmacological interventions to manage their withdrawal symptoms and provide comfort during the highly sensitive postnatal period. Choice D rationale Placental abruption is a severe complication associated with the use of substances like cocaine and tobacco. These substances cause significant fluctuations in blood pressure and acute vasoconstriction of the uterine vessels. This physiological stress can cause the placenta to prematurely detach from the uterine wall before delivery. Abruption leads to maternal hemorrhage and fetal hypoxia, representing a true obstetric emergency that carries a high risk of maternal and fetal mortality if not managed immediately. Choice E rationale Preterm delivery is a common outcome of substance abuse due to the induction of uterine irritability and premature rupture of membranes. Substances can trigger early contractions or cause placental issues that necessitate an early delivery for the safety of the mother or fetus. Infants born prematurely face numerous challenges, including respiratory distress syndrome, intracranial hemorrhage, and long-term neurodevelopmental issues, significantly increasing the complexity of neonatal care required after birth.