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Health

Doctors say methamphetamine use does not cause miscarriages

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The number of criminal charges brought against people for using drugs during their pregnancies is rising in Oklahoma; a trend doctors say is rooted in a misunderstanding of how drug use affects pregnancy.

In Oklahoma, a person can be charged with felony child neglect for using drugs while pregnant. In cases like Brittney Poolaw’s, a person can be charged with manslaughter if they have a miscarriage and the fetal remains test postive for drugs like methamphetamine.

In Poolaw’s case, prosecutors claimed her use of methamphetamine during her pregnancy contributed to her miscarriage. However, many doctors agree this claim is not based in science.

Related: Under looming threat of criminalization, one new program seeks to help Oklahoma mothers with substance use disorders

“There is actually no biological reason that methamphetamine should cause a pregnancy loss,” said Dr. Harvey Kliman from the Yale School of Medicine’s Department of Obstetrics, Gynecology and Reproductive Sciences. “There's no mechanism for that medication to even affect a pregnancy.”

Kliman studies the placenta’s role in infertility, pregnancy complications, and loss.

He said methamphetamine use affects the brain but not the placenta, which he describes as the root system of the fetus and an essential part of pregnancy.

“There's nothing that methamphetamines actually even do that affects the placental function. Transport of things, blood flow into the placenta, nothing,” Kliman said.

Additionally, Kliman said methamphetamines and similar compounds are used to treat attention deficit hyperactivity disorder or ADHD, but there has been no increase in miscarriages related to people who take those medications while pregnant.

Based on his study of the placenta, Kliman said smoking cigarettes could be harmful for the development of a fetus, as it impacts the smoker’s blood flow and could decrease blood flow to the placenta.

However, he said that should not be grounds for arresting someone in the case of a miscarriage because it is difficult to determine the exact cause of a pregnancy loss.

“We all have to remind ourselves that association is not causation. We know that putting your baby to sleep on her back carries with it a decreased risk of sudden infant death syndrome,” said Dr. Gregory Davis, a professor of pathology and laboratory medicine at the University of Kentucky. “But no pathologist is going to say, well, you killed your baby because you put them face down as opposed to putting them on their back. And I would argue that the same logic applies to methamphetamine.”

Davis’ work as a pathologist involves performing autopsies and determining the cause and manner of death. While most deaths can be classified as homicides, suicides, accidents, or natural deaths, he said between one and five percent of cases are undetermined, meaning there is not enough evidence to support a different classification.

“One thing I always like to remind folks is shows like NCIS and CSI are very entertaining, but they don't reflect the real world reality of the work we do. Diagnostic uncertainty exists in my world, even though fun popular television shows wrap things up, you know, at the end of the hour,” Davis said.

Apart from being difficult to determine the exact cause, miscarriages are very common. Dr. Mishka Terplan, an OB/GYN and the Medical Director of the Friends Research Institute, said around 20% of known pregnancies end in loss.

Terplan said miscarriages are so common, doctors don’t typically investigate the cause until a person has had multiple losses to determine if a chronic health condition could be causing the issue. But sometimes, miscarriages just happen.

“You can do everything wrong, both as a provider and even as a patient and have a healthy birth,” Terplan said. “And you can do everything right and have an unhealthy birth.”

While being in good health improves the probability of a healthy pregnancy, genetic abnormalities and other pregnancy complications can happen to anyone. This is where Terplan said the disconnect between medicine and philosophy can lead to misconceptions about pregnancy loss.

“Perhaps what's missing is that recognition of human frailty and limitation, and that we can’t control everything all the time,” Terplan said. “Tragedy does occur and it’s not somebody’s fault. And that doesn’t always sit well with people who want certainty.”

Drug use is associated with negative health outcomes. There’s no debate there. But pregnancy loss isn’t as black and white as we may think. And experts say there’s too much uncertainty to put people in prison for the loss of a pregnancy due to meth use.

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