Pregnancy is a time when all members of the family may be much more willing to try to stop substance abuse of all kinds because of their concern for the fetus, and all members of the family should be offered help. Improved diet and nutritional supplements may help improve fetal outcomes for smokers or former smokers,9092 but those measures are not an acceptable substitute for smoking cessation.

Alcohol Use. Alcohol intake during pregnancy—especially if the intake is high—is associated with fetal anomalies, prenatal or postnatal growth restriction, and mental retardation.93 Information about alcohol abuse often emerges in a nutritional history; all members of the health care team are advised to learn to ask specific questions, such as those presented by Sokol and colleagues,94 to improve the chance of detecting the problem.95 Masis and May96 provide evidence that a comprehensive local program can help to prevent fetal alcohol syndrome. Intensive nutritional management should complement a program of drinking cessation and subsequent support.

Use of Illegal Drugs. Illegal drug use has reemerged as a serious and widespread problem among women of childbearing age in the United States.10,97 Stimulant drugs such as cocaine and amphetamines are easily obtained. Moreover, the relatively low-cost, highly addictive forms of these drugs, such as "crack" and "ice," are being used with increasing frequency by young men and women. Drug addiction has been associated with serious health problems (including infections such as AIDS, syphilis, and hepatitis); such addiction can also cause serious social and nutritional problems. One major nutritional effect of stimulant drugs is that they suppress the appetite.98 Moreover, women with limited income may spend all their household food money for drugs or trade their WIC foods and food stamps either for drugs or money.

All addicted women, no matter what drug or drugs they are using, need comprehensive, concentrated nutritional assistance and counseling to complement their prenatal care and drug rehabilitation programs.

Miscellaneous Disorders

Phenylketonuria. Pregnancy complicated by PKU is rare, but the consequences of inadequate dietary treatment are serious and potentially quite costly. Dietary treatment prior to conception (see "Preconceptional Nutrition") and throughout gestation may help to reduce the high rates of

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