Illicit ecstasy (MDMA, 3,4-methylenedioxymethamphetamine) use has escalated over the last decade and concern increases about its potential acute toxicity and long term effects [1]. Few published data exist on the teratological effects of ecstasy in animal or human pregnancy [2,3] but structurally related amphetamines increase cardiac malformations in animals [4].

We have followed up prospectively 198 pregnancies with 201 outcomes (three sets of twins) referred to us for risk assessment, using methods detailed previously [5]. The majority (82) of the exposures, where stage of pregnancy was stated, were in the first trimester. Ecstasy only was taken by 87 (44%) of the mothers and 111 (56%) took ecstasy with other drugs, mainly combinations of amphetamine, cannabis, cocaine, ethanol, and LSD.

There were 123 liveborn babies, 9 of whom were premature; 101 (82%) healthy, 16 (13%) with congenital abnormalities, 6 (5%) with minor anomalies (normally excluded from general population data). Fetal loss occurred in 78 pregnancies; 18 miscarriages, 1 intrauterine death and 59 elective terminations (malformations reported in 3 fetuses –2 with multiple defects, 1 anencephaly).

Eight infants and one aborted fetus with malformations were exposed to ecstasy alone, the other eight infants and two aborted fetuses were exposed to multiple drugs. One term neonate exposed in utero to heroin and methadone died. The malformations in liveborns included CNS (3), septal defects (2), ptosis of the eye (1), talipes equinovarus (4) and other different musculoskeletal defects (6).

The miscarriage rate was within the expected range (9% vs 10–20%) but the elective terminations were slightly higher than expected (29% vs 23%).

In conclusion, the data from this small case series show that the incidence of congenital malformations excluding minor anomalies (16/123 livebirths) is 4–7 times higher than expected for the general population (13% vs 2–3%). After taking account of the higher prevalence of malformations associated with high risk pregnancies in the NTIS database (13% vs 6.4%) there is still a 2 fold increased incidence of malformations associated with exposure to ecstasy with or without other illicit drugs which raises concern. However, at present, insufficient data are available to establish whether a single exposure to ecstasy alone, with no maternal toxicity, increases the risk of malformation. Further research is required.

1. Henry JA. Br Med J 1992; 305: 5.
2. vanTonningen M, et al. 1999; 143: 27.
3. McElhatton PR, et al. Lancet 1999; 354: 1441.
4. Schardein JL. Chemically induced birth defects 3rd edition. Marcel Dekker inc, New York. 2000.
5. McElhatton PR, et al.Human Toxicol 1990; 9: 147.