If a baby's mother uses crystal meth during pregnancy, birth defects are all but unavoidable. This is a problem not widely known or recognized by much of German society, but it is one that's growing.
In the eastern German state of Saxony there are around 35,000 births per year. According to official statistics between 160 and 180 of these infants are exposed to methamphetamine hydrochloride - commonly known as crystal meth - during their prenatal development.
But Eva Robel-Tillig, who heads the neonatal unit at St. Georg Hospital in Leipzig, warns this is way below the actual number.
DW: The statistics make it pretty clear that crystal meth use among pregnant women is a growing trend in Saxony. In Leipzig, an 800-percent increase has been recorded since 2007. In Dresden, it was over 1000 percent. But you say the situation is even worse than these numbers indicate. Why is that?
Professor Eva Robel-Tillig: I don't know the correct number. I don't think anybody here knows the correct number of babies born from mothers who abused crystal while pregnant. But I would say subjectively it could be one in every 10 or 15 babies born here.
Based on mere suspicion?
Yes, we suspect that the mother abused crystal when she was pregnant, but we can't know for sure. Unless she admits to having used, or we test the infant and there is still crystal meth in its blood. Then we know for sure, but this is rare.
What happens to the baby if its mother used crystal meth during pregnancy?
There are many different things that can happen. Some babies are born smaller and have less appetite. Some are born with malformations, or with smaller heads. Some are more tired than normal. Others are irritable and don't want to drink the mother's milk.
And others show no signs at all.
So there's no typical case?
No, you can't compare it to cases where the mother used heroine during pregnancy. In almost every instance [with heroin], the child cries incessantly. This is not the case with crystal meth.
How does crystal meth affect a fetus?
The real answer is - we don't really know for sure.
We know that the child receives the crystal meth through the placenta. We have performed tests on the blood and the meconium [first fecal matter after birth] that confirm this 100 percent. But we don't know exactly how the fetus reacts to the [drug]. This is one area where more research must be done.
We can only say what the consequences are. More often than not, and in varied form, the child shows irregularities in its size and shape and deficiencies in its motor and psychological functions. We have seen malformations of the heart. We have seen malformations of the brain.
Can these babies die?
They can die, yes. Last year, two twins were handed to us anonymously via a baby deposit [known in German as a "Babyklappe" - see picture] immediately after being born. They both died and they had an extremely high level of crystal meth in their blood. This doesn't happen often, but it's possible.
You have spoken with many women who are still pregnant about their use of crystal meth. Why do they continue to use if they know it will harm their child?
You have to understand that many of the women we talk to use crystal meth because they are pregnant. This is a very difficult time for them, a time with many problems for such mothers. So they don't want to stop.
In many cases, these women had previously stopped using crystal meth and began using again after finding out they were pregnant. Many began taking it very early in life, some as young as 12 or 13 years old. They come back to crystal meth when they are pregnant because they have problems with the father of the child, for example, or other social problems, such as unemployment.
These women can stop using crystal meth. It is possible. But they don't want to. They feel strong when they have crystal meth. They feel much better with it than without it.
What do you say to a pregnant woman face-to-face when she comes in your office and says, 'I'm using crystal meth and I can't stop' - how do you get through to them?
I say that I want to help her. I say that we don't want to take her baby away, because often what happens is that these children are placed in foster care. But we don't want to do this. We want to help them, and that is what I say. But they have to stop [using the drug]. And that is not easy.
Professor Eva Robel-Tillig is a principle consultant in neonatology at St. Georg Hospital in Leipzig. It is one of only two hospitals with a dedicated neonatology department. Robel-Tillig is recognized as a leader in her field.