1.5 teratogens

Question 1

tobacco

Answer 1

↓ placental perfusion. Poor vitamin/mineral metabolism (esp. Calcium, Vitamin B12 & C). ↑ risk for prematurity, LBW, abruption, SIDS. fetal brain development affected. (↑ risk with second hand smoke too);

Teach: Stopping in 1st trimester completely wipes out risks. Stopping in 3rd trimester can still help improve growth.

Ask- systematically ID all tobacco users at every visit
Advise- strongly urge all tobacco users to quit
Assess- determine willingness to make quit attempt
Assist- aid the pt in quitting
Arrange- schedule follow up contact

Question 2

alcohol

Answer 2

First Δ- cell membranes, tissue organization.

Second and Third Δ- interferes with nutrient metabolism, ↓ cell growth.

Fetal Alcohol Syndrome- prenatal/postnatal growth restriction. CNS impairment. Recognizable facial features.

Teach: NO AMOUNT IS SAFE

Question 3

Marijuana

Answer 3

risks during pregnancy, slow fetal growth, possible ↑ risk of PTB, ???fetal anomalies???, withdrawal in babies

Question 4

cocaine

Answer 4

CNS stimulant. ↑ risks: miscarriage, preterm delivery d/t to a variety of reasons, low birthweight, small heads which reflect small brains, jittery/irritable newborns, withdrawn/shutdown, ?SIDS?; Crack cocaine is a powerful vasoconstrictive agent. The chorionic villi atrophy as a result of the vasoconstrictive effects of the drug. Placental abruption, when the placenta detaches from the decidual lining of the uterus, is therefore of particular concern.

Question 5

Methamphetamine

Answer 5

more addictive than heroin, has affect similar to cocaine, not much research out yet.

SOME THOUGHTS: nutrition, dental caries, accompanying use of tobacco

Question 6

Opioids/Heroin

Answer 6

preeclampsia, miscarriage, abruption, prematurity, stillbirth. Effects of baby: withdrawal, methadone treatment, SIDS; Teach: Treatment is most essential; Methadone suppresses withdrawal symptoms during detox and maintenance from heroin and other opioids; No sudden stopping

Question 7

caffeine

Answer 7

slow clearance in mom, crosses placenta, metabolized slowly by fetus, stresses fetal metabolic system, ↓ blood flow to placenta (↑ risk of miscarriage, shortened gestation, lower birth weight), fluid loss in mom; drinking caffeine during pregnancy can pass through breast milk to baby and cause hyperactivity;

Teach: <200 mg/day of caffeine; Equivalent of 12 oz coffees or colas