8B) Antenatal Care - Pregnancy & complex social factors Flashcards
Definition of domestic abuse
Incident of threatening behaviour, violence or abuse (psychological, physical, sexual, financial or emotional) between adults who are intimate partners or family members.
Can include forced marriage, FGM and “honour violence”.
Who is classed as a recent migrant?
Women who moved to the UK within previous 12 month
What percentage of women experience DV each year?
7%
What percentage of women report experiencing DV in their lifetime?
30%
What proportion of cases of DV start or escalate in pregnancy?
30%
On average, how many episodes of DV and how many professionals does a woman see before seeking help?
35 episodes and 5 professionals
Fetal mortality associated with DV
16 per 1000
Complications of DV in pregnancy
Depression Preterm delivery Miscarriage Low birthweight IUFD Perinatal maternal and infant death
Incidence of teenage pregnancy in UK
40 per 1000
What percentage of teenage pregnancies end in termination?
40%
What percentage of teenagers who become pregnancy will become pregnant again during their teenage years?
25% (including 18% of those who terminate first pregnancy)
What percentage of girls who leave school at 16 without qualifications will have a teenage pregnancy?
30%
What percentage of girls who leave school at 16 with qualifications will have a teenage pregnancy?
15%
What percentage of girls who leave school after the age of 17 will have a teenage pregnancy?
1%
Adverse pregnancy outcomes associated with teenage pregnancy
Prematurity SGA Neonatal mortality Anaemia Pregnancy induced hypertension STIs
In what age group (amongst teenagers) is the rate of miscarriage and PTB highest?
13-15 years (likely due to gynaecological immaturity)
What percentage of adolescents continue to grow whilst pregnant?
50%
What are the implications of an adolescent continuing to grow whilst pregnant?
Larger weight gains, increased fat stores and postpartum weight retention.
Reduced fetal growth due to competition for nutrients.
What percentage of UK women have signs of alcohol dependence?
4%
What is a safe amount of alcohol in pregnancy?
We don’t know!
How many units of alcohol in 1/2 pint lager/beer?
1 unit
How many units of alcohol in small glass wine?
1.5 units
How many units in pint of lager/beer?
2 units
How many units in large glass of wine or pint strong lager/beer?
3 units
How many units in bottle of spirits?
30 units
What is fetal alcohol syndrome?
- Intrauterine or postnatal growth problems
- Facial anomalies (short palpebral fissures, epicanthal folds, flat mid face, short nose, indistinct philtrum, thin upper lip, micrognathia)
- CNS anomalies
What is partial fetal alcohol syndrome?
Some of the growth/facial anomalies in addition to CNS abnormalities
What is alcohol related neurodevelopment disorder
Range of possible abnormalities e.g. cognitive, speech & language deficits, sensory impairments, behavioural challenges, social/relationship abnormalities
What percentage of women are smokers at the time of delivery?
10%
What does the carbon monoxide in cigarette smoke do?
Binds Hb and forms carboxyhaemoglobin.
Causes left shift of dissociation curve and impairs delivery of O2.
What does the tar in cigarette smoke do?
Contains majority of carcinogenic compounds.
Cadmium accumulates in placenta –> FGR.
What does the nicotine in cigarette smoke do?
Stimulator of parasympathetic nervous system.
Leads to cognitive emotional and behavioural problems and increased risk of smoking (and other addictive behaviours) in the child.
Who should be screened with CO monitoring?
Everyone!
Who should be referred to smoking cessation services?
- All smokers
- People who have quit in last 2 weeks
- People with exhaled CO levels >4ppm
What percentage of smokers quit within first trimester?
27-47%
Which women are more likely to maintain smoking cessation?
Women who quit early in pregnancy
What is the effect on smoking cessation as pregnancy progresses?
Little change from 2nd trimester onwards and intention to quit is reduced.
What percentage of spontaneous quitters in pregnancy remain abstinent 1 year postpartum?
<1/3
What is the recommended smoking cessation technique?
Psychosocial interventions
What benefits have been shown of psychosocial interventions?
Reduced incidence of low birthweight and NICU admissions
What is the effect of NRT on cessation rates?
Improves 50%
Effect of NRT on pregnancy
Doesn’t improve pregnancy outcomes.
May improve developmental outcomes.
Percentage harm reduction reported by use of e-cigs
95%
What percentage of adults smoke e-cigs?
5%
What is the most common smoking cessation aid used in the UK?
E-cigarettes
E-Cigs in pregnancy
Lack of safety data and effectiveness data
Percentage of pregnant women with a drug abuse problem?
1%
Most common drug of abuse in UK
Cannabis (second is cocaine)
Effect of heroin on congenital abnormalities
No effect
What is neonatal abstinence syndrome?
Opiates cross placenta and therefore fetus becomes physically dependent. Signs include CNS features, autonomic features and GI features.
What percentage of infants born to opiate users develop neonatal abstinence syndrome?
40-80%
When does neonatal abstinence syndrome occur?
usually 24-72h after birth but can occur up to 2w
Risk of cannabis in pregnancy
Harmful primarily because of associations with other substances.
Risks with benzos in pregnancy
Increased risk facial cleft and skeletal abnormalities.
Neonatal withdrawal.
