Chapter 11: Substance Abuse in Pregnancy

Question 1

What substances are abused?

Answer 1

• opioids

- methamphetamine

Question 2

Opioid Abuse

Answer 2

includes use of heroin and the misuse of prescription opioid analgesic medications (codeine, fentanyl, methadone, oxycodone, merperidine, and hydrocodone)
-maternal chronic untreated heroin use is associated with an increased risk of fetal growth restriction, abruptio placentae, fetal death, PTL, and the intrauterine passage of meconium
>Neonatal Abstinence Syndrome; characterized by CNS hyperirritability, gastrointestinal dysfunction, respiratory distress, and various autonomic symptoms (yawning, sneezing, fever), follows prenatal exposure to opioids

Question 3

Management with Opioid Use

Answer 3

• to lessen health risks, pregnant woman who are opioid dependent are treated with methadone maintenance therapy (MMT)
• also treated with Buprenorphine, associated with lower risk of overdose, fewer drug interactions, ability to be treated on outpatient basis without need for daily visits to licensed treatment program, and evidence of less severe neonatal abstinence syndrome

Question 4

Methamphetamine Abuse

Answer 4

a powerful stimulant that can be smoked, snorted, injected, or ingested orally or anally
-associated with SGA, low birth weight, neonatal and childhood neurodevelopmental abnormalities

Question 5

Methamphetamine Management

Answer 5

-seek care at residential treatment center
-comprehensive prenatal care, nutritional assessment, social support services, STD/HIV testing
-fetal monitoring for growth restriction involves baseline ultrasonography with follow-up ultrasound examinations for growth determination in third trimester
>use of amphetamines inhibits prolactin release and can reduce breastmilk supply
>concentration of amphetamines found in breast milk is higher than maternal plasma, and infants who ingest the breastmilk will exhibit increased irritability, agitation, and crying (women actively using amphetamines should not breastfeed)

Question 6

Nursing Implications

Answer 6

• responsible for assessing psychosocial risks and conducting mutual goal setting to minimize harm associated with risks
• support and respect should be offered regardless of woman’s decision about her health care or self care
• a nonjudgmental, concerned, and empathetic environment should be provided so that the patient feels encouraged to express her feelings ad concerns about herself, her drug use, and unborn child