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PSYT 301 > L8 - SUBSTANCE USE DURING PREGNANCY > Flashcards

L8 - SUBSTANCE USE DURING PREGNANCY Flashcards

1
Q

List 4 risk factors for substance use during pregnancy.

A

-Family history of substance use
-Encounters with law enforcement
-History of sexual abuse
-Psychiatric illness

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2
Q

Through what organ are the drugs transferred to the fetus?

A

The placenta.

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3
Q

List 4 functions of the placenta.

A
  • Providing oxygen and nutrients (drugs take the same passage)
  • Removal of harmful waste products
  • Produces hormones
  • Pass immunity
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4
Q

What are the two variables determining on which depends drug transfer into the placenta?

A

-Physical properties of the placenta
-Specific physiochemical properties of the drug

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5
Q

List 7 placental properties.

A

-Placenta surface area
-Placenta thickness
-pH of maternal and fetal blood
-Placenta metabolism
-Uteroplacental blood flow
-Presence of placental drug transporters
-Concentration gradient across placenta

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6
Q

Name the 4 drug properties affecting drug transfer across the placenta. For each of the property, state under what condition it facilitates the transfer.

A
  • Molecular weight: LOW increases transfer
  • Ionization: LOW increases transfer
  • Lipophilicity : HIGH increases transfer
  • Protein binding: FREE increases transfer
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7
Q

True or false: drugs are most likely passing into breast-milk with different physiochemical properties that allow them to transfer across the placenta.

A

False.

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8
Q

True or false: tobacco crosses the placenta.

A

True.

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9
Q

Name the two mechanisms of fetal harm of tobacco.

A

-Increase of nicotine and CO2 levels -> vasoconstriction -> reduces oxygen levels
-Nicotine increases the levels of collateral chemicals causing deregulation in fetal development

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10
Q

List five obstetrical complications associated with tobacco use during pregnancy.

A

-Miscarriage
-Placenta abruption
-Placenta previa (when the placenta completely or partially covers the opening of the uterus)
-Premature rupture of membranes
-Uterine infections

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11
Q

List five neonatal complications associated with tobacco use during pregnancy.

A

-Low birth weight
-Fetal growth restriction
-Increased risk of sudden infant death syndrome (SIDS)
-Stillbirth
-Premature births

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12
Q

List six childhood complications associated with tobacco use during pregnancy.

A

-SIDS
-Increased risk for asthma
-Congetinal heart defects (increased risks for first trimester)
-Diabetes
-Cognitive ability
-Cleft lip

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13
Q

Nicotine is readily absorbed into breast milk. What is a potentially fatal consequence from this?

A

SIDS.

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14
Q

Name 4 effects on the newborn that may cause nicotine presence in breast-milk.

A

-SIDS
-Reduced appetite
-Decrease milk supply
-Sleep disturbances

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15
Q

What is the consequence of the fetus liver being underdeveloped when the mother importantly consumes alcohol?

A

Unable to completely eliminate ethanol.

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16
Q

At what trimester is the fetus more susceptible to teratogenic effects of ethanol?

A

First trimester.

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17
Q

What is the primary cellular mechanism of fetal harm of alcohol?

A

Production of reactive oxygen species from the metabolization of ethanol that interact with DNA, protein and lipids.

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18
Q

List 3 obstetrical complications associated with alcohol use during pregnancy.

A

-Intrauterine growth restriction
-Increased risk of stillbirth
-Increased risk of miscarriage

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19
Q

List 4 neonatal complications associated with alcohol use during pregnancy.

A

-FAS*
-Withdrawal symptoms at birth
-Fetal death
-Reduced birth weight

20
Q

List 3 physical neonatal outcomes and 3 cognitive outcomes in childhood development associated with FAS.

A

Physical neonatal outcomes
- Inadequate growth
- Birth defects of face
- Microcephaly (inadequate growth of brain)
Cognitive outcomes in childhood development
- Intellectual disability
- Abnormal behavioural development
- Increased risk of ADHD and antisocial behaviour

21
Q

Overall, what childhood outcomes are associated with alcohol exposure in utero?

A

-Poor growth
-ADHD
-Delinquent behaviour
-At risk for substance use
-Impaired learning and memory
-Lower IQ scores
-Communication disabilities

22
Q

Compared to adults, at what rate are newborns metabolizing alcohol?

A

Half the rate.

23
Q

How did legalization impact the use of cannabis by pregnant women?

A

Increased.

24
Q

Due to what drug property in particular does cannabis cross easily the placenta?

A

High lipophilicity.

25
Q

What is the main mechanism of fetal harm of cannabis?

A

Deregulation of the endogenous cannabinoid system development.

26
Q

List 4 obstetrical complications associated with cannabis during pregnancy.

A

-Premature delivery
-Risk of miscarriage
-Intrauterine growth restriction
-Reduced blood flow to placenta

27
Q

List 3 neonatal complications associated with cannabis during pregnancy.

A

-Neonatal morbidity
-Small head circum.
-Neurobehavioural outcomes

28
Q

For an individual exposed to cannabis prenatally, there are neurocognitive and behavioural effects at different stages of childhood. Associate two of them for the following stages:
3-6 years
9-11 years
14-16 years
17-22 years

A

3-6 years:
-Deficits in verbal and perceptual skills
-Impulsivity
9-11 years
-Depressive and anxious symptoms
-Deficits in abstract and visual reasoning
14-16 years
-Deficits in information processing speed
-Delinquency
17-22 years
-Deficits in response inhibition
-Substance use

29
Q

True or false: lack of evidence for negative association between effects on infants and breast-feeding while consuming cannabis.

A

True.

30
Q

What physiochemical properties of opioids allow them to cross readily the placenta?

A

-Low molecular weight
-Low protein binding
-High lipid solubility

31
Q

List 7 obstetrical complications associated with opioids during pregnancy.

A

-Placenta abruption
-Intrauterine infection
-High blood pressure (preeclampsia)
-Premature rupture of membranes
-Premature labour
-Miscarriage
-Postpartum hemorrhage

32
Q

List 4 noenatal complications associated with opioid use during pregnancy. Which one is the most prominent?

A

-NAS (neonatal abstinence syndrome)*
-Pre-term birth
-Poor fetal growth
-Low birth weight

33
Q

What is the NAS? What are the three categories of withdrawal symptoms? Give 2 examples for each withdrawal symptom category.

A

NAS is a group of conditions that can occur if newborns withdraw from certain substances, notably opioids, to which they were exposed prenatally.

CNS:
-inconsolable crying
-tremor
GI:
-poor feeding
-excessive sucking
Autonomic:
-sweating
-tachypnea (abnormally rapid breathing)

34
Q

What could account for preterm infants having a later onset and less severe symptoms from NAS?

A

Developmental immaturity of the nervous system and reduced total drug exposure.

35
Q

What is the first factor for the duration of NAS withdrawals from opioids?

A

Type of opioid consumed prenatally.

36
Q

To what kind of childhood outcomes is leading prenatal use of opioids?

A

Adverse neurocognitive, behavioural, and developmental outcomes (lower IQ, intellectual difficulties, behavioural problems, hyperactivity, poor language development)

37
Q

What are 3 consequences of neonatal toxicity resulting from breastfeeding in the presence of opioid?

A

-CNS depression
-lethargy
-reduced appetite

38
Q

Name 2 mechanisms of fetal harm of cocaine.

A

-Increased heart rate
-Blood flow decreased (vasoconstriction)

39
Q

List 6 obstetrical complications associated with cocaine use during pregnancy.

A

-Miscarriage (up to 38%, likely bc. of reduced blood flow)
-Intrauterine growth restriction
-Hypertension
-Placental abruption
-Premature birth
-Cardiovascular cocaine toxicity

40
Q

List 4 neonatal complications associated with cocaine use during pregnancy.

A

-Low birth weight
-Growth restriction
-Small head circumference
-Developmental deficiencies due to reduced blood flow

41
Q

List physical and neurodevelopmental childhood outcomes associated with cocaine use during pregnancy.

A

Physical
-Cardiovascular disorders
-Cleft palate
-Polydactyl
-Kidney malformation
Neurodevelopmental issues
-Impaired adolescent functioning
-Impaired perceptual reasoning and procedural learning
-Defiance
-ADHD
-Impaired memory and EF
-Impaired language development

42
Q

What is the main mechanism of fetal harm of amphetamines?

A

Oxygen limited to fetus bc. of maternal high blood pressure.

43
Q

List 2 obstetrical complications associated with amphetamines use during pregnancy.

A

-High blood pressure (reduced oxygen flow to placenta)
-Increased heart rate
= mechanisms of harm

44
Q

List 2 neonatal complications associated with amphetamines use during pregnancy.

A

-Risk of premature birth
-Low birth weight

45
Q

What drug is found in the breast milk usually at much higher concentration than in maternal plasma?

A

Amphetamines.

PSYT 301 (8 decks)

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