L8 - SUBSTANCE USE DURING PREGNANCY Flashcards by Thomas Prud'homme

List 4 risk factors for substance use during pregnancy.

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

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Through what organ are the drugs transferred to the fetus?

The placenta.

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List 4 functions of the placenta.

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

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

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

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List 7 placental properties.

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

Molecular weight: LOW increases transfer
Ionization: LOW increases transfer
Lipophilicity : HIGH increases transfer
Protein binding: FREE increases transfer

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

False.

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True or false: tobacco crosses the placenta.

True.

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Name the two mechanisms of fetal harm of tobacco.

-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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List five obstetrical complications associated with tobacco use during pregnancy.

-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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List five neonatal complications associated with tobacco use during pregnancy.

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

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List six childhood complications associated with tobacco use during pregnancy.

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

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

SIDS.

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

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

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

Unable to completely eliminate ethanol.

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

First trimester.

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

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

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List 3 obstetrical complications associated with alcohol use during pregnancy.

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

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List 4 neonatal complications associated with alcohol use during pregnancy.

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

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

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

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

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

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

Half the rate.

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

Increased.

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

High lipophilicity.

What is the main mechanism of fetal harm of cannabis?

Deregulation of the endogenous cannabinoid system development.

List 4 obstetrical complications associated with cannabis during pregnancy.

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

List 3 neonatal complications associated with cannabis during pregnancy.

-Neonatal morbidity -Small head circum. -Neurobehavioural outcomes

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

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

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

True.

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

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

List 7 obstetrical complications associated with opioids during pregnancy.

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

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

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

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

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)

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

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

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

Type of opioid consumed prenatally.

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

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

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

-CNS depression -lethargy -reduced appetite

Name 2 mechanisms of fetal harm of cocaine.

-Increased heart rate -Blood flow decreased (vasoconstriction)

List 6 obstetrical complications associated with cocaine use during pregnancy.

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

List 4 neonatal complications associated with cocaine use during pregnancy.

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

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

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

What is the main mechanism of fetal harm of amphetamines?

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

List 2 obstetrical complications associated with amphetamines use during pregnancy.

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

List 2 neonatal complications associated with amphetamines use during pregnancy.

-Risk of premature birth -Low birth weight

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

Amphetamines.