Define Perinatal Period
Continuum that extends from the beginning of a woman’s pregnancy through delivery and the first month of a child’s life
Use of illicit drugs during pregnancy
Marijuana was used most frequently followed by amphetamines, sedatives, and non-medical analgesics, cocaine, and heroine. These numbers are significantly lower than for alcohol use (18%) and cigarette smoking (20%) during pregnancy
Medical Issues (2)
- Frequently inconsistent prenatal care due to chronic, relapsing nature of addiction, and the chaotic lives of substance abusing women 2. increased risk for anemia, bacteremia, septicemia, dental caries, nutritional deficiencies, plneumonia, hepatitis, tetanus, TB, and UTIs
Opiate Addiction during Pregnancy risks
extremes of feeling “high” or “sick” within a relatively brief time
Cocaine use during Pregnancy risks
increased risk of hypertensive crises, cardiac and cerebral vascular complications, seizures, substance-induced mood variability
Excessive Alcohol intake during Pregnancy risks
increased rates of hypertension, cardiovascular mortality, GI hemorrhage, breast cancer
How STDs linked to illicit drug use
- direct sex-for drug activity 2. prostitution to purchase drugs 3. sharing of infected needles and drug paraphernalia 4. infants contract HIV virus from their mothers during pregnancy or birth 5. HIV transmission can be reduced by opting for c-section before onset of labor or rupture of membranes.
Obstetric risk with illicit drug use
- abrupto placentae 2. amnionitis 3. early pregnancy loss 4. intrauterine grown retardation 5. placental insufficiency 6. pre-eclampsia 7. premature labor 8. premature rupture of membranes
Barriers to treatment (6)
- women’s fear of loss of children to protective agencies 2. insufficient financial means 3. unsafe living conditions 4. difficulties in obtaining transportation 5. lack of support from family, social contacts 6. inaccessibility of gender specific programs
Substance Abuse Prevention and Treatment Block Grant
states are required to grant pregnant women priority for treatment to provide them with access to health care, and child care, and assistance with transportation
Treatment for Heroine Dependence during pregnancy
- treatment of choice = methadone maintenance (it reduces both maternal mortality and fetal morbidity rate)
- Effectiveness of Buprenorphine and safety to neonates is being studied to treat opioid-dependency in pregnant women
Psychosocial issues of pregnant women
- drug-dependent and alcohol-using women often present anxiety, depression, and low self-esteem 2. past and current physical and sexual abuse 3. homeless women more likely to have had experienced childhood abuse and are more involved in drug use 4. women in recovery likely to have history of violent trauma and risk for PTSD 5. stressful psychosocial factors are aggravated by low SES, thus increasing probability of using drugs
The Opiate-Exposed Infant
Experiences Neonatal Abstinence Syndrome (because most opiates are short-acting, signs of abstinence will develop shortly after delivery, generally within 1-3 days). Methadone-associated abstinence symptoms are more unpredictable because it collects in fetal tissue, thus affecting the rate of metabolism and excretion
Signs of Neonatal Abstinence Syndrome (CNS, GI, Respiratory, autonomic nervous system signs)
CNS signs: irritability, high-pitched crying, tremors, hyperreflexia, seizures, dysrhythmic sucking and swallowing. GI signs: vomiting and diarrhea combined with poor intake of nutrients and increased water loss = excessive weight loss. Respiratory signs: excessive secretions and nasal stuffiness, hypernea. Autonomic nervous system signs: sweating, tearing, hyperthermia
Treatment of Opioid-Exposed Infants
- increased amount of fluids and calories needed to offset the infant’s hypermetabolic state 2. reduced sensory stimulation 3. positioning, use of a soothing waterbed, dark room 4. close observation to avoid unnecessary treatment of mildly affected infants 5. short-acting opiate preparations (paregorics) for stabilization
Stimulant-effects in neonates (COCAINE) (5)
- neurological signs: restlessness, irritability, tremors, depressed interactive behavior, poor organizational response to stimuli, disturbance in dopaminergic and serotonergic systems. 2. Slower learning rate and habituation of response 3. abnormalities in reflex activities and motor performance 4. poorer auditory and visual tracking 5. treatment generally not required, though phenobarbital may be prescribed for excessive irritability
Alcohol-effects in neonates (3)
- NO safe level of alcohol use during pregnancy 2. FAS - dysmorphology, growth deficits, cognitive/intellectual deficits. 3. FAE = partial FAS
Nicotine-effects in neonates (2)
- long-term maternal smoking linked to placental breaches, infarcts, changes caused by vasoconstriction 2. elevated CO levels in smokers adversely affect the fetus, leading to reduction in birth weight, prematurity, increased rates of SIDS, increased rates of mortality from respiratory disorders
