Lecture Notes Session 8

Question 1

Define Perinatal Period

Answer 1

Continuum that extends from the beginning of a woman’s pregnancy through delivery and the first month of a child’s life

Question 2

Use of illicit drugs during pregnancy

Answer 2

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

Question 3

Medical Issues (2)

Answer 3

1. 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

Question 4

Opiate Addiction during Pregnancy risks

Answer 4

extremes of feeling “high” or “sick” within a relatively brief time

Question 5

Cocaine use during Pregnancy risks

Answer 5

increased risk of hypertensive crises, cardiac and cerebral vascular complications, seizures, substance-induced mood variability

Question 6

Excessive Alcohol intake during Pregnancy risks

Answer 6

increased rates of hypertension, cardiovascular mortality, GI hemorrhage, breast cancer

Question 7

How STDs linked to illicit drug use

Answer 7

1. 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.

Question 8

Obstetric risk with illicit drug use

Answer 8

1. 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

Question 9

Barriers to treatment (6)

Answer 9

1. 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

Question 10

Substance Abuse Prevention and Treatment Block Grant

Answer 10

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

Question 11

Treatment for Heroine Dependence during pregnancy

Answer 11

1. treatment of choice = methadone maintenance (it reduces both maternal mortality and fetal morbidity rate)
2. Effectiveness of Buprenorphine and safety to neonates is being studied to treat opioid-dependency in pregnant women

Question 12

Psychosocial issues of pregnant women

Answer 12

1. 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

Question 13

The Opiate-Exposed Infant

Answer 13

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

Question 14

Signs of Neonatal Abstinence Syndrome (CNS, GI, Respiratory, autonomic nervous system signs)

Answer 14

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

Question 15

Treatment of Opioid-Exposed Infants

Answer 15

1. 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

Question 16

Stimulant-effects in neonates (COCAINE) (5)

Answer 16

1. 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

Question 17

Alcohol-effects in neonates (3)

Answer 17

1. NO safe level of alcohol use during pregnancy 2. FAS - dysmorphology, growth deficits, cognitive/intellectual deficits. 3. FAE = partial FAS

Question 18

Nicotine-effects in neonates (2)

Answer 18

1. 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