Maternal Substance Abuse ✅ Flashcards
What % of women of child-bearing age are affected by alcoholism?
1-2%
What is the effect of alcohol on a developing embryo?
Alcohol and its acetaldehyde metabolite impairs embryogenesis by disrupting cellular differentiation and growth, inhibiting cell migration, and disrupting DNA synthesis
What is the name of the clinical syndrome caused by alcohols effect on embryogenesis?
Fetal alcohol spectrum disorder (FASD)
What is the incidence of fetal alcohol syndrome?
1-2 per 1000 live births
What is the recommended maximum intake of alcohol during pregnancy?
None
Why is it recommended that pregnant women avoid alcohol completely?
The effect of low or moderate alcohol ingestion or occasional binge drinking is unknown
What systems does fetal alcohol syndrome affect?
- Neurological
- Craniofacial
- Cardiac
- Limb
What are the neurological features of fetal alcohol syndrome?
- Microcephaly
- Abnormalities of corpus callous, cerebellar vermis, and dentate gyrus
- Cognitive impairment and developmental delay
What are the craniofacial features of fetal alcohol syndrome?
- Short palpebral fissures
- Smooth philtrum
- Maxilla hypoplasia
- Cleft palate
- Micrognathia
What are the cardiac features of fetal alcohol syndrome?
VSD
What are the limb features of fetal alcohol syndrome?
Joint abnormalities
What is neonatal abstinence syndrome most commonly associated with?
Chronic narcotic abuse
What other classes of drugs can be associated with neonatal abstinence syndrome?
- Non-narcotic sedatives
- Stimulants
- Anti-depressants
- Anti-epileptics
- Neuroleptics
What effect does chronic narcotic misuse have on a developing foetus?
It stimulates the opiate receptors in the locus cerulean of the fetal brainstorm, and acclimatisation occurs
What happens when narcotics are suddenly removed at birth?
Increased adrenergic activity of the locus ceruleus causes withdrawal symptoms
What can complicate the situation in neonatal abstinence syndrome?
Multiple drug use
Is opiate replacement therapy recommended in pregnant women?
Yes
What is used for opiate replacement therapy in pregnant women?
Methadone
What are the advantages of opiate replacement therapy in pregnant women?
- Clinical improvement
- Better control of drug use
- Less crime
- Reduced risk of hepatitis B and C, and HIV in IV users
How long after birth is the onset of opiate withdrawal symptoms in neonatal abstinence syndrome?
Usually within 48 hours of birth, but can be delayed for up to 2 weeks
What systems does opiate withdrawal affect in neonatal abstinence syndrome?
- CNS
- GI
- Autonomic
What are the CNS symptoms of opiate withdrawal in neonatal abstinence syndrome?
- Irritability and high-pitched cry
- Hyperactivity with reduced periods of sleep
- Tremors
- Increased tone
- Seizures (rare)
What are the GI symptoms of opiate withdrawal in neonatal abstinence syndrome?
- Poor feeding
- Vomiting
- Diarrhoea
What are the autonomic symptoms of opiate withdrawal in neonatal abstinence syndrome?
- Sweating
- Fever
- Yawning
- Sneezing
How are infants with neonatal abstinence syndrome monitored?
By recording them regularly using a standardised scoring system
How long might irritable and restless behaviour continue for in neonatal abstinence syndrome?
A number of months after birth
How can mild withdrawal symptoms be managed in neonatal abstinence syndrome?
Conservatively with;
- Swaddling
- Frequent feeds
- Decreased sensory stimulation
What is the first line treatment if required for neonatal abstinence syndrome?
Oral morphine
How is the dose of oral morphine in neonatal abstinence syndrome determined?
Titrated against clinical features
How are seizures treated in neonatal abstinence syndrome?
IV morphine or anti-convulsants
What immunisation is recommended in neonatal abstinence syndrome?
Hepatitis B
What is required longer term in neonatal abstinence syndrome?
Follow up by the MDT
Is breastfeeding recommended in mothers on opiate replacement therapy?
Yes
Why is breast-feeding recommended in mothers on opiate replacement therapy?
Concentration of methadone in breastmilk is low
What property of cocaine causes its effects on pregnancy?
It is a potent vasoconstrictor
What is the effect of cocaine being a potent vasoconstrictor on a developing foetus?
It affects the uteroplacental bed and fetal vasculature
What pregnancy complications does cocaine increase the risk of?
- Miscarriage
- Abruption
- Premature birth
- Cerebral artery infarction
When does foetal cerebral artery infarction caused by cocaine occur?
Most likely in second and third trimesters
Do neonatal symptoms of cocaine withdrawal occur early?
Yes
Should a mother be encouraged to breastfeed if they continue to use cocaine?
No
Why should a mother who continues to use cocaine not breastfeed?
As it may be transferred in breast milk
