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TAS Perinatal Medicine ✅ > Maternal Substance Abuse ✅ > Flashcards

Maternal Substance Abuse ✅ Flashcards

1
Q

What % of women of child-bearing age are affected by alcoholism?

A

1-2%

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2
Q

What is the effect of alcohol on a developing embryo?

A

Alcohol and its acetaldehyde metabolite impairs embryogenesis by disrupting cellular differentiation and growth, inhibiting cell migration, and disrupting DNA synthesis

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3
Q

What is the name of the clinical syndrome caused by alcohols effect on embryogenesis?

A

Fetal alcohol spectrum disorder (FASD)

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4
Q

What is the incidence of fetal alcohol syndrome?

A

1-2 per 1000 live births

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5
Q

What is the recommended maximum intake of alcohol during pregnancy?

A

None

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6
Q

Why is it recommended that pregnant women avoid alcohol completely?

A

The effect of low or moderate alcohol ingestion or occasional binge drinking is unknown

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7
Q

What systems does fetal alcohol syndrome affect?

A
  • Neurological
  • Craniofacial
  • Cardiac
  • Limb
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8
Q

What are the neurological features of fetal alcohol syndrome?

A
  • Microcephaly
  • Abnormalities of corpus callous, cerebellar vermis, and dentate gyrus
  • Cognitive impairment and developmental delay
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9
Q

What are the craniofacial features of fetal alcohol syndrome?

A
  • Short palpebral fissures
  • Smooth philtrum
  • Maxilla hypoplasia
  • Cleft palate
  • Micrognathia
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10
Q

What are the cardiac features of fetal alcohol syndrome?

A

VSD

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11
Q

What are the limb features of fetal alcohol syndrome?

A

Joint abnormalities

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12
Q

What is neonatal abstinence syndrome most commonly associated with?

A

Chronic narcotic abuse

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13
Q

What other classes of drugs can be associated with neonatal abstinence syndrome?

A
  • Non-narcotic sedatives
  • Stimulants
  • Anti-depressants
  • Anti-epileptics
  • Neuroleptics
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14
Q

What effect does chronic narcotic misuse have on a developing foetus?

A

It stimulates the opiate receptors in the locus cerulean of the fetal brainstorm, and acclimatisation occurs

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15
Q

What happens when narcotics are suddenly removed at birth?

A

Increased adrenergic activity of the locus ceruleus causes withdrawal symptoms

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16
Q

What can complicate the situation in neonatal abstinence syndrome?

A

Multiple drug use

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17
Q

Is opiate replacement therapy recommended in pregnant women?

A

Yes

18
Q

What is used for opiate replacement therapy in pregnant women?

A

Methadone

19
Q

What are the advantages of opiate replacement therapy in pregnant women?

A
  • Clinical improvement
  • Better control of drug use
  • Less crime
  • Reduced risk of hepatitis B and C, and HIV in IV users
20
Q

How long after birth is the onset of opiate withdrawal symptoms in neonatal abstinence syndrome?

A

Usually within 48 hours of birth, but can be delayed for up to 2 weeks

21
Q

What systems does opiate withdrawal affect in neonatal abstinence syndrome?

A
  • CNS
  • GI
  • Autonomic
22
Q

What are the CNS symptoms of opiate withdrawal in neonatal abstinence syndrome?

A
  • Irritability and high-pitched cry
  • Hyperactivity with reduced periods of sleep
  • Tremors
  • Increased tone
  • Seizures (rare)
23
Q

What are the GI symptoms of opiate withdrawal in neonatal abstinence syndrome?

A
  • Poor feeding
  • Vomiting
  • Diarrhoea
24
Q

What are the autonomic symptoms of opiate withdrawal in neonatal abstinence syndrome?

A
  • Sweating
  • Fever
  • Yawning
  • Sneezing
25
Q

How are infants with neonatal abstinence syndrome monitored?

A

By recording them regularly using a standardised scoring system

26
Q

How long might irritable and restless behaviour continue for in neonatal abstinence syndrome?

A

A number of months after birth

27
Q

How can mild withdrawal symptoms be managed in neonatal abstinence syndrome?

A

Conservatively with;

  • Swaddling
  • Frequent feeds
  • Decreased sensory stimulation
28
Q

What is the first line treatment if required for neonatal abstinence syndrome?

A

Oral morphine

29
Q

How is the dose of oral morphine in neonatal abstinence syndrome determined?

A

Titrated against clinical features

30
Q

How are seizures treated in neonatal abstinence syndrome?

A

IV morphine or anti-convulsants

31
Q

What immunisation is recommended in neonatal abstinence syndrome?

A

Hepatitis B

32
Q

What is required longer term in neonatal abstinence syndrome?

A

Follow up by the MDT

33
Q

Is breastfeeding recommended in mothers on opiate replacement therapy?

A

Yes

34
Q

Why is breast-feeding recommended in mothers on opiate replacement therapy?

A

Concentration of methadone in breastmilk is low

35
Q

What property of cocaine causes its effects on pregnancy?

A

It is a potent vasoconstrictor

36
Q

What is the effect of cocaine being a potent vasoconstrictor on a developing foetus?

A

It affects the uteroplacental bed and fetal vasculature

37
Q

What pregnancy complications does cocaine increase the risk of?

A
  • Miscarriage
  • Abruption
  • Premature birth
  • Cerebral artery infarction
38
Q

When does foetal cerebral artery infarction caused by cocaine occur?

A

Most likely in second and third trimesters

39
Q

Do neonatal symptoms of cocaine withdrawal occur early?

A

Yes

40
Q

Should a mother be encouraged to breastfeed if they continue to use cocaine?

A

No

41
Q

Why should a mother who continues to use cocaine not breastfeed?

A

As it may be transferred in breast milk

TAS Perinatal Medicine ✅ (16 decks)

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