Substance Misuse In Preancy g Flashcards
What is a drug
Any substance which the taken into the body altered the body’s function either physically and or pysocholoically
Legal - alcohol caffeine and Tobacco
Prescription legally or illegally obtained pressrciption drugs
Drug categories and classes
Stimulants - cocaine/ amphetamines
Depressants - alcohol/ benzos
Opiates/ opioids - heroin/ morphine/codeine
Hallucinogens - LSD/MDMA/PCP
Cannabis - hallucinogenic to a lesser degree
Inhalants - volatile substances, gases and nitrates
New psychoactive substances
Cannabis/smooking
Increase risks t any such as low birth weight likely due to placental dysfunction and potential lungs and chest problems in later life
Cannabis has hallucinogenic properties this can cause paranoia/ psychosis in the mother
Cannabis has increased levels of CO and tar
Advice for smoking
Stop smoking or if struggling add filters when using roll ups
Referra to smoking cessation team - use NRT patched, gum or lozenges. Vapes
Alternate coping strategies to help relax and sleep
Very brief advice - ask, advice and act
Cocaine
Associated with placental dysfunction including placental abruption and pre eclampsia
In the infant, adverse neuro development outcomes have been reported but some if th noted effectd of cosine may have een mis attributed to confounding variables such as as social factors
Opioids
Estimated eggesct of opioids on pregnancy are viable between drugs, doses, individuals and other drugs bing used. There is some association with opioid use and low birth weight infants. Exposure to opioids can result in Nekntal abstinence syndrome
Alcohol
FASD or FAS can result from excessive use of (binges more than 4 units_ or dependence of alcohol in pregnancy
Fetal alcohol syndrome disorder can cause learning disabilities and behavioural problems in the child as they grow
Fetal alcohol syndrome - term given for the appearance and significant issues from alcohol use n the first 12 weeks of pregnancy such as facial features
No safe limit for alacohol in pregnancy and use of brief interventions to reduce intake should occur at booking appt
Early referral to specialist midwife is important as brief inter Venetian can be given and additional scans and referral made as required
If alcohol dependent
DO NOT STOP SUDDENLY
This can cause death in the mum
Urgent referral to turn in point via specialist midwives for in depth assessment and detox
Accurate assessment of alcohol consumption, document what patient drinks - do not guess units if unsure
Advise to divide alcohol consumption in divided doses (treat as medicine) eg 12 doses
Example
client drinking 2-3 bottles of red wine a day - reduce to 125mls x 12 doses
Advise to divide alcohol consumption in divided doses (treat as a medicine) eg 12 doses -
(1500mls = 2 bottles) this will include a dose for the middle of the night (thus preventing /
reducing withdrawal and need for a larger drink in the morning) reduce further to 115mls x
12, then 100mls x 12, then 100mls x 11 etc until detox bed available. Dose should be
reduced only when stable therefore approx every 2 days depending on how the mother
feels.
Neonatal abstinence syndrome
Condition that can arise from maternal substance use - even prescribed medicine
Symptoms
Irritable baby
Jittery
High pitch cry
Sneezing
Sucking
Ridgity in arms or legs
Sever nappy rash
Loose stool
Rise in body temp
Wight loss of often more than 10%of birth weight due to increase use of energy when withdrawing
Supporting Dyaus through NAS
Potential effects on parents - low self efficacy, low self esteem, guilt and blame, sleep deprivation and impact on mood
Potential effects on babies - discomfort and distress and pain of nappy rash Loose stool
Supporting parent babyrelationships
Skin to skin
Breastfeeding
Social support
Swaddling
Non nutritive sucking
Substance use and infant feeding
Many drugs and substances are transferred to breast milk as its is synthesised from constituents f blood
As per all meds, seek specialist advice on safety
Vast majority for not entirely prohibit breastfeeding
Factors associated with substance misuse that affect Nekntal mortality - deprivation und=safe sleeping and smoking - can be mitigated b provision of breast milk and breastfeeding
Breastfeeding offers a stable foods source, negates cost and risks of unsafe formula preparation and provision increases self efficacy
Not safe to breastfeed if consciousness is impaired by any substances
What can herion and cocaine use cause
Contraindication for breastfeeding
Advised to wai 24hrs or more
Both can cause orbidity in the baby
Observe for vomiting add respiratory disease
What can the transfer small quantities of of opioids cause via breastfeeding
May ease NAS
Is methadone and subtext safe fo breastfeeding
Yes
Pre conception care
Specalist support transition from non prescribe substances (street drugs, alcohol, tabacco0 into cessation, reduction or alternatives
Aim - stability and harm reduction
Referra to Lola drug and alcohol services - in Leicester (turning point)
Health optimisation screening and vaccinations, weight and nutrion, folic acid
Holistic support
Pyscho social - community integration, establishing social support, psychological counselling
Financial - access to benefits, stable housing
Antenatal care considerations
Build trust ad rapport through honest, compassionate care
Thorough review of medicinal, best retro, facial and social factors
Multi displinary care - specialist midwife, obstruction, specialist nurse, GP, local drug and alcohol services
Urine toxocology
Offer/sinpost to relevant health promotion opportunities - antenatal classes, children’s centre s, mental health and wellbeing and food banks
Consider racial risk assessments and referral A form
Serial growth scans due to risk o growth restriction and stillbirth for substance use
Access and engagement
Substance use may ,are i mores difficult for women to consistently access and engage in care
Offer flexibility one stop shop approach
Be proactive i outreach to engage women in heir are
Support continuity of carer modes where possible
Consider home visits
Trauma informed care
Women affected by substance use have a higher rate of a history of trauma
You do not need to know if someone has experienced trauma to provide trauma - informed care
You o not need to know the root of the trauma to provide trauma informed care You o
Postnatal answer neonatal care
Multi displinary care continues -neonatologist and obstruction
Consider safeguarding and parenting practices - document accordingly
Carefully consider safe sleeping practices and SIDS risk
Consider plan for NAS scoring - may continue for 5+days. Longer inpatient say
Continue to support mthadone programme whilst inpatient to avoid sudden changes - contact outpatient pharmacy to inform of admission
Holistic discharge planning - home environment, social support, enquire re caregivers, finances, pyschologically stability, routine and enquiry
