Substance misuse in pregnancy Flashcards
What are the typical facial features seen in foetal alcohol syndrome?
Flat upper lip
Flattened philtrum
Flat mid-face
What neurodevelopment abnormalities may occur in foetal alcohol syndrome?
Decreased cranial size at birth
Structural brain abnormalities - e.g. microcephaly, corpus callosum agenesis, cerebellar hypoplasia
Hard/soft neurological signs - e.g. impaired fine motor skills, neurosensory hearing loss, poor hand-eye coordination
What pregnancy-related problems can be caused by alcohol?
- Infertility
- Early miscarriage
- Structural abnormalities
- Preterm labour
- Foetal growth restriction - e.g. LBW or SGA
- Foetal alcohol syndrome (and neurodevelopment problems)
What pregnancy-related problems can be caused by sedatives?
Neonatal withdrawal symptoms
What pregnancy-related problems can be caused by stimulants?
- Early miscarriage
- Structural abnormalities
- Preterm labour
- Placental abruption
- Foetal growth restriction
- Still birth
- Sudden infant death
What pregnancy-related problems can be caused by opioids?
- Structural abnormalities
- Foetal growth restriction
- Foetal distress in labour
- Admission to NICU (with respiratory distress)
- Sudden infant death
- Neurodevelopmental
Why might female opiate users in particular be unaware they are pregnant?
Because opiate-use can induce amenorrhoea
How should opioid-users be managed during pregnancy?
Use should be stabilised during the first trimester, and then detoxification may start from the second in small-frequent reductions of methadone
How should cocaine-users be managed during pregnancy?
Complete discontinuation during pregnancy should be advised. There is no safe pharmacological substitute, but psychological therapies can be employed
How should sedative-users be managed during pregnancy?
BZD dependant women should be stabilised on diazepam and then dose reduced if tolerated
Misusers of what should be discouraged from breast feeding?
Only those that use crack cocaine or high doses of BZDs
