substance use and DV in pregnancy

Question 1

referrals made

Answer 1

medical teams
SUPS
social worker
psych
neonatologist
child protection
mandatory DOCS referral

Question 2

SUPS - management issues

Answer 2

• Poly-drug use and maternal, fetal and long term neonatal effects and outcomes
• Recreational drug use
• Mental health
• Child protection
• DOCS referral
• Pain relief
• Pharmacological treatments for withdrawal
• Staff beliefs and negative attitudes
• Staff education

Question 3

general care principles

Answer 3

multidisciplinary approach
- Vertical transmission of blood-borne viruses
- Mental health
- Confidentiality
- Pregnancy care facilities
- Child protection obligations
- Contraception

Question 4

smoking

Answer 4

risk factors
- LBW
- preterm
- SGA
- perinatal death
-17.3% aus
- 8.8% 2021

Question 5

smoking interventions

Answer 5

quit for new life program - NSW Health smoking cessation
nicotine replacement therapy - controversial

Question 6

alcohol

Answer 6

• Maternal alco consumption can harm the developing fetus or BF baby
• Crosses placenta – blood flow supply decrease and placenta detaches – bleeding, miscarriage, stillbirth and premmie
• Suffer withdrawal symptoms – poor coordination, movemet, fetal alcohol spectrum disorder syndrome (FASD)

Question 7

caffeine

Answer 7

• Moderate (4 cups of coffee) can cause dependence and withdrawal
• Caffeine and osteoperosis, high blood pressure, heart disease, heartburn, ulcers, severe insomnia, infertility
• Miscarriage, difficult birth, LWB

Question 8

marijuana

Answer 8

• Crosses placenta, LWB, secreted in breastmilk
• Serious risks to mental health

Question 9

heroin

Answer 9

• Affect fetal development
• Increased risk in miscarriage, premmie, SGA and prone to illness
• Hepatitis and HIV
• Cause NAS
• 60-90% of opiate exposed infants to NAS
• Sudden withdrawal can harm baby

Question 10

treatments (heroin)

Answer 10

• Buprenorphine (Subutex)
• Methadone (transfer can occur rapidly
• Naltrexone (transfer can take up to 3-5 days)

Question 11

methadone

Answer 11

clean and cheap
a long-acting opioid agonist, reduces opioid craving and withdrawal and blunts or blocks the effects of opioids. Taken daily, it is available in liquid, powder and diskettes forms.

Question 12

NAS

Answer 12

• Finnegan scoring system
• Central nervous system – hyperirritability, gastro, resp distress, yawning, sneezing, mottling, fever
• Within 72 hours
• Care of the opoid-dependent pregnant woman from a drug and alcohol perspective based on the harm minimisation
• Care of newborn from child protection perspective

Question 13

cocaine

Answer 13

• Fetal tachycardia and affect fetal variability
• Decrease uterine blood flow by 50% and increase uterine vascular resistance = placental flow issues
• Preterm, SGA, grow slowly after birth, language and executive function issues
• Miscarriage, placental abruption, prem, stillbirth
• Unsettled, hyperactivity, agitation, distressed breathing, sleepiness, poor feeding, lack of responsiveness

Question 14

amphetamines

Answer 14

• ICE
• SGA 3x likely
• Preterm birth
• Placental abruption
• Heart and brain abnormalities
• Lethargy and developmental delay