substances in pregnancy Flashcards
What is the incidence of FAS
The incidence of FAS in the developed world is estimated to be 0.05 to 3.0 per
1000 live births (NIAAA, 1997). This is considered an under estimation, however,
FAS is considered to be a leading preventable cause of birth defects in the
developed world.
What does Fetal Alcohol Spectrum Disorder (FASD) mean?
What is the incidence?
FASD is the umbrella term used to describe a range of adverse effects
including FAS, Partial FAS (PFAS), Alcohol-Related Neurodevelopmental
Disorders (ARND) or Alcohol Related Birth Defects (ARBD).
Overseas studies estimate that Fetal Alcohol Spectrum Disorder, which includes
FAS, collectively affects 1 in 100 live births
What is the rate of alcohol in pregnancy?
A 2005 national survey in Australia revealed that 33% of mothers aged 25-34
years report continuing to drink in pregnancy and a similar number believed it
is unnecessary to abstain
What are the 3 features of FASD?
The clinical features of FASD include three characteristic facial features (short palpebral fissures, thin vermillion border, and smooth philtrum) (picture 1),
central nervous system (CNS) abnormalities, and growth retardation
How to diagnose FAS?
At least 2 characteristic facial features
Growth retardation
Clear evidence of brain involvement
Neurobehavioral impairment
With or without documented prenatal alcohol exposure
What are other associated abnormalities of FAS?
cardiac 2% - ASD VSD conotruncal defects
Skeletal
Renal
Ocular
auditory - chronic hearing loss in up to 18% of patients with FASD
What should woman with substance use specifically be screened for?
Where appropriate, pregnant women with identified
substance use should be re-screened for blood borne viruses,
Hepatitis B, Hepatitis C and HIV later in pregnancy
If dx of substance use is made, what are the first 4 steps
Counselling
MDT referral
Consider mental health involvement
If heavy consider T-ace questionnaire
What is the T Ace
T-ACE is a measurement tool of four questions that are significant identifiers of risk drinking (i.e.,
alcohol intake sufficient to potentially damage the embryo/fetus).
What are the T ACE questions ?
- How many drinks does it take to make you feel high?
- less than or equal to 2 drinks
- more than 2 drinks
Tolerance - Have people annoyed you by criticizing your drinking?
- No
- Yes
Annoyance - Have you felt you ought to cut down on your drinking?
- No
- Yes
Cut Down - Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?
- No
- Yes
Eye openner
How to manage substance use?
10 steps
The following specialised modules of care may be undertaken as deemed appropriate:
1. Treatment of withdrawal, including pharmacotherapy. 2. Provision of information about substance use, and encouragement to participate in
decisions about care.
3. Involvement of the partner, family, the extended family and community according to
the woman’s preference and available supports.
4. Medical, mental health, psychosocial, pregnancy, and drug and alcohol management,
and care of co-morbidities.
5. Pre-birth child protection notification to be made.
6. Links to community or Indigenous health, mental health, drug and alcohol support services,
midwifery and or neonatal nursing services, outreach services, general practitioner or
Flying Doctor services should be established and maintained.
7. Pre- birth liaison with paediatric colleagues to provide early counselling for parents of
possible outcomes for baby
8. Management of Neonatal Abstinence Syndrome if this occurs.
9. Information, counselling and support are provided to minimise the incidence of relapse.
10. Appropriate follow-up arrangements are made for both mother and baby.
What are the substances implicated in of neonatal abstinence syndrome?
When can it occur?
Monitoring of the neonate is recommended, with neonatal abstinence syndrome scoring according
to the appropriate guidelines. The neonate of a woman with substance use disorder may develop
signs of withdrawal, usually within the first week of life. Opioids, alcohol, cannabis, benzodiazepines,
amphetamines and antidepressants are most commonly implicated. The effect on the neonate
depends on the substance used, the amount, duration, maternal renal and hepatic function and
whether full-term or preterm
What is the prevalence of smoking in pregnancy ?
In 2010, 11.7% of Australian women smoked during some or all of their pregnancy. In the period
before they knew they were pregnant, 11.7% of pregnant women smoked and 7.7% reported that they
smoked after they knew they were pregnant. The likelihood of smoking during pregnancy was higher
among teenagers, women in disadvantaged circumstances and Indigenous women.23
What chemicals in cigarettes are harmful?
Carbon monoxide leads to potential hypoxic changes by binding to the haemoglobin molecule.
Cadmium, a carcinogen, accumulates in the placenta and has been detected in umbilical cord blood,
and is associated with a reduction in fetal capillary volume.
Nicotine has been found in fetal blood, amniotic fluid and breast milk
How does smoking affect placental development?
Smoking disturbs the development of the placenta, potentially disrupting the implantation process and
interfering with the transformation of the uterine spiral arteries. Studies show thickening of the villous
membrane of the placenta in smokers, lessening the ability of the placenta to function. Nicotine also
impairs amino acid transport across the placenta. These changes increase the risk of intrauterine fetal
growth restriction and preterm birth.
