SUBSTANCE ABUSE AND PREGNANCY

Krista Miles

OBJECTIVES
Alcohol

Smoking

Drugs

ALCOHOL & PREGNANCY

Leading preventable cause of
birth defects and
neurodevelopmental
abnormalities in U.S.
20 to 30% of women report
drinking at some point during
pregnancy

WHAT HAPPENS WHEN MOM DRINKS?

Baby drinks but doesnt have a
mature liver that is able to filter
toxins
Interferes with development of the
brain and other key organs and
structures

EFFECTS OF ALCOHOL EXPOSURE ON FETUS

Umbrella diagnosis is Fetal
Alcohol Spectrum Disorders
(FASD)
Structural and functional
developmental issues
Withdrawal at birth

PREVENTION OF FASD
There is no known
safe level of
alcohol
consumption
during pregnancy

INTERVENTIONS FOR FASD

At birth be prepared for
physical abnormalities,
seizures, difficulty feeding
As they grow, families will
need to implement learning
and behavioral interventions
Family support

DRUGS & PREGNANCY FACTS

Street drugs = those that are
illegal: cocaine, meth, ecstasy,
heroin, marijuana, abused
prescription medications
5% of pregnant women take
street drugs

EFFECTS OF STREET DRUGS

Pregnancy/Mom

Baby

Infertility
Placenta Issues (Abruption)
Pre Term Labor
Miscarriage
Still Birth
Weight loss
Death Due to Respiratory Failure,
Stroke, or Heart Attack

Low Birth Weight

Reduced Head Circumference
Heart and Other Birth Defects
Infections: HIV and Hep C
Neonatal abstinence syndrome NAS
Learning and Behavior Problems
Failure to Thrive
SIDS

Marijuana

Cocaine

Heroin

Meth

Shorter Gestation
IUGR
Long term effects
on memory,
attention and
cognitive function

Placental abruption
Perinatal morbidity
IUGR & LBW
Preterm birth
Dont withdraw
but neurotoxic
affects that mimic
heroin NAS

Mother Overdose
IUGR
Stillbirth
Preterm birth
NAS

Placental abruption
IUGR
Preterm birth
Brady/Tachycardia
Lethargy
Infections
Poor weight gain

Ecstasy
Congenital
anomalies
Long-term memory
and learning
problems

Other
Opioids
Possible congenital
heart abnormalities
with codeine
Heroin symptoms
NAS

NEONATAL ABSTINENCE SYNDROME (NAS)

When: First 12 48 hours but can be up to a week if methadone was used
Jittery & hyperactive
Shrill persistent cry

Frequent yawning and sneezing

Increased tendon reflexes
Decreased Moro reflex
Poor feeding and sucking
Tachypnea

Vomiting and diarrhea

Hypo or hyperthermia
Sweat
Abnormal sleep cycle

If untreated
NAS can lead to
severe
dehydration,
seizures and
eventually death

INTERVENTIONS FOR NAS

Treat Electrolyte Imbalance
Swaddling with legs flexed
Holding close to the body
Reducing Stimuli cluster care
Nutrition - evaluation of
breastfeeding safety
Support for Mother

Medications:
First Line: Morphine &
Methadone (opioid)
Second Line:
Phenobarbital (for
seizures), Clonidine (for
other NAS symptoms)

WHAT ABOUT NON-ABUSED RX AND OVER THE

COUNTER MEDICATIONS?
90% of pregnant women
take some kind of
medication
70% of pregnant women
take prescription medication

NOT ALL MEDICATIONS ARE CREATED EQUAL

Less than 10% of
medications approved
by the FDA since 1980
have enough
information to
determine their risk
for birth defects

TOBACCO
Nicotine cause vasoconstriction
throughout body - fetal
hypoxia and undernourishment
Second hand smoke problem
during pregnancy and for a
newborn
Nicotine is excreted in
breastmilk for up to two hours
after smoking also smokers
produce less breastmilk

REFERENCES
http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committeeon-Health-Care-for-Underserved-Women/Opioid-Abuse-Dependence-and-Addictionin-Pregnancy
http://www.marchofdimes.org/pregnancy/alcohol-and-drugs.aspx
http://www.nlm.nih.gov/medlineplus/pregnancyandsubstanceabuse.html
http://emedicine.medscape.com/article/978763-medication
Lowdermilk, D. L., Perry, S. E., Cashion, K., & Alden, K. R. (2016). Maternity and
womens health care. (11th ed.). St. Louis, MO: Elsevier Inc.