Maternal & Newborn Effects of Prenatal Substance Abuse
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Transcript of Maternal & Newborn Effects of Prenatal Substance Abuse
مردم دو دسته اند: دسته اي برادر ديني تو و دسته ديگر همانند تو در آفرينش .اگر
گناهي از آنان سر مي زند يا علت هايي بر آنان عارض مي شود، يا خواسته و ناخواسته اشتباهي مرتكب مي گردند
آنان را ببخشاي و بر آنان آسان گير. آن گونه كه دوست داري خدا تو را
ببخشايد و بر تو آسان گيرد. امام علی)ع(
Maternal & Newborn Effects ofPrenatal Substance Abuse
Noori-Shadkam M)MD(
Objectives
Substance use and pregnancy Maternal & fetal effects during
pregnancy Withdrawal syndrome treatment
Behavior during pregnancy
Behaviors of drug-using pregnant women contribute to H.R pregnancy Unsafe sex with risk of violence Infection from injection Stimulant abuse may lead to early labor Poor nutrition Lack of prenatal care
Drug Classes
Alcohol Opioids Stimulants Nicotine Marijuana
Opioids
Morphine heroin OxyContin methadone
Effects on mothers•Extrauterine pregnancies•Premature labor•PROM•Uterin irritability•Breech presentation•Antepartum hemorrhage•Toxemia
Con…
•Anemia•Infections•Stillbirth
Opioids: Effects on fetus
Hyperactivity Hypoxia Meconium passage No known fetal
anomalies Utero demise
Effect on neonate•LBW•Thrombocytosis & increased circulating platelet aggregation•Abnormal thyroid function•Decrease HMD•Decrease sever hyperbilirubinemia
Neonatal withdrawal syn.
Follow-up reports
•Neurobehavioral deficits•Decrease visual & auditory orientation•Decrease motor maturity•More jerkiness•Tremulousness•Hypertonicity
Con…
•Irritability•Increase cry•Decrease PDI•Increase nystagmus;strabismus & otitis media
Stimulants
o Cocaineo Cracko Amphetamineo Methamphetamineo MDMA)Ecstasy(o Caffeine
Cocaine
Pharmacologic effects
Norepinephrine effect tachycardia arrhythmias hypertension vasoconstriction diaphoresis mild tremors
Pharmacologic effects
Dopamin effects increased alertness enhanced sense of well-being & self-stem heightened energy sexual excitement
Effects on mother
•Spontaneous abortion•Abruptio placenta•PROM•STD
Effects on fetus & neonate
Fetal hypoxia Fetal hypertention Cocaine-Induced ischemia intestinal atresia infarction NEC
Con…
•G.U malformation•STD•Prematurity•IUGR•SIDS•Diminished alertness•Poorer state regulation
Con…
•Abnormal reflex;tone & motor maturity•Impaired autonomic control•Irritability•Poorer orientation•Decreased habituation
Amphetamine
Effects on mother
•Miscarriage•Placental hemorrhage
Effects on fetus
•Prematurity•IUGR•Congenital anomaly cardiovascular musculoskeletal
Complication•Cardiac arrhythmia•ARF•DIC•Rhabdomyolysis•Learning & memory damage
Con…
•Loss of sexual pleasure•Effect on cognitive;sleep;appetite•death
Nicotine
Cigarettes pipe
Nicotine release
•Acetylcholine•Norepinephrine•GABA•Glutamine•Dopamine
Nicotine
•Increase HR•Increase BP•Increase RR•Hyperglycemia•Decrease appetite
Nicotine:Withdrawal symptom
•Irritability•Headache•Nausea•Craving
Smoking: Effects on fetus
Prematurity IUGR SIDS Increased risk for oral
cleft
Neurobehavioral & Developmental Effects In Infancy
•Increase tremulousness•Increase autonomic excitability•Increase ADHD•Decrease auditory habituation•Decrease auditory responsiveness•Decrease verbal comprehension•Decrease verbal learning & memory
Marijuana & Hashish
Acute Effect
•Euphoria & Relaxation•Increase HR•Increase BP in a seated or supine•Decrease BP in a standing•Dizziness•Decrease salivation•Increase appetit
Con…
•Impaired coordination•Poor decision making•Delayed responding•Altered sense of time•Impaired concentration & learning
Effects on fetus & neonate
Brain abnormalities )in animal model(o LBW)?(o Meconium passage
treatment
Pregnancy
Neonate
Treatment in pregnancy Reduce disease & crime
Counseling Social service
Avoid withdrawal & craving
Maintenance vs.detoxification
Long-acting medication for control
o STD
Methadone
Long-acting pure opioid agonist Available for opioid addiction
treatment Requires daily clinic visits, but may
get take-home dose privileges Also used for pain like other
Schedule II opioids
Methadone and Pregnancy
Standard of care for opioid-dependent pregnant women
Stabilization of mother and fetus Medical and social Higher dose in 3rd trimester
Improves growth of fetus & newborn
Decreases practice of high-risk behaviors
Buprenorphine
Long-acting opioid agonist-antagonist Office-based opioid addiction treatment
Schedule III Buy at local pharmacy )Subutex,
Suboxone( Very low risk of overdose Combined with naloxone Used for acute pain treatment
)Buprenex(
Buprenorphine and Pregnancy
Pregnancy Category C
Use Subutex instead of Suboxone to avoid naloxone
NAS less intense than with methadone
Studies ongoing, results encouraging
Treatment in neonate
The goal is an infant who
• No irritable• No vomitting• No diarrhea• Can feed well• Sleep between feeding
Symptomatic treatment
•Tight swaddling•Holding•Rocking•Placing in a slightly darkened quiet area •Hypercaloric formula•Never give naloxone
Medication
•Neonatal morphine solution)NMS(• Phenobarbital•NMS+Pb
NMS
score NMS 8-10 0.8ml/kg/day 11-13 1.2 14-16 1.6 17or >17 2
Phenobarbital
Loading Maintenance 20mg/kg 5mg/kg/d 30 6.5 40 8
NMS & pb
NMS 0.4ml/kg/day
Pb loading dose 10mg/kg then 5mg/kg/day