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Substance Abuse in Pregnancy Issues in West Virginia

Substance Abuse in Pregnancy Issues in West Virginia. Stefan Maxwell M.D. Women & Childrens’ Hospital Charleston W.V. Objectives. Substances commonly used Methods of data collection What are our motives? Should we attempt to improve our information?. Substances commonly used.

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Substance Abuse in Pregnancy Issues in West Virginia

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  1. Substance Abuse in PregnancyIssues in West Virginia Stefan Maxwell M.D. Women & Childrens’ Hospital Charleston W.V.

  2. Objectives • Substances commonly used • Methods of data collection • What are our motives? • Should we attempt to improve our information?

  3. Substances commonly used

  4. Substances commonly used

  5. Substances commonly used • Of West Virginia women who reported using addictive drugs or alcohol during pregnancy • 78% also reported they used tobacco

  6. Smoking in WV and USA

  7. Common Substances used • Marijuana • Cocaine and Methamphetamines • Narcotics: Heroin and Methadone • “Legal” drugs: Nicotine and Alcohol • ?Others yet to be identified

  8. Other drugs • Opiates and opiate-like substances: --propoxyphene HCL (Darvon) --codeine --pentazocine (Talwin) • Non-opiates: --Barbiturates --Chlordiazepoxide, diazepam --Diphenhydramine, imipramine

  9. Other drugs • Selective serotonin reuptake inhibitors (SSRIs): • Paroxetine HCL (Paxil) • Fluoxetine (Prozac) • Citalopram HBr (Celexa) • Sertraline HCL (Zoloft) • Venlafaxine HCL (Effexor)

  10. Data collection • Maternal history (unreliable) • Maternal and newborn urine (unreliable) • Newborn meconium (collection issues) • Newborn hair (collection issues) • Umbilical cord tissue

  11. What are our motives? • Initially: • To address growing problem of illicit drug use. Collected data from chart reviews and then from birth score data. Data dependent on maternal history. Maternal screening tool (SB307) will help get more accurate data • Evident now that nicotine and alcohol are more prevalent and ?more teratogenic than illicit drugs

  12. What are our motives? • Suggest: • We need more accurate information to develop the maternal screening tool in order to start education and rehabilitation early in pregnancy • Umbilical cord pilot study

  13. Umbilical cord tissue • Universally available • Rapid results • ELISA (enzyme-linked immunosorbent assay) as reliable and less expensive than “gold standard” tandem mass spectrometry (JPerinatology,vol28,#11) • Anonymous epidemiologic screening tool

  14. Umbilical cord tissue

  15. Umbilical cord tissue

  16. IRB Protocol: Non-Human subject research • Collection of discarded specimens (umbilical cord segments) to test for substances of abuse • Goal is to determine more exactly the rate and types of substances used during pregnancy in neonates delivered at WV Hospitals

  17. Cord tissue study • Cord specimens de-identified; labeled only by hospital of origin • No consent required (WVU ORC) • Specimens “batched” and sent to USDTL or other lab for “cordstat 12 +ETOH” testing • Results released when collection complete

  18. Cord tissue study • Society may benefit from knowing the true incidence of substance abuse during pregnancy in West Virginia • This information should help in developing a more focused maternal screening tool which will direct antenatal education and rehabilitation, and ultimately improve the health of our mothers and babies in the state.

  19. Summary • Substances commonly used • Methods of data collection • Suggested a pilot study using discarded cord tissue specimens to more accurately determine the prevalence of certain drugs in this state • Ultimately achieve our motives

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