EFFECTS OF USING SUBSTANCES DURING PREGNANCY

1. EFFECTS OF USING SUBSTANCES DURING PREGNANCY CHILD CARE HEALTH CONSULTATION PROGRAM Sources cited: Missouri Dept. of Health & Senior Services, State Health Assessment, 2013 March of Dimes, 2007 American Pregnancy Association: www.americanpregnancy.org

2. oBJECTIVES • BECOME FAMILIAR WITH SUBSTANCES THAT CAUSE HARM IF USED DURING PREGNANCY • BE AWARE AND PREPARED TO MAKE REFERRALS TO COMMUNITY RESOURCES

3. Some of the ‘numbers’ • Missouri’s smoking rate at 23 percent is slightly higher than the U.S rate of 21.2 percent. The smoking rate in the Southeast region is higher than the state rate. • The life expectancy at birth for Missourians (76.9 years) is lower than for all Americans (78.1). The life expectancy at birth for residents in the Southeast region is nearly two years less than that for the state. Missouri Dept. of Health & Senior Services, State Health Assessment, 2013

4. “Numbers” con’t • Missouri’s infant death rate is significantly greater than the U.S. rate but the infant death rate for African Americans is more than double the rate for all Missourians. • The impact of drug use in Missouri is felt in families, communities, the criminal justice system and the public health system. The Missouri drug arrest rate is significantly higher than the U.S. rate. Missouri Dept. of Health & Senior Services, State Health Assessment, 2013

5. Substance abuse during pregnancy • Pregnant women are less likely to use substances than their peers. • The exception is pregnant women aged 15 to 17; this substance use rate is 26 percent for pregnant women, compared with 19.6 percent for non-pregnant women. March of Dimes, 2007

6. Substance abuse during pregnancy Women more prone to substance abuse: • Earn below poverty level • Were exposed to violence as a child • Have a history of domestic abuse • Suffer depression or other mental health problems • Have less than a high school education • Are unmarried • Are unemployed • Are involved with the criminal justice system March of Dimes, 2007

7. Substance abuse during pregnancy • Substance use is highest in the first trimester. (they may not know they’re pregnant) • The most common form of substance use in pregnancy is smoking among White women. • Tobacco, alcohol and drug use in pregnancy occurs across all demographic groups. March of Dimes, 2007

8. Tobacco

9. Tobacco Use in Pregnancy: Maternal Effects Cigarette smoking is the most common form of substance abuse in pregnancy. It is linked to: • Decreased fertility • Spontaneous abortion • Placenta praevia • Placental abruption • Ectopic pregnancy • Preterm premature rupture of membranes (PPROM) • Preeclampsia March of Dimes, 2007

10. Tobacco Use in Pregnancy: Fetal Effects • Impaired transfer of oxygen and nutrition • Long-term cognitive function and increased risk of brain damage • Chronic low-level hypoxia • Intrauterine growth restriction (IUGR) • Preterm delivery • Low birth weight (LBW) in term infants March of Dimes, 2007

11. Tobacco Use in Pregnancy: Neonatal Effects • Impaired respiratory function in premature infants • Low neurobehavior scores and higher withdrawal-symptom scores • Asthma, respiratory illness and pneumonia • Infections of the middle ear • Increased risk of cancer and SIDS

12. alcohol

13. Alcohol Use in Pregnancy There is no safe amount of alcohol consumption during pregnancy (Jones & Chambers, 1999).

14. Alcohol Use in Pregnancy: Maternal Effects • Cardiovascular and liver disease • Breast and gynecological cancer • Osteoporosis • Menstrual symptoms • Neurological and mental health problems • Compromised ability to conceive • Spontaneous abortion

15. Alcohol Use in Pregnancy: Fetal Effects • Abnormalities in brain and neuron development • Growth deficiency • Structural changes • Prematurity • LBW • Decreased length and head circumference

16. Alcohol Use in Pregnancy: Neonatal Effects Fetal Alcohol Spectrum Disorders (FASD) • Fetal alcohol syndrome (FAS) • Fetal alcohol effects (FAE)

17. fetal alcohol spectrum disorders (FASD) FASD = All problems that result from fetal exposure to alcohol • Fetal Alcohol Syndrome (FAS)—Most common • Fetal Alcohol Effect • Alcohol-related Neuro-Development Disorder • Alcohol-related Birth Defects

18. Fetal alcohol syndrome • Effects are irreversible but 100% preventable! • Mental retardation • Malformation of bones and major organs • Central nervous system problems, poor motor skills • Death • Problems with growth & development/speech & hearing • May have distinct facial features

19. Fetal alcohol effects Alcohol-related Neuro-Development Disorder --mental and behavioral impairments such as learning disabilities, poor school performance, poor impulse control, and problems with memory, attention and/or judgment. Alcohol-related Birth Defects --malformations of the skeletal system and major organ systems such as defects of the heart, kidneys, bones, and/or auditory system

20. How is Fetal Alcohol Syndrome different from Fetal Alcohol Effects? Fetal Alcohol Syndrome is a result of high doses of alcohol consumption during pregnancy such as binge drinking and/or drinking on a regular basis. Fetal Alcohol Effects are a result of moderatedrinking throughout pregnancy. The effects of FAE are still irreversible and lifelong.

21. Illicit drugs

22. Marijuana: Maternal Effects • Is the illicit drug most commonly used during pregnancy, although only 3.6 percent of pregnant women report using it (SAMSHA, 2005) • Does not cause a defined physical withdrawal syndrome • Heavy use linked to lung problems

23. Marijuana: Fetal and Neonatal Effects • Does not appear to cause anomalies or serious effects on the fetus • Does not appear to decrease intelligence • Newborns may show increased startle response, tremors, hand-to-mouth behavior and disturbed sleep patterns.

24. Cocaine: Maternal Effects • Hypertension • Tachycardia • Cardiac events and maternal death • Spontaneous abortion • Placental abruption • Premature rupture of membranes (PROM)

25. Cocaine: Fetal Effects Fetal effects of cocaine are caused by the drug’s direct effects (vasoconstriction and neuro-excitation) and by lifestyle issues that maternal drug use brings, including poor nutrition and avoidance of prenatal care.

26. Cocaine: Neonatal Effects • Jitteriness • Hyperactivity • Inconsolability • Poor feeding and state regulation • No physiological withdrawal: Neonates are not dependent on cocaine and do not need medication to lessen withdrawal.

27. Amphetamines: Maternal Effects • Stroke • Cardiac problems • Psychiatric emergencies • Growth restriction • Placental abruption • Preterm delivery

28. Amphetamines: Fetal and Neonatal Effects • Similar effects to cocaine, with decreased fetal growth • Some researchers expect that as with cocaine,effects can be seen early in life but are quickly overpowered by environmental factors.

29. MDMA (Ecstasy): Maternal Effects • Anxiety • Twitching • Depression • Impaired cognitive processing and memory performance

30. MDMA: Fetal and Neonatal Effects • Animal studies do not show an increase in harmful fetal effects. • A small, uncontrolled, retrospective study suggests a possible increase in heart defects. • Nurses should treat infants and families based on demonstrated health needs.

31. Heroin: Maternal Effects Heroin can cause severe physiological withdrawal symptoms, including fatal seizures when withheld for 12 to 48 hours.

32. Heroin: Treatment • Methadone • The most common treatment for heroin abuse in pregnant women • During pregnancy, brings addicted women into agencies that promote prenatal care • Buprenorphine • Linked to better treatment adherence with fewer side effects and overdoses than methadone

33. Heroin: Fetal Effects • Opiates, such as heroin, methadone and buprenorphine, have not been linked to fetal anomalies. • Fetal withdrawal responses include arrhythmias, seizure activity and fetal demise.

34. Heroin: Neonatal Effects • Drug withdrawal • Suck-swallow difficulties • Central nervous system (CNS) irritability • Gastrointestinal upset • Yawning • Sneezing • Frantic sucking with uncoordinated feeding • High-pitched cry • Increased or decreased muscle tone

35. Providers’ role

36. How can you help Support children in your care who may have special needs as a result of some of these effects on them • Seek further training on children with special health care needs • Know your community resources

37. How you can help • Be aware of community resources for families that may need referral for help • Have information available to educate/inform (posters, flyers, brochures) in areas where adults gather.

38. Referrals and resources

39. Addiction Recovery (Kearney, 1998) Recovery involves: • Abstinence • Self and psychological issues • Connections and relationships with men and women, family, community and culture

40. Community resources • Local health department • Medical providers • Mental health professionals • Associations (March of Dimes) • Web resources: • National Council on Alcoholism and Drug Dependence https://ncadd.org • National Institute on Drug Abuse: www.drugabuse.gov

41. Thank you