Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Pregnancy and Drug Abuse Eva Janecek-Rucker Learning Objectives 1. To develop a knowledge base of the effects of substances of abuse (e.g., alcohol, cocaine, nicotine et al.) during pregnancy. 2. To examine the pharmacist’s role and develop a comfort level with respect to prevention, counselling and referral of women planning pregnancy as well as those who are pregnant and using psychoactive substances. Drugs in Pregnancy • CNS depressants – alcohol – benzodiazepines – barbiturates – inhalants (toluene; often combined with alcohol) • CNS stimulants –cocaine –caffeine –nicotine Drugs in Pregnancy • Hallucinogens – cannabis – LSD • Opioids – codeine, morphine – heroin Interpretation of Results • Animal studies • Prenatal drug exposure (dose, timing, duration) • Withdrawal • Breastfeeding Issues with Illicit Drug Use During Pregnancy • Drug – authenticity – dose – additives • Pharmacological effects • Multiple drug use • Injection drug use • Effect of father’s drug use Issues (cont’d) • Lack of prenatal care • Poor diet • Smoking • Drinking • Violence Alcohol Fetal Alcohol Spectrum Disorder (FASD) • High risk: woman drinking 6 standard drinks/day during the first trimester • Signs of FAS: – prenatal and postnatal growth retardation – CNS dysfunction (often including mental retardation) • Facial dysmorphology • Other congenital abnormalities • Fetal alcohol effects (FAE) Alcohol (cont’d) • No safe level established – a Canadian committee recommended abstinence ‘or at least to limit consumption to less than 4 drinks per week’ Alcohol (cont’d) • Treatment of a pregnant alcoholic – diazepam loading for alcohol withdrawal • Disulfiram -contraindicated in pregnancy • Naltrexone ? Solvents • Effects similar to FAS: – CNS dysfunction – Attentional deficits – Growth deficiency – Development delay – Facial dysmorphology Benzodiazepines • Likely not teratogenic; cleft lip/palate??? • Neonatal withdrawal symptoms Barbiturates and other hypno-sedatives • No evidence of teratogenicity • Neonatal withdrawal syndrome • Treatment: phenobarbital Cocaine • • • • • • • • Spontaneous abortion Prematurity Intrauterine growth retardation Abruptio placentae Perinatal cerebral infarction Structural CNS abnormalities Urogenital abnormalities Concomitant use of other drugs (alcohol and benzodiazepines) Nicotine • Spontaneous abortion • Low birth weight • Perinatal mortality • Prematurity • Abruptio placentae • Congenital malformations (most studies show lack of) • Sudden infant death syndrome (SIDS) Caffeine • Low dose - no effect • High dose: – in animals - adverse effects – in humans - ? Heroin • Fetal distress or death during withdrawal in utero • Decreased birth weight • Higher incidence of Infections medical complications obstetrical complications • Neonatal withdrawal • SIDS Heroin (cont’d) Treatment of pregnant woman • methadone Cannabis • Decreased birth weight • Prematurity • Effect of tar • No congenital abnormalities LSD • Limb defects • CNS abnormalities • Ocular abnormalities Pharmacist’s Role • Identification • Information • Referral Resources • Alcohol and Drug Assessment and Treatment Services • Motherisk: www.motherisk.org (416) 813-6780 • www.pregnets.org • Information sources –Textbooks Drugs in Pregnancy and Lactation 6th Edition, GG Briggs, RK Freeman, SJ Yaffe (eds), 2001 Maternal-Fetal Toxicology: A Clinician’s Guide 2nd Edition, G Koren (ed), 1994 –Journals