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Pregnancy and Drug Abuse

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Title: Pregnancy and Drug Abuse


1
Pregnancy and Drug Abuse
  • Eva Janecek-Rucker

2
Learning Objectives
  1. To develop a knowledge base of the effects of
    substances of abuse (e.g., alcohol, cocaine,
    nicotine et al.) during pregnancy.
  1. To examine the pharmacists 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.

3
Drugs in Pregnancy
  • CNS depressants
  • alcohol
  • benzodiazepines
  • barbiturates
  • inhalants
  • (toluene often combined with alcohol)
  • CNS stimulants
  • cocaine
  • caffeine
  • nicotine

4
Drugs in Pregnancy
  • Hallucinogens
  • cannabis
  • LSD
  • Opioids
  • codeine, morphine
  • heroin

5
Interpretation of Results
  • Animal studies
  • Prenatal drug exposure (dose, timing,
    duration)
  • Withdrawal
  • Breastfeeding

6
Issues with Illicit Drug Use During Pregnancy
  • Drug
  • authenticity
  • dose
  • additives
  • Pharmacological effects
  • Multiple drug use
  • Injection drug use
  • Effect of fathers drug use

7
Issues (contd)
  • Lack of prenatal care
  • Poor diet
  • Smoking
  • Drinking
  • Violence

8
AlcoholFetal 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)

9
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12
Alcohol (contd)
  • No safe level established
  • a Canadian committee recommended abstinence or
    at least to limit consumption to less than 4
    drinks per week

13
Alcohol (contd)
  • Treatment of a pregnant alcoholic
  • diazepam loading for alcohol withdrawal
  • Disulfiram
  • -contraindicated in pregnancy
  • Naltrexone ?

14
Solvents
  • Effects similar to FAS
  • CNS dysfunction
  • Attentional deficits
  • Growth deficiency
  • Development delay
  • Facial dysmorphology

15
Benzodiazepines
  • Likely not teratogenic cleft
    lip/palate???
  • Neonatal withdrawal symptoms

16
Barbiturates and other hypno-sedatives
  • No evidence of teratogenicity
  • Neonatal withdrawal syndrome
  • Treatment phenobarbital

17
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)

18
Nicotine
  • Spontaneous abortion
  • Low birth weight
  • Perinatal mortality
  • Prematurity
  • Abruptio placentae
  • Congenital malformations (most studies show lack
    of)
  • Sudden infant death syndrome (SIDS)

19
Caffeine
  • Low dose - no effect
  • High dose
  • in animals - adverse effects
  • in humans - ?

20
Heroin
  • Fetal distress or death during withdrawal in
    utero
  • Decreased birth weight
  • Higher incidence of
  • Infections
  • medical complications
  • obstetrical complications
  • Neonatal withdrawal
  • SIDS

21
Heroin (contd)Treatment of pregnant woman
  • methadone

22
Cannabis
  • Decreased birth weight
  • Prematurity
  • Effect of tar
  • No congenital abnormalities

23
LSD
  • Limb defects
  • CNS abnormalities
  • Ocular abnormalities

24
Pharmacists Role
  • Identification
  • Information
  • Referral

25
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 Clinicians Guide
    2nd Edition, G Koren (ed), 1994
  • Journals
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