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Maternal Drug Use
How to Create the Best Offspring or Not …
Alison Freeman, Geleen Antonio, Jae Eun Kim, Matthew White, and Sydney Shera
Overview
• Development– Babies and mommies
• Cocaine– Moms– Babies
• Heroin– Moms– Babies
• Other bad decisions
Review
• You take a drug– Hopefully feel good
• Brain notices NT difference– Brain adapts to this
• Up-regulation• Down-regulation
• Life decision– Rehab / withdrawal
http://www.google.com/imgres?imgurl=http://katemoller.com/wp-content/uploads/2010/10/iStock_000008922315XSmall.jpg&imgrefurl=http://katemoller.com/a-healthy-dose-of-ecstacy/&usg=__QHNfRMMCwiyeLhkGP4vL7x2_toQ=&h=282&w=425&sz=60&hl=en&start=31&sig2=I_1y8wDSHPTtjCrN8KrPTA&zoom=1&tbnid=gethF2oCyfBCDM:&tbnh=117&tbnw=183&ei=0ghoTYPDL42ssAPOp92mBA&prev=/images%3Fq%3Dbabies%2Band%2Becstasy%26hl%3Den%26gbv%3D2%26biw%3D1003%26bih%3D564%26tbs%3Disch:10%2C869&itbs=1&iact=hc&vpx=701&vpy=117&dur=4328&hovh=183&hovw=276&tx=215&ty=101&oei=ywhoTbzGH4GssAPh7eCoBA&page=3&ndsp=16&ved=1t:429,r:4,s:31&biw=1003&bih=564
Pregnancy Basics
• Consists of a Mom and a growing ‘baby’• ‘baby’ development
– Genes, embryos, development• Average duration 42 weeks
– One cell a mini-person• 10 – 25 % of recognized pregnancies
miscarriages• Birth defects occur in 150,000 America babies
per year
http://www.google.com/imgres?imgurl=http://www.cerebralpalsychildren.com/CP1.jpg&imgrefurl=http://www.cerebralpalsychildren.com/CPFetal.html&usg=__0-oqJOJ9ROBuxUo59HhmaH1W3_o=&h=606&w=894&sz=91&hl=en&start=0&sig2=o1wSmbVQveFriw9-8kseFQ&zoom=1&tbnid=M6kLfgXXVJNokM:&tbnh=111&tbnw=164&ei=hSdoTbbOFIHAsAP5tuioBA&prev=/images%3Fq%3Dfetal%2Bdevelopment%26hl%3Den%26gbv%3D2%26biw%3D1003%26bih%3D564%26tbs%3Disch:1&itbs=1&iact=hc&vpx=603&vpy=124&dur=266&hovh=185&hovw=273&tx=120&ty=73&oei=hSdoTbbOFIHAsAP5tuioBA&page=1&ndsp=15&ved=1t:429,r:3,s:0
Effects of Cocaine and Heroin on Effects of Cocaine and Heroin on the Pregnant Woman and Co.the Pregnant Woman and Co.
Effects of Cocaine and Heroin on Effects of Cocaine and Heroin on the Pregnant Woman and Co.the Pregnant Woman and Co.
http://www.google.com/imgres?imgurl=http://www.onlinenewsreporters.com
The Effects of Heroin & Cocaine on the Normal Physiology of Pregnancy
The Effects of Heroin & Cocaine on the Normal Physiology of Pregnancy
• Placental abruption:-Placental lining has separated from the mother’s uterus , causing late pregnancy bleeding within uterus, which can ultimately result in maternal mortality. -Fetal membranes prematurely rupture, triggering pre-term labor.
How Drugs Cross the Placenta
http://www.merckmanuals.com/home/sec22/ch259/ch259a.html
Cocaine
http://www.google.com/imgres?imgurl=http://www.topnews.in/usa/files/pregnant-lady http://www.google.com/imgres?imgurl=http://www.drugnet.net
The Effects of Cocaine on the Normal Physiology of Pregnancy
The Effects of Cocaine on the Normal Physiology of Pregnancy
• Pre-term labor, Pre-term delivery: -Cocaine use during pregnancy may cause the down-regulation of myometrial (middle layer of uterine wall) beta-adrenergic receptors
HOW?
http://www.google.com/imgres?imgurl=http://www.epigee.org
MechanismMechanism
(Cocaine inhibits the reuptake of 5-HT, NE, and E)Normally NE and E bind to Beta-2 adrenergic receptors in the smooth muscles of the uterine walluterine relaxation Cocaine Use An increase in NE and E in the synapse over-activates the myometrial Beta-2 adrenergic receptors
-Over time, down-regulation of these receptorsprevent over-activation-Down-regulation of myometrial Beta-2 adrenergic
receptors prevents normal uterine relaxation, prolonging the contraction state and inducing pre-term labor and pre-term delivery
Cocaine Norepinephrine Epinephrine
http://www.google.com/imgres?imgurl=http://www.edinformatics.com
http://www.google.com/imgres?imgurl=http://images.wikia.com/psychology/images
http://www.google.com/imgres?imgurl=http://3.bp.blogspot.com
The Effects of Cocaine on the Normal Physiology of Pregnancy
The Effects of Cocaine on the Normal Physiology of Pregnancy
• Normal pregnancy: Vasodilation occurs due to increased levels of progesterone. This vasodilation may be counteracted by cocaine-induced vasoconstriction
• Hyperthermia caused by vasoconstriction– An increase in [E]synaptic from cocaine
usevasoconstriction, resulting in the retention of heathyperthermia
– Cocaine-induced maternal hyperthermiafetal prematurity, low birth weight, and fetal death.
--May also alter the mother’s mental status
Epinephrine Causes Vasoconstriction and Progesterone Causes VasodilationEpinephrine Causes Vasoconstriction
and Progesterone Causes Vasodilation
http://www.google.com/imgres?imgurl=http://www.pgbeautygroomingscience.com/assets/images
The Socio-political Effects of Cocaine on the Pregnant Woman
The Socio-political Effects of Cocaine on the Pregnant Woman
• The Anti-Drug Abuse Act of 1986 –mandatory minimum sentencing time for cocaine use/possession– A negative unforeseen affect: pregnant woman who
abuse cocaine are less likely to seek prenatal care, drug treatment, and other social services; may lead to unnecessary abortions
– Very few US drug treatment programs will admit pregnant women
– Minority women constitute 80% of those prosecuted for delivering drug-abused babies, regardless of equal levels of drug use in pregnant Caucasian women.
How a drug affects a fetus depends on…
• The fetus’s stage of development– Early in pregnancy (within 20 days after
fertilization)– Between 3rd and 8th week after fertilization– After organ development
• The strength & dose of the drug
http://adoption.families.com/blog/considerations-in-adoption-prenatal-drug-and-alcohol-exposure
What are the risks with use of cocaine during pregnancy?
• Increased risk of miscarriage• Preterm labor• Premature & low-birth weight
– 3 to 6 times more likely to be born at a low birth weight (less than 5.5 pounds)
• Smaller heads
More problems…• Placental & urinal tracts problems• Physical condition & overall responsiveness• Sudden Infant Death Syndrome (SIDS)• Dependence & withdrawal symptoms
http://www.thepanamadigest.com/2010/04/daddys-baby-grabs-1400-kilos-of-cocaine/ http://www.drugcouncil.tc/cocaine.html
What is the long-term outlook for babies who were exposed to
cocaine before birth?
• Negative effects of cocaine exposure is permanent– Normal intelligence but subtle learning &
behavioral problems• Lower IQ• Language delays & attention problems
– Deficits in cognitive & emotional development
http://www.google.com/imgres?imgurl=http://tothewire.files.wordpress.com/2008/12/heroin.gif&imgrefurl=http://tothewire.wordpress.com/2008/12/01/swiss-approve-pioneering-legal-heroin-program/&usg=__ZPbm9ae-kHUSTu0LygOHtm7uy2E=&h=400&w=400&sz=49&hl=en&start=0&sig2=R7FaNkAz2UskHWdzraYiqg&zoom=1&tbnid=cL3i26vnbAlUiM:&tbnh=122&tbnw=121&ei=FC5oTbLvBZOssAP0w9SoBA&prev=/images%3Fq%3Dheroin%26hl%3Den%26biw%3D1020%26bih%3D564%26gbv%3D2%26tbs%3Disch:1&itbs=1&iact=hc&vpx=752&vpy=105&dur=94&hovh=225&hovw=225&tx=172&ty=88&oei=FC5oTbLvBZOssAP0w9SoBA&page=1&ndsp=17&ved=1t:429,r:5,s:0
Heroin Addicts and Pregnancy
Pregnant heroin addicts tend to be:– younger than non-addicted pregnant patients– unmarried or separated from spouses– disproportionately large number are members of minority ethnic groups
http://www.ncbi.nlm.nih.gov/pubmed/2304039
Injection drug use during pregnancy
-Increases risk of contracting HIV and the Hepatitis C virus
-These infections can be passed on to the infant during pregnancy or at birth
Photo: http://www.topnews.in/law/australian-woman-who-hid-heroin-stomach-held-235974
Complications
Pregnancy Maternal Fetal
Poor Fetal Growth Malnutrition Retardation
Premature rupture of membranes( water breaks too soon)
STDs Fetal death
Premature birth Hepatitis or HIV Intrauterine growth restriction
Stillbirth Preeclampsia Prematurity
Breech birth Third-Trimester Bleeding
Withdrawal Symptoms
Placenta: can separate too soon, or not have enough blood
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1272838/
http://www.ireta.org/sbirt/pdf/Heroin_in_Pregnancy.pdf
Significant medical and obstetrical complications resulting in acute and chronic abnormalities in neonates:
Treatment Options
Prenatal care and comprehensive drug treatment program
– -Detoxification– -Methadone– -Buprenorphine
(2002)
Photo: http://www.whatwinnersdo.com/recommended-addiction-recovery-books/
Heroin Withdrawal SymptomsShame and embarrassment deters pregnant women from seeking help with addiction
Women who become pregnant while addicted to heroin should not stop using heroin without the advice of a doctor.
Severe effects and death may occur in both mothers and unborn babies.
Health effects resulting from Heroin withdrawals:Diarrhea Restlessness Vomiting Muscle or bone pain Insomnia Cold flashes
Detoxification-For women who do not want or are not able to receive
pharmacotherapy for heroin addiction-Medical supervision necessary-Potential risk to fetus and likelihood of relapse-Pregnant women advised not to detoxify from opiates
because of increased risk of spontaneous abortion or premature delivery
Methadone Treatment for a Healthy Pregnancy
Methadone: long-acting opioid drug used with counseling and other services to help people to stop using heroin
Methadone Maintenance Treatment(MMT): • Helps with a healthy pregnancy and birth(increased birth weight,
gestational age of infant, and increased prenatal and antenatal visits)
• Safe for babies but has resulting side effects: Fussiness Not eating or sleeping well Fever Vomiting Trembling
Symptoms go away after a few weeks
http://www.recoveryconnection.org/blog/2010/08/addiction-treatment-over-suboxone-or-methadone-clinic/
BuprenorphineIn the United States, several studies have found buprenorphine to be equally
effective and as safe as methadone in the adult outpatient treatment of opioid dependence.
Given this efficacy among adults, current studies are attempting to establish the safety and effectiveness of buprenorphine in opioid-dependent pregnant women.
http://arch1design.com/blog/2010/06/03/cold-turkey-obesity-and-sterilization/
Buprenorphine Side Effects:
Dysphoric mood Piloerection
Nausea or vomiting Diarrhea
· Muscle aches/cramps Yawning · Lacrimation · Mild fever
Rhinorrhea Insomnia
Pupillary dilation Craving
Sweating Distress/irritability
Buprenorphine-An opioid partial agonist-Although an opioid that can produce the typical side effects of euphoria and
respiratory depression, it is less effective than full agonists like heroin and methadone.
-At low doses, can produce an agonist effect that enables opioid-addicted individuals to discontinue opioid misuse without withdrawals.
-”Ceiling effect”: at moderate doses, plateau is reached and effects do not increase with dosage(safer in overdose)
-Max effects occur around the 16-32 mg range for sublingual tablets.-Lower risk of abuse, addiction, and side effects compared to full opioid
agonists.-No evidence of organ damage with chronic use-No evidence of significant disruption of cognitive or psychomotor
performance with buprenorphine maintenance dosing
Effect of Heroin Use on Newborns
• Increased chance of:– Low birth weight– Small Head Circumference– Breathing difficulties– Hypoglycemia– Intracranial Hemorrhage– Sudden Infant Death Syndrome
Effect of Heroin Use on Fetal Development•Unborn baby can develop drug dependence•Withdrawal Symptoms in Babies of Heroin Users:
FeverSneezing
TremblingIrritabilityDiarrheaVomiting
Continual cryingSeizures
Sleep abnormalitiesJoint stiffness
Thrombocytosis-High platelet counts in the bloodStudy by Calderon et al.:
» Thrombocytosis observed in infants exposed to in-utero to illicit drugs, has been assoc. with methadone exposure
» Took a retrospective look at medical records of newborns with intrauterine drug exposure admitted to San Juan City Hospital (1999-2001)
» Found 96% of these infants had thrombocytosis.» Of these 75% were exposed to methadone, heroin and
cocaine» Began at ten days of life and resolution seen in 3-4
weeks without complications
Breastfeeding-Social drug use in pregnant and breastfeeding mothers
-Breastfeeding nourishment for baby
-Transfer of heroin
-Not absorbed well by infant because of poor oral
bioavailability from the milk
- Risk of HIV and Hepititis C.
-Acute Stages of Illness
http://www.wellsphere.com/wellpage/neonatal-withdrawal-syndrome-from-methadone-while-pregnanthttp://www.health-e-learning.com/articles/Social_Drugs_and_Breastfeeding.pdf
Breastfeeding and Methadone
• The American Academy of Pediatricians states that methadone use of 20 mg or less per day is compatible with breast-feeding.– However, no dose information or other guidelines
are included.
Heroin and Its Effect on Children After Birth
• Low Birth weight linked to:• Language, visual-motor and other learning disabilities• Behavior problems• Suffered performance in school
Inconclusive data relating to long-term effects to prenatal exposure to heroin/methadone
Other Drugs
http://www.google.com/imgres?imgurl=http://images.paraorkut.com/img/funnypics/images/l/like_father_like_son-11995.jpg&imgrefurl=http://www.graphicshunt.com/funny/search/1/babies.htm&usg=__2kYUuD04iTirE1tbn8zLvY7OYGE=&h=300&w=440&sz=25&hl=en&start=0&sig2=VAkSm3iypeUh7akVFyB1Qg&zoom=1&tbnid=yWnAplc_KK13XM:&tbnh=135&tbnw=180&ei=mShoTairIYW2sAOkkOmoBA&prev=/images%3Fq%3Dfather%2Bdrinking%2Bwith%2Bbaby%26hl%3Den%26gbv%3D2%26biw%3D1003%26bih%3D564%26tbs%3Disch:1&itbs=1&iact=rc&dur=344&oei=mShoTairIYW2sAOkkOmoBA&page=1&ndsp=20&ved=1t:429,r:0,s:0&tx=91&ty=58
Marijuana and your ‘Baby’
• Gestation Age• Birth Weight• Head Circumference• Birth Length
• However, the # of joints in the third trimester does not correlate
•http://www.google.com/imgres?imgurl=http://gal.darkervision.com/wp-content/uploads/2008/07/baby.jpg&imgrefurl=http://gal.darkervision.com/2008/07/25/teen-jailed-for-8-years-for-giving-a-toke-to-2-and-4-year-old-nephews-who-are-then-placed-into-care-just-another-fine-day-in-the-war-on-drugs-madhouse/&usg=__zBgv4Xcn3kwwpcPgbEThg8GlT44=&h=377&w=398&sz=18&hl=en&start=0&sig2=p0l8_v8OIZV_ZmPZ32jwHw&zoom=1&tbnid=s2WKF-2oEM3FFM:&tbnh=120&tbnw=135&ei=cAhoTZq5KIu4sQOR1fyoBA&prev=/images%3Fq%3Dmarijuana%2Bbabies%26hl%3Den%26biw%3D1020%26bih%3D564%26gbv%3D2%26tbs%3Disch:1&itbs=1&iact=hc&vpx=658&vpy=104&dur=15&hovh=218&hovw=231&tx=118&ty=121&oei=cAhoTZq5KIu4sQOR1fyoBA&page=1&ndsp=18&ved=1t:429,r:4,s:0
Your Bab
• Impaired brain development
• MDMA interferes with neuronal differentiation– Atg5 gene on overdrive
• Severe teratogenesis• Fetal brain damage• Persistent alteration in
brain – Changes in DA and 5-HT
metabolism
http://www.google.com/imgres?imgurl=http://www.motifake.com/image/demotivational-poster/1003/crack-meth-ecstasy-crack-meth-ecstasy-demotivational-poster-1267977486.jpg&imgrefurl=http://www.motifake.com/crack-meth-ecstasy-crack-meth-ecstasy-demotivational-posters-93079.html&usg=__Y3lmUHtYC0KZn6n_dafcszDHfN4=&h=844&w=640&sz=100&hl=en&start=0&sig2=JdgWUoD_nGoCukjdwYukfg&zoom=0&tbnid=VanbHMJzDalAbM:&tbnh=128&tbnw=97&ei=UiJoTdqZOoT2swPV6N2oBA&prev=/images%3Fq%3Decstasy%2Bmeth%2Bcrack%26hl%3Den%26gbv%3D2%26biw%3D1003%26bih%3D564%26tbs%3Disch:1&itbs=1&iact=hc&vpx=135&vpy=112&dur=31&hovh=145&hovw=110&tx=67&ty=55&oei=UiJoTdqZOoT2swPV6N2oBA&page=1&ndsp=15&ved=1t:429,r:0,s:0
Other Things to be Scared of …
• Terbutaline treatment (medication)– Increased incidence of autism spectrum disorder
• Organophosphates (pesticides)– Inhibit cholinesterase; produce cholinergic
overstimulation
• Manganese (naturally occurring heavy metal)– Manganism – similar to Parkinson’s– Childhood behavioral disinhibition
http://www.google.com/imgres?imgurl=http://inigobautista.files.wordpress.com/2010/01/vaccination-comic-2.jpg&imgrefurl=http://inigobautista.wordpress.com/2010/01/28/&usg=__g5SqawA_Cjv2rrifApH6fcL6Drg=&h=370&w=530&sz=52&hl=en&start=17&sig2=Fqrtr6L7ZwVIKY1zxP-V2Q&zoom=1&tbnid=eCs4-gVGEMZUUM:&tbnh=110&tbnw=158&ei=pending&prev=/images%3Fq%3Ddoctor%2Band%2Bbaby%2Bcomic%26hl%3Den%26gbv%3D2%26biw%3D1003%26bih%3D564%26tbs%3Disch:10%2C4350%2C435&itbs=1&iact=rc&dur=156&oei=YB9oTYj_BtS2twfYsoXoAw&page=2&ndsp=18&ved=1t:429,r:14,s:17&tx=79&ty=54&biw=1003&bih=564
Works Cited Chae, Myounghee, and Gyu-Seek Rhee. "ATG5 Expression Induced by MDMA (Ecstasy), Interferes with Neuronal Differentiation of Nueroblastoma Cells." Molecules and Cells 27 (2009): 571-75. Springer. Web. 15 Feb. 2011. <http://moleculesandcells.org>.
Frederick, Aliya L., and Gregg D. Stanwood. "Drugs, Biogenic Amine Targets and the Developing Brain." Developmental Neuroscience 31 (2009): 7-22. Karger. Web. 13 Feb. 2011. <http://www.karger.com/dne>.
Frost, Elizabeth A., Richard S. Gist, and Elizabeth Adriano. "Drugs, Alcohol, Pregnancy, and the Fetal Alcohol Syndrome." Wolters Kluwer Health 49.1 (2011): 119-33. Ovid. Web. 15 Feb. 2011. <http://ovidsp.tx.ovid.com>.
Gray, Teresa R., Rina D. Eiden, Kenneth E. Leonard, Gerard J. Connors, Shannon Shisler, and Marilyn A. Huestis. "Identifying Prenatal Cannabis Exposure and Effects of Concurrent Tobacco Exposure on Neonatal Growth." Clinical Chemistry 56 (2010):
1442-450. PubMed. Web. 15 Feb. 2011. <http://www.clinichem.org/cgi/content/full/56/9/1442>.
Websites: http://www.americanpregnancy.org/pregnancyhealth/illegaldrugs.html
http://www.marchofdimes.com/pregnancy/alcohol_illicitdrug.htmlhttp://www.teach-nology.com/tutorials/teaching/abuse/print.htm
http://www.drugpolicy.org/library/research/cocaine.cfm?printpage=1&printpage=1http://www.mayoclinic.com/health/medical/IM03117
http://www.ncbi.nlm.nih.gov/pubmed/7862372http://www.tgorski.com/Prevention/cocaine_use_during_pregnancy.html
http://www.americanpregnancy.org/pregnancyhealth/illegaldrugs.htmlhttp://www.marchofdimes.com/pregnancy/alcohol_illicitdrug.htmlhttp://www.merckmanuals.com/home/sec22/ch259/ch259a.htm
www.drugpolicy.org/library/research/cocaine.cfm?printpage=1&printpage=1http://www.mayoclinic.com/health/medical/IM03117
http://www.ncbi.nlm.nih.gov/pubmed/7862372