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

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)

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

Infectionsmedical complicationsobstetrical 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), 2001Maternal-Fetal Toxicology: A Clinician’s Guide 2nd Edition, G Koren (ed), 1994–Journals