¿Qué son los opioides? Los opioides son drogas depresivas que
incluyen drogas ilícitas y medicamentos legales de receta basados
en el opio. Son considerados narcóticos y deprimen el sistema
nervioso. Drogas en este grupo incluyen: Heroína Morfina Metadona
Otros medicamentos para calmar el dolor de receta como codeína,
Oxycontin, Vicodin, Percodan, Dilaudid, etc.
¿Qué tan frecuentemente son usados? Según la Encuesta Nacional
del Uso de Drogas y la Salud (2010), aproximadamente 200,000
individuos mayores de 12
años reportaron el uso de heroína en el mes anterior de la
encuesta, que es ilegal, y 5.1 millones de individuos reportaron el
uso no médico de medicamentos de receta para calmar el dolor
legales en el mismo período.
Entre mujeres embarazadas de esta muestra nacional, .2%
reportaron usar heroína y .7% reportaron uso no médico de
medicamentos para calmar el dolor durante los 30 días anteriores.
Cuando el uso entre 30 días y 12 meses anteriores fue examinado,
.1% reportaron el uso de heroína, y 4.3% reportaron el uso no
medico de medicamentos para calmar el dolor.
El uso incorrecto de medicamentos para calmar el dolo basado en
el opio es un problema significativo de salud pública. Las ventas
de drogas, el ingreso a tratamiento del abuso de drogas, y
mortalidad relacionada a estas drogas han aumentado dramáticamente
en la década anterior. Las ventas de medicamentos opioides para
calmar el dolor a organizaciones de salud (farmacias, oficinas
médicas, hospitales) en 2010 fueron cuatro veces más altas que en
1999. Según un informe del Centro de Control y Prevención de las
Enfermedades (CDC), los medicamentos para calmar el dolor opioides
fueron usados no medicamente por 4.8% de la población de E.E.U.U.
mayor de 12 años de edad en 2010.
En el 2008, aproximadamente 14,800 individuos en E.E.U.U. se
murieron de una sobredosis de opioides de receta. Esta tasa ha
aumentado más del triple desde 1999 y eso sugiere que ahora es una
epidemia.
¿Cómo afecta la exposición a un opioide en el embarazo un recién
nacido? Los estudios del uso de opioides en el embarazo sugieren
que los bebés pueden Nacer prematuramente Tener bajo peso al nacer
y/o circunferencia de la cabeza más pequeña Experimentar síntomas
de abstinencia o síndrome de abstinencia neonatal. Puede ser que
estos bebés necesiten ser
transferidos en el hospital a tomar otras drogas para tratar los
síntomas de abstinencia y disminuir su dependencia a los opioides
(vea el otro lado de esta hoja).
Los estudios no han mostrado una relación entre el uso de
opioides en el embarazo y defectos de nacimiento en general.
Algunos estudios han mostrado una relación entre el uso de
opioides y opioides de receta en el primer trimestre y defectos
congénitos del corazón, pero el riesgo parece ser pequeño.
El uso de la heroína y la metadona ha sido relacionado a
resultados más severos, incluyendo efectos del sistema visual y un
aumento en la tasa de mortalidad neonatal y el síndrome de la
muerte súbita infantil (SIDS).
*La mayoría de los estudios se han llevado a cabo con bebés
expuestos a heroína o metadona durante el embarazo.
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Frequently Asked Questions about Maternal Smoking during
Pregnancy
How many mothers smoke during pregnancy?
According to the 2010 Pregnancy Risk Assessment and Monitoring
System (PRAMS) data from 27 states:
o Approximately 10.7% of women reported smoking during the last
three months of pregnancy.
How many mothers who smoke are able to quit during their
pregnancy?
Of women who smoked 3 months before pregnancy, 54% quit during
pregnancy. Among women who quit smoking during pregnancy, 44%
relapsed within 6 months after delivery. How does cigarette smoke
harm an unborn baby? Tobacco smoke has over 3,800 products in it
with carbon monoxide and nicotine being the two largest components
of the smoke. Cigarette smoke may harm a fetus by reducing blood
flow or flow of oxygen to the fetus, by reducing the nutrients that
reach the fetus, and by direct action to the fetus. Does maternal
smoking during pregnancy result in smaller babies? The most
consistent finding associated with maternal smoking during
pregnancy is lower birth weight. Most studies find a difference of
200-250 grams between babies of mothers who smoke and those who do
not. In addition, the incidence of intrauterine growth retardation
has been found to be higher among women who smoked during their
pregnancy. Does maternal smoking during pregnancy result in
premature babies? The length of the pregnancy has been found to be
lower among women who smoked during the pregnancy but the average
decrease is typically 1-2 days. Studies assessing the incidence of
prematurity have found mixed results, with some finding a
significant increase and others not. Does prenatal exposure to
tobacco smoke cause Sudden Infant Death Syndrome (SIDS)? Studies
examining the incidence of SIDS among women who smoke during
pregnancy have also been mixed with some finding significant
effects and others not. Parental smoking during early development
has also been linked to an increased incidence of SIDS as a result
of environmental tobacco smoke on a young respiratory system.
Does maternal smoking during pregnancy cause birth defects?
Smoking during pregnancy can cause a baby to be born with cleft lip
and/or cleft palate. There may be a correlation with other birth
defects, including congenital heart defects, clubfoot, or
gastroschisis. However, there have been no consistent findings of a
pattern of birth defects associated with maternal smoking.
Additional studies that control for other important factors that
may impact fetal development are needed. What are the long-term
effects on the growth of children exposed to tobacco smoke during
pregnancy? The results from the British National Child Development
Study on children’s growth and development suggested that children
of women who smoked during their pregnancy continued to be shorter
(an average of 1.0 cm) at seven and 11 years of age than children
of women who did not smoke during pregnancy.
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Understanding Effects of Illicit Drugs Used During Pregnancy
Cocaine Facts Cocaine is a stimulant of the central nervous
system, crosses the placenta during pregnancy, and enters the
baby’s blood circulation. Researchers have not determined how much
cocaine it takes to cause birth defects. It is recommended that any
amount of cocaine be avoided during pregnancy.
Some studies have reported an increased risk of birth defects
including abnormalities of the brain, heart,intestines, and limbs
in babies whose mothers used cocaine prenatally. The risk for birth
defects may be greaterif the mother used cocaine frequently during
the pregnancy.
Increased risk for preterm delivery and low birth rate; before
labor begins, cocaine can cause the placenta toseparate from the
wall of the uterus (placental abruption) which can lead to
extensive bleeding and can be fatalfor both the mother and baby;
intracranial hemorrhage (bleeding in the brain) before or soon
after birth cancause permanent disability.
The following behaviors and significant central nervous system
problems have been seen in infants and young children whose mothers
abused cocaine during pregnancy, especially close to delivery:
Irritability, interrupted sleep patterns, and problems with
sensory stimulation. Problems with impulsive behavior, poor
attention span, and language difficulties.
Marijuana Facts The main active chemical in marijuana is
delta-9-THC and is known to cross the placenta during pregnancy.
Smoking marijuana may decrease the amount of oxygen and nutrients
the baby receives, thereby affecting the growth of the baby.
Some studies have suggested there is an increased risk of
premature birth and low birth weight for babies whosemothers smoked
marijuana regularly throughout the pregnancy and after
delivery.
Most research studies have not found an increased risk for birth
defects among babies exposed to marijuanaprenatally.
Some studies of prenatal exposure to marijuana have shown an
effect on behavior, academic performance andshort term memory of
children. These results were seen more often in children whose
mothers were heavymarijuana users, typically one or more marijuana
cigarettes per day.
Although the results from studies have been inconsistent, the
possibility of an effect on the developing braincannot be ruled
out.
It can be difficult to draw conclusions from studies on the use
of drugs during pregnancy because some women use multiple drugs of
abuse at the same time, or have increased risks because of poverty,
poor nutrition, lack of prenatal care, or mental illness. Alcohol
is quite often used concurrently with other drugs of abuse,
typically marijuana, cocaine and cigarettes.
¿Qué es el síndrome de abstinencia neonatal (NAS)? Es el nombre
para un grupo de síntomas que ocurren cuando un bebé es retirado de
exposición a una sustancia adictiva que es una droga depresiva, no
estimulante, al nacer. Algunas de las drogas depresivas que pueden
causar NAS son opioides como la morfina, la metadona, o la heroína.
Síntomas de abstinencia pueden variar entre los bebés. Síntomas
posibles incluyen:
Llorar frecuentemente; llanto agudo Irritabilidad Signos
respiratorios-respiración rápida Disturbios del sueño/desvelo
Hiperactividad, híper excitación
Problemas gastrointestinales (diarrea, vómito) Sudar Estornudar,
congestión nasal Bostezar Arquear la espalda, rigidez
¿Cómo es el tratamiento para NAS?
Un pediatra debe determinar si un bebe necesita intervención
médica. Si el NAS no es tan severa, a veces puede ser tratado con
cuidado (tratamiento?) de apoyo. Esto puede incluir el uso de
estrategias efectivas para calmar tales como envolver, luces
suaves, u otras modificaciones de la interacción entre madre y bebé
hasta el bebé se ajusta a los cambios psicológicos. Si el NAS es
severa, usualmente los bebés son tratados en el hospital con un
poco de una droga basada en el opio. La dosis es reducida
gradualmente hasta que no la necesite.
¿La metadona y la bupenorfina: cómo se comparan? Las mujeres
embarazadas adictas a los opioides pueden ser cambiadas a otra
droga como metadona o bupenorfina durante el embarazo. Los bebés
tienen mejores resultados cuando se cambia a la mamá a estas drogas
que con ningún tratamiento. Un proyecto de investigación reciente,
Tratamiento Maternal de Opioides: Investigación Humana Experimental
(MOTHOR) fue patrocinado por el Instituto Nacional de la Salud y
comparó resultados del bebé cuando se administró metadona o
bupenorfina en el embarazo. Se reportó que los bebés con madres
tratadas con bupenorfina tenían menos síntomas de abstinencia y
podían salir del hospital más pronto que los que fueron tratados
con metadona.
¿Qué se sabe sobre los efectos de la exposición a opioides en el
embarazo a largo plazo?
Lo que sabemos está basado en estudios de exposición a heroína y
metadona en el embarazo. Estos estudios son complicados porque
algunos factores como si la madre usó alcohol u otras drogas
durante el embarazo y la calidad del hogar pueden influir los
resultados del niño.
Algunos estudios muestran efectos de crecimiento físico (el
peso, circunferencia de la cabeza) persisten, pero otros sugieren
que el crecimiento se alcanza después.
La coordinación motor, tensión, y atención se han demostrado
afectados en el primer año. Los resultados de pruebas de función
cognitiva no han sido constantes. A pesar de que la exposición
es
frecuentemente relacionada a peor función cognitiva, estos
efectos pueden ser por influencia del hogar. En un estudio de niños
de la edad escolar, la exposición fue relacionada a reportes de
parientes de problemas de
conducta y características de déficit de atención e
hiperactividad (TDAH). Los niños criados por madres adictas
tuvieron resultados más significativos que niños en hogares
adoptivos; ambos tuvieron resultados más significativos que niños
no expuestos.
*A pesar de que el mal uso de opioides de receta ha aumentado,
datos (información) de efectos a largo plazo no están
disponibles.
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Frequently Asked Questions about Maternal Smoking during
Pregnancy
How many mothers smoke during pregnancy?
According to the 2010 Pregnancy Risk Assessment and Monitoring
System (PRAMS) data from 27 states:
o Approximately 10.7% of women reported smoking during the last
three months of pregnancy.
How many mothers who smoke are able to quit during their
pregnancy?
Of women who smoked 3 months before pregnancy, 54% quit during
pregnancy. Among women who quit smoking during pregnancy, 44%
relapsed within 6 months after delivery. How does cigarette smoke
harm an unborn baby? Tobacco smoke has over 3,800 products in it
with carbon monoxide and nicotine being the two largest components
of the smoke. Cigarette smoke may harm a fetus by reducing blood
flow or flow of oxygen to the fetus, by reducing the nutrients that
reach the fetus, and by direct action to the fetus. Does maternal
smoking during pregnancy result in smaller babies? The most
consistent finding associated with maternal smoking during
pregnancy is lower birth weight. Most studies find a difference of
200-250 grams between babies of mothers who smoke and those who do
not. In addition, the incidence of intrauterine growth retardation
has been found to be higher among women who smoked during their
pregnancy. Does maternal smoking during pregnancy result in
premature babies? The length of the pregnancy has been found to be
lower among women who smoked during the pregnancy but the average
decrease is typically 1-2 days. Studies assessing the incidence of
prematurity have found mixed results, with some finding a
significant increase and others not. Does prenatal exposure to
tobacco smoke cause Sudden Infant Death Syndrome (SIDS)? Studies
examining the incidence of SIDS among women who smoke during
pregnancy have also been mixed with some finding significant
effects and others not. Parental smoking during early development
has also been linked to an increased incidence of SIDS as a result
of environmental tobacco smoke on a young respiratory system.
Does maternal smoking during pregnancy cause birth defects?
Smoking during pregnancy can cause a baby to be born with cleft lip
and/or cleft palate. There may be a correlation with other birth
defects, including congenital heart defects, clubfoot, or
gastroschisis. However, there have been no consistent findings of a
pattern of birth defects associated with maternal smoking.
Additional studies that control for other important factors that
may impact fetal development are needed. What are the long-term
effects on the growth of children exposed to tobacco smoke during
pregnancy? The results from the British National Child Development
Study on children’s growth and development suggested that children
of women who smoked during their pregnancy continued to be shorter
(an average of 1.0 cm) at seven and 11 years of age than children
of women who did not smoke during pregnancy.
fgdgrsgfgrgrwtgwgsfgsgsef
Understanding Effects of Illicit Drugs Used During Pregnancy
Cocaine Facts Cocaine is a stimulant of the central nervous
system, crosses the placenta during pregnancy, and enters the
baby’s blood circulation. Researchers have not determined how much
cocaine it takes to cause birth defects. It is recommended that any
amount of cocaine be avoided during pregnancy.
Some studies have reported an increased risk of birth defects
including abnormalities of the brain, heart,intestines, and limbs
in babies whose mothers used cocaine prenatally. The risk for birth
defects may be greaterif the mother used cocaine frequently during
the pregnancy.
Increased risk for preterm delivery and low birth rate; before
labor begins, cocaine can cause the placenta toseparate from the
wall of the uterus (placental abruption) which can lead to
extensive bleeding and can be fatalfor both the mother and baby;
intracranial hemorrhage (bleeding in the brain) before or soon
after birth cancause permanent disability.
The following behaviors and significant central nervous system
problems have been seen in infants and young children whose mothers
abused cocaine during pregnancy, especially close to delivery:
Irritability, interrupted sleep patterns, and problems with
sensory stimulation. Problems with impulsive behavior, poor
attention span, and language difficulties.
Marijuana Facts The main active chemical in marijuana is
delta-9-THC and is known to cross the placenta during pregnancy.
Smoking marijuana may decrease the amount of oxygen and nutrients
the baby receives, thereby affecting the growth of the baby.
Some studies have suggested there is an increased risk of
premature birth and low birth weight for babies whosemothers smoked
marijuana regularly throughout the pregnancy and after
delivery.
Most research studies have not found an increased risk for birth
defects among babies exposed to marijuanaprenatally.
Some studies of prenatal exposure to marijuana have shown an
effect on behavior, academic performance andshort term memory of
children. These results were seen more often in children whose
mothers were heavymarijuana users, typically one or more marijuana
cigarettes per day.
Although the results from studies have been inconsistent, the
possibility of an effect on the developing braincannot be ruled
out.
It can be difficult to draw conclusions from studies on the use
of drugs during pregnancy because some women use multiple drugs of
abuse at the same time, or have increased risks because of poverty,
poor nutrition, lack of prenatal care, or mental illness. Alcohol
is quite often used concurrently with other drugs of abuse,
typically marijuana, cocaine and cigarettes.
