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Why is this important:
5.5% of pregnant women in the United States reported using at least one illicit drug during pregnancy.
21.2% of pregnant women aged 12-44 reported use of alcohol and 21.5% use of cigarettes during the past month.
Impact on Mom’s Prenatal Care/ Newborn
Outcome Poor Nutrition Late Prenatal Care Greater risk for: infectious diseases &
Sexually transmitted diseases Limited financial resources Increased risk: premature
birth, abruptio placenta,
and fetal demise.
Impact on Baby
60-90% of opiate
exposed infants develop
neonatal abstinence
syndrome (NAS). Symptoms will manifest within 48 to 72 hours
after birth
S&S of Neonatal Abstinence Syndrome
Withdrawal Irritability Tremors High-pitched cry Diarrhea & Vomiting Respiratory Distress Abrasions Weight loss Aberrant temp control Lack of sucking Sneezing
Signs of Neonate Withdrawl Irritability
Tachypena Tremors Shrill Cry Mottling Hypertonicity of muscles Frantic Sucking of hands Temperature instability Loose diarrheal stools Seizures Nasal stuffiness
Sleep Disturbances
Which leads to:“Unlovable Infant…
Baby Outcomes
Guilt and Denial from the mother contribute to a poor communication/ connection between mom and baby
Leads to impaired language development, social-emotional problems, and/ or neglect and abuse.
Increased risk for medical, emotional/ behavior, and developmental difficulties.
Haven House and CAP
Most drug treatment programs cater to male clients
Those who accept women will often rescind treatment to women who become pregnant while in program
Provision of child-care for existing children is also vital to most women… high risk of relapse during immediate postpartum period.
So….
Pathophysiology of Fetal Alcohol Syndrome: Symptoms of a baby with
fetal alcohol syndrome Poor growth while the baby is in the womb and after birth Decreased muscle tone and poor coordination Delayed development and significant functional problems in
three or more major areas: thinking, speech, movement, or social skills (as expected for the baby's age)
Heart defects such as ventricular septal defect (VSD) or atrial septal defect (ASD)
Structural problems with the face, including: Narrow, small eyes with large epicanthal fold Small head Small upper jaw Smooth groove in upper lip Smooth and thin upper lip
Fetal Alcohol Syndrome: Tests
Blood alcohol level in pregnant women who show signs of being drunk (intoxicated)
Brain imaging studies (CT or MRI) shows abnormal brain development
Pregnancy ultrasound shows slowed growth of the fetus
Toxicology screen
Cocaine Abusing Pregnant Women
Increase the risk of miscarriage When the drug is used late in pregnancy, it may trigger
premature labor It also may cause an unborn baby to die or to have a
stroke, which can result in irreversible brain damage More likely to have a low birth-weight baby More likely to have babies born with smaller heads and
smaller brains proportionate to body size Twice as likely to have a premature baby Placental abruption Baby with a malformation of the urinary tract Feeding difficulties and sleep disturbances in newborn
Smoking while Pregnant Lower the amount of oxygen available to you and your
growing baby Increase your baby's heart rate Increase the chances of miscarriage and stillbirth Increase the risk that your baby is born prematurely
and/or born with low birth weight Increase your baby's risk of developing
respiratory (lung) problems Elevates the risk of having a child with
excess, webbed or missing fingers and toes
CLINICAL SIGNS associated with Opiate Withdrawal in Newborns
Central Nervous System Dysfunction
Autonomic Dysfunction
Respiratory Dysfunction
Gastrointestinal Dysfunction
Risk Factors for Newborns of Substance Abusers
FEEDING PROBLEMS Suck-swallow incoordination Tongue thrust during feedings Poor formula intake Failure to thrive
SLEEP Sleep-wake cycles disorder
ATTENTION Difficulty with reactivity to stimuli
Risk Factors for Newborn of Substance Abusers
HYPERTONIC BABIES Also known as “stiff babies” Brief deep tendon reflexes Persistence of primitive infant reflexes
IRRITABILITY Neurological fragility Difficulty managing day-to-day stimuli Jerky movements
Screening
Every infant born to a substance abuser should be evaluated for HIV infection.
Signs of neonatal abstinence syndrome Small head size (brain size) Newborns who are underweight Stroke in the newborn Intestinal blood flow compromise (NEC) Positive drug screen in mother
REFERENCESAlbersheim, S. (1991). Newborn Patients of Mothers with Substance AbuseProviding proper
health care for mothers and their babies. Can Fam Physician.(37):1739–1746.
Bertrand J, Floyd LL, Weber MK. Guidelines for identifying and referring persons with fetal alcohol syndrome. MMWR Recomm Rep. 2005 Oct 28;54(RR-11):1-14.
Gorski, Terence T. (2001). Cocaine use during pregnancy. Gorski-Cenaps Web Publications. Retrieved on November 10, 2009. http://www.tgorski.com/Prevention/cocaine_use_during_pregnancy.htm
Nazario, Brunilda MD. Smoking During Pregnancy, Retrieved November 10, 2009. http://www.nlm.nih.gov/medlineplus/ency/article/000911.htm
Perinatal Substance Abuse. UCSF Children’s Hospital: http://www.ucsfchildrenshospital.org/pdf/manuals/59_SubAbuse.pdf
Stoll BJ. Metabolic disturbances. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 106.