Substance Misuse in Pregnancy

Question 1

What social problems are associated with substance misuse?

Answer 1

• Housing
• Crime
• Children in care/abuse
• Co-existent addictions – alcohol or smoking
• Malnutrition – iron, folate, vitamin B, C
• Risk of viral infections – HIV, Hep B

Question 2

What are the complications of alcohol use in pregnancy?

Answer 2

• Miscarriage, stillbirth, infant mortality
• Congenital abnormalities
• LBW, preterm delivery, SGA
• Foetal alcohol spectrum disorders with later neurodevelopmental abnormalities
• Cognitive/behavioural change, adverse language outcomes
• Executive functioning defects, psychosocial consequences in adulthood

Question 3

What are the complications of smoking in pregnancy?

Answer 3

• Damage to umbilical cord structure
• Miscarriage
• Increased risk of ectopic pregnancy
• LBW & preterm birth
• Placental abruption
• Increased foetal mortality

Question 4

What are the complications of cannabis use in pregnancy?

Answer 4

• Preterm labour, LBW, SGA
• Increased NICU admission
• Prenatal cannabis use linked to:
  
  • Reduced growth of foetal and adolescent brains
  • Reduced attention and executive functioning skills
  • Poorer academic achievement
  • Behavioural problems

Question 5

What are the complications of cocaine use in pregnancy?

Answer 5

• PROM
• Preterm birth
• Placental abruption
• LBW, SGA

Question 6

What are the complications of methamphetamine use in pregnancy?

Answer 6

• SGA/LBW
• Foetal loss/intrauterine foetal death
• Developmental and behavioural defects
• Pre-eclampsia/gestational HTN

Question 7

What are the complications of opioid use in pregnancy?

Answer 7

• LBW/growth deficiency
• Respiratory problems
• 3rd trimester bleeding
• Toxaemia
• Mortality
• Microcephaly
• Behavioural problems
• Sudden infant death syndrome (SIDS)
• Neonatal abstinence syndrome (NAS)

Question 8

What is neonatal abstinence syndrome?

Answer 8

• Opiate exposure in utero triggers postnatal withdrawal syndrome
  
  • 45-94% of infants exposed to opioids in utero - includes methadone and buprenorphine
  • Substantial neonatal morbidity + increased healthcare utilisation

Question 9

What is the presentation of neonatal abstinence syndrome?

Answer 9

• Irritability
• Feeding difficulties
• Tremors
• Hypertonia
• Emesis
• Loose stools
• Seizures
• Respiratory distress