Substance use disorder in pregnancy (Complete) Flashcards
(19 cards)
What are the main substances abused in SUD in pregnancy?
Alcohol
Illicit drugs
- Cocaine
- Heroine
- Cannabis
- Methamphetamine
Prescription drugs
- Opiods
- Benzodiazepines
- Stimulants
Nicotine
SUD occurs in what percentage of pregnancies?
5-10%
May be higher due to undereporting
What are the main risk factors for SUD in pregnancy?
Biopsychosocial:
- Young maternal age
- Mental health conditions (e.g. anxiety, deppresion
- Past trauma or adverse childhood experiences
- Low socioeconomic status (e.g. poverty, homelessness, unemployment)
- Genetic predisposition
What signs are sugestive of SUD?
Maternal:
Fatigue
Poor-self care
Erratic behaviour
Withdrawal symptoms (e.g. headaches, sweats and shakes, irritability)
Frequent healthcare visits with non-specific symptoms
Foetal:
Poor growth on US
Reduced foetal movements
Neonatal abstinence syndrome (after birth)
What investigations should be conducted in suspected cases of SUD in pregnancy?
Bedside:
Urine toxicology screen
Mental health screening
Bloods: Check for nutritional deficiencies
FBC
Folate
B12
Ferritin levels
Infection screen (e.g. HIV, hep B)
Imaging:
US scans: Check foetal growth
What is the management plan for patients with SUD?
Conservative:
Psychosocial support:
- Tailored therapies
- Suppourt groups
- Specialist perinatal teams
Medication:
Opiod addiction: Methadone or buprenorphine
Alcohol: Detoxification under supervision
Smoking: Nicotine replacement therapy
What psychosocial support options are available for pregnant woman with SUD?
Tailored counselling
Support groups
Specialist perinatal teams
How are pregnant women with opiod related SUD medically managed?
Methadone
OR
Buprenorphine
How are pregnant women with alcohol related SUD medically managed?
Detoxification under medical supervision in case withdrawal complications arise
How are pregnant women with smoking related SUD medically managed?
Nicotine replacement therapy
What advice should mothers be given regarding breastfeeding?
Should be encouraged to continue breastfeeding UNLESS continued illicit drug use
Can continue using methadone/buprenorphine in stable doses
What are maternal complications of SUD in pregnancy?
Poor antenatal care attendance
Pre-eclampsia
Infections (e.g. hepatitis, HIV)
Placental abruption
Preterm labour
Mental health deterioration
What are foetal complications of SUD in pregnancy?
Miscarriage
Stillbirth
Preterm birth
Intrauterine growth restriction (IUGR)
Neonatal abstinence syndrome
Long-term neurodevelopmental and behavioural issues
What are complications associated with smoking?
Miscarriage (increased risk of around 47%)
Pre-term labour
Stillbirth
IUGR
Sudden unexpected death in infancy
What are complications associated with cannabis?
Similar to smoking due to tobacco content
What are complications associated with alcohol?
Fetal alcohol syndrome (FAS)
- Learning difficulties
- Characteristic facies (e.g. smooth philtrum, thin vermilion, small palpebral fissures, epicanthic folds, microcephaly
What are the characteristic facies of FAS?
Smooth philtrum
Thin vermilion
Small palpebral fissures
Epicanthic folds
Microcephaly
What are complications associated with cocaine?
Pre-eclampsia
Placental abruption
Prematurity
Neonatal abstinence syndrome
What are complications associated with heroine?
Neonatal abstinence syndrome
