Pregnancy and Drug Abuse

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Pregnancy and Drug Abuse

• Eva Janecek-Rucker

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Learning Objectives

1. To develop a knowledge base of the effects of
   substances of abuse (e.g., alcohol, cocaine,
   nicotine et al.) during pregnancy.

1. To examine the pharmacists 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.

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Drugs in Pregnancy

• CNS depressants
• alcohol
• benzodiazepines
• barbiturates
• inhalants
• (toluene often combined with alcohol)

• CNS stimulants
• cocaine
• caffeine
• nicotine

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Drugs in Pregnancy

• Hallucinogens
• cannabis
• LSD
• Opioids
• codeine, morphine
• heroin

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Interpretation of Results

• Animal studies
• Prenatal drug exposure (dose, timing,
  duration)
• Withdrawal
• Breastfeeding

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Issues with Illicit Drug Use During Pregnancy

• Drug
• authenticity
• dose
• additives
• Pharmacological effects
• Multiple drug use
• Injection drug use
• Effect of fathers drug use

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Issues (contd)

• Lack of prenatal care
• Poor diet
• Smoking
• Drinking
• Violence

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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)

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Alcohol (contd)

• No safe level established
• a Canadian committee recommended abstinence or
  at least to limit consumption to less than 4
  drinks per week

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Alcohol (contd)

• Treatment of a pregnant alcoholic
• diazepam loading for alcohol withdrawal
• Disulfiram
• -contraindicated in pregnancy
• Naltrexone ?

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Solvents

• Effects similar to FAS
• CNS dysfunction
• Attentional deficits
• Growth deficiency
• Development delay
• Facial dysmorphology

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Benzodiazepines

• Likely not teratogenic cleft
  lip/palate???
• Neonatal withdrawal symptoms

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Barbiturates and other hypno-sedatives

• No evidence of teratogenicity
• Neonatal withdrawal syndrome
• Treatment phenobarbital

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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)

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Nicotine

• Spontaneous abortion
• Low birth weight
• Perinatal mortality
• Prematurity
• Abruptio placentae
• Congenital malformations (most studies show lack
  of)
• Sudden infant death syndrome (SIDS)

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Caffeine

• Low dose - no effect
• High dose
• in animals - adverse effects
• in humans - ?

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Heroin

• Fetal distress or death during withdrawal in
  utero
• Decreased birth weight
• Higher incidence of
• Infections
• medical complications
• obstetrical complications
• Neonatal withdrawal
• SIDS

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Heroin (contd)Treatment of pregnant woman

• methadone

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Cannabis

• Decreased birth weight
• Prematurity
• Effect of tar
• No congenital abnormalities

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LSD

• Limb defects
• CNS abnormalities
• Ocular abnormalities

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Pharmacists Role

• Identification
• Information
• Referral

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Resources

• Alcohol and Drug Assessment and Treatment
  Services
• Motherisk www.motherisk.org [phone]
• www.pregnets.org
• Information sources
• Textbooks
• Drugs in Pregnancy and Lactation 6th Edition, GG
  Briggs, RK Freeman, SJ Yaffe (eds), 2001
• Maternal-Fetal Toxicology A Clinicians Guide
  2nd Edition, G Koren (ed), 1994
• Journals