SUBSTANCE ABUSE DURING PREGNANCY

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SUBSTANCE ABUSE DURING PREGNANCY

• Kristina Gatmaitan
• Anna Lutz
• Marvie Ramos
• Reuben Ramos
• Rosheena Robles

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Substance Abuse Pregnancy...

• The fetus grows develops d/t the nourishment
  from the mother via the placenta.
• Toxins in the mother's system may be delivered to
  the fetus.
• Can cause damage to the fragile, developing fetal
  organs.
• Long-term effects mental problems such as
  retardation and seizures.

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Drugs and the Stages of Pregnancy

• The stage of organ formation
• First ten weeks Most of the body organs and
  systems of the baby-to-be are formed. During this
  stage, some drugsand alcohol in particularcan
  cause malformations of such parts of the
  developing fetus as the heart, the limbs, and the
  facial features

• The stage of prenatal growth
• After about the tenth week,
• Eyes
• Nervous system
• ? risk of miscarriage premature delivery
• IUGR
• Low birthweight
• Death

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Baby Jonah

• Jonahs mother was a heroin addict. Shortly
  after birth, it was obvious Jonah was in
  withdrawal. His jittery movements and crying
  persisted for the next 2 days and there was
  little anyone could do to console him. He
  scratched his face trying to get his hands to his
  mouth. His knees and elbows were rubbed raw from
  his agitated movements, and the muscles in his
  tiny legs were so stiff that it was difficult to
  straighten his legs to diaper him.

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• The full extent of the effects of prenatal drug
  exposure on a child is not known, however studies
  show that various drugs of abuse may result in
  premature birth, miscarriage, low birth weight,
  and a variety of behavioral and cognitive
  problems.

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Drugs that may have adverse prenatal effects

• Cocaine
• Tobacco
• Heroin
• Inhalants

• Marijuana
• MDMA (Ecstasy)
• Methamphetamine
• Nicotine

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• Two most common drugs

Marijuana
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Marijuana

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• The active Ingredients in Cigarette smoke are
  nicotine, tar, and harmful gases, such as carbon
  monoxide and cyanide.
• Indirect effects of cigarette smoking include
  decreased maternal appetite.
• Can cause neonatal prematurity and low birth
  weights.
• The degree of restriction of fetal growth
• varies with the number of cigarettes
• smoked daily (2009, McKinney).

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Marijuana

• The active constituent of marijuana is
  tetrahydrocannabinol (THC), which crosses the
  placenta and accumulates in the fetus.
• Marijuana is the most commonly used illicit drug
  (2009, McKinney).

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Factors that affect maternal smoking
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Maternal age
VS
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Education Level
VS
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Marital Status
VS
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Poverty Status
VS
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Health Insurance coverage before conception
VS
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Statistics

• Studies from the US Department of Health and
  Human Services, Substance Abuse and Mental Health
  Services Administration report that 3.3 of
  America women use illicit drugs during gestation
  and 80 of whom use marijuana.

• The National Household Survey on Drug abuse
  state 2.8 of pregnant women use illicit drugs.
  Marijuana is used by 75 during gestation and
  more than 50 also use tobacco.

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Statistics cont.

• A study in Seattle was done on 396 females. Of
  them 77 reported smoking cigarettes and 50 said
  they smoked marijuana during pregnancy

• In the UK 15-20 of women continue to smoke
  throughout their pregnancy.

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Statistics cont.

• A study done in the U.S. from 2002-2006 on 94,483
  women found that cigarette use was reported by
  nearly a quarter of pregnant women in their first
  trimester and that 1 in 7 reported cigarette
  smoking in the second or third trimester.

• According to the CDC approximately 13 of women
  smoke during the last 3 months of pregnancy

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Maternal Effects of tobacco
Decreases Nutrition
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Tobacco
Inability to absorb oxygen
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Maternal Effects of Marijuana
Lack of coordination
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Marijuana
Increased Heart Rate/decreased BP
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Marijuana
Decreased oxygen
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Effects of Tobacco and Marijuana on the Child
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Tobacco - Effects

• Prematurity
• Low birth weight
• Sudden infant death syndrome (SIDS)
• Stillbirth
• Neurodevelopmental problems
• Neurobehavioral problems
• Increased risk for some types of cancers
• Childhood obesity

Article Tobacco and Pregnancy Overview of
Exposures and Effects Maternal-Child Nursing
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Marijuana - Effects

• ? risk of low birth weight IUGR
• ? risk of miscarriage, premature labor ectopic
  pregnancy
• Affects memory
• Developmental delays
• Jitteriness
• Withdrawal-like symptoms
• Behavioral problems

Research Study EXPOSURE TO MARIJUANA DURING
PREGNANCY ALTERS NEUROBEHAVIOR IN THE EARLY
NEONATAL PERIOD - Carvalho de Moraes Barros et
al Research Study Prenatal Marijuana Exposure
and Intelligence Test Performance at Age 6
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RN INTERVENTIONS
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RN INTERVENTIONS

• 4 AS
• Educate mother be accurate
• Be supportive, listen to pt concerns
• Increase self-esteem
• Be both Pts advocate

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4 As

• According to a research article Smoking
  Cessation in Pregnant Women Utilizing
  Evidence-Based Interventions the rate of smoking
  cessation increased 30-70 when interventions
  (ie.4 As) were implemented compared to no
  interventions

Research Study Albrecht, S., PhD, RN, FAAN.
Smoking cessation in pregnant women utilizing
evidence-based Strategies in womens health
care. 2007
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4 As

• AVOID high temptation situations -- these are
  situations where you know you will be tempted to
  smoke, or situations where you regularly smoked.

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• ALTER those situations you can't avoid -- make a
  plan to change your behavior or some aspect of
  the situation so that you'll be less likely to
  smoke.

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• ALTERNATIVES -- find other things to do besides
  smoking. Think ahead What activities can you do
  that will distract you from wanting that
  cigarette?

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• ACTIVE - Get active to help you cope with urges
  to smoke. That's right! Get moving! Go for a
  short walk to clear your head and remind yourself
  why you want to stay smoke-free.
• http//www.psychiatry.emory.edu/PROGRAMS/GADrug/Fa
  ctsheets/smoking20cessation202.pdf

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EDUCATE

• Ask what they know
• You as RN need to educate the mother about the
  dangers side effects of their actions.
• The more informed pts are the better educated
  the more they will change their behavior
• Assess readiness to learn

Would you let your child do this?
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RN SUPPORT

• Do not threaten or frighten pt
• Give positive feedback
• State facts not opinions
• Refer to support groups
• LISTEN to pt

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Self-esteem

• ? self-esteem successful outcomes (smoking
  cessation)
• Low self-esteem is a frequent characteristic in
  women who abuse drugs

Bowie. B. H., RN, PhC, MBA Interventions to
Improve Interactions between Drug Abusing Mothers
and Their Drug-Exposed Infants A Review of the
Research Literature Journal of Addictions
Nursing,161, 2005
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PT Advocate

• Be both pts advocate
• You have a right to speak up for the fetus inside
• According to a research article by Mullen, A
  woman is more likely to quit smoking during
  pregnancy than at any other time in her life
• Mullen PD. Maternal smoking during pregnancy and
  evidence-based intervention to promote cessation.
  Prim Care199926(3)577-589

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Consequences
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Conclusion

• When you are pregnant, you are not just "eating
  for two." You also breathe and drink for two, so
  it is important to carefully consider what you
  give to your baby. If you smoke, use alcohol or
  take illegal drugs, so does your unborn baby

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Watch this video!!!

• http//www.youtube.com/watch?vA2JUuQOlEzs

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• First, don't smoke.
• Smoking during pregnancy passes nicotine and
  cancer-causing drugs to your baby. Smoke also
  keeps your baby from getting nourishment and
  raises the risk of stillbirth or premature birth.

• Don't use illegal drugs.
• Using illegal drugs may cause underweight
  babies, birth defects or withdrawal symptoms
  after birth

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• ATI
• 1) What week is the unborn baby most risk for
  malformation?
• a) first 10 weeks
• b) 25 Wks
• c) 30 Wks
• d) 40 Wks
• 1) The active ingredients in Cigarette smoke are?
• a. Nicotine
• b. Tar
• c. THC
• d. A and B

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• 3) All of the following systems are significantly
  impacted in marijuana smokers except
• a. cardiovascular
• b. neurological
• c. genitourinary
• d. Respiratory
• 4) Children born to women who use tobacco during
  pregnancy are likely to be
• a. premature
• b. have low birth weight
• c. at increased risk for SIDS
• d. all of the above
• 5) The 4 A's include all except
• a) Avoid
• b) Accept
• c) Alter
• d) Alternative
• e) Active

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If you are pregnant and you smoke, drink alcohol
or do drugs, get help. Your health care provider
can recommend programs to help you quit. You and
your baby will be better off.
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• Numbers that can help you locate a treatment
  center include
• National Drug Help Hotline
• 1-800-662-4357
• National Alcohol Drug Dependence Hopeline
• 1-800-622-2255