ADDICTION WEEK 3
CONSEQUENCES OF SUBSTANCE ABUSE
Forray 2016 - substance use during pregnancy
Intro
- women are at highest risk for developing a SUD during their reproductive years,
especially ages 18-29
- the most commonly used substance during pregnancy is nicotine, followed by
alcohol, marijuana, and cocaine
- polysubstance use is as high as 50%
- recent increase in use of opioid during pregnancy
- levels of abstinence are high in pregnancy but the impact of this is diminished due to
high rates of relapse postpartum
- maternal relapse happens at a time of high childcare needs
Adverse effects of substance use in pregnancy
alcohol
- heavy alcohol use associated with: increased risk of miscarriage, stillbirth and infant
mortality, congenital anomalies, low birthweight, reduced gestational age, preterm
delivery, small-for-gestational age
- low to moderate drinking: inconclusive or no risk
- most well established adverse fetal effects
- associated with fetal alcohol spectrum (FAS) disorders and adverse
neurodevelopmental outcomes
- long-term cognitive and behavioral challenged, adverse speech and language
outcomes, executive functioning deficits, psychosocial consequences as an adult
smoking
- damage to umbilical cord structure, miscarriage, increased risk for ectopic pregnancy,
low birthweight, placental abruption, preterm birth, increased infant mortality
- health effects of second-hand smoke on newborns: higher rates of respiratory and
ear infections, sudden infant death syndrome, behavioral dysfunction and cognitive
impairment
- women who used to be smokers might stop breastfeeding early to stat smoking again
cannabis
- preterm labor, low birthweight, small-for-gestational age, admission to neonatal ICU
- consequences on the growth of fetal and adolescent brains, reduced attention,
executive functioning skills, poorer academic achievement, behavioral problems
- adverse effects of marijuana are frequently observed with comorbid substance use,
and are greatest in heavy users
cocaine
- extent of effects has been overestimated
, - premature rupture of membranes, placental abruption, preterm birth, low
birthweight, small-for-gestational age
- inconsistent report on long-term effects, confounding effects of postnatal
environment like unsteady and disordered home, dysfunctional parenting etc.
- methamphetamine also related to similar outcomes
opioid
- greater risk of low-birth weight, respiratory problems, third trimester bleeding,
toxemia, mortality
- increased risk of neonatal abstinence syndrome (NAS)
o symptoms: irritability, feeding difficulties, tremors, hypertonia, emesis, loose
stools, seizures, respiratory stress
- also: postnatal growth deficiency, microcephaly, neurobehavioral problems, sudden
infant death syndrome
- cigarette smoking, very common together with opioid use, may confound the effects
important to remember:
- confounding effects of coexisting substance use and comorbid psychiatric illnesses
- women with SUDs often experience inadequate prenatal care, poor nutrition, chronic
medical problems, poverty and domestic violence
- SUD in pregnancy may also result in early dysfunctional maternal-infant relationship
that potentiates the negative effects of drug exposure
treatment of substance use in pregnancy
- primarily behavioral counseling
- reduce prenatal alcohol use:
o brief interventions that utilize motivational interviewing
o screening via non-healthcare community workers
o counseling by midwives
o multimedia and educational efforts
- smoking cessation:
o mainly behavioral counseling
o psychotherapeutic interventions only led to moderate success
o pharmacological treatment not yet evaluated for safety and efficacy
o nicotine replacement therapy only shows limited efficacy
o most successful: contingency management (CM) with financial incentives
- cannabis:
o lacking
o screening of pregnant women to increase early identification of cannabis use
o motivational interviewing (MI), CBT, and CM show some success for women
but not known for pregnant women
- cocaine:
o CBT, MI, CM
o CM shows most potential, associated with much longer duration of
abstinence compared to reinforcement approach and 12-step facilitation
o currently no evidence based pharmacological treatments
o 1 study shows promise of using progesterone in postpartum to reduce use
CONSEQUENCES OF SUBSTANCE ABUSE
Forray 2016 - substance use during pregnancy
Intro
- women are at highest risk for developing a SUD during their reproductive years,
especially ages 18-29
- the most commonly used substance during pregnancy is nicotine, followed by
alcohol, marijuana, and cocaine
- polysubstance use is as high as 50%
- recent increase in use of opioid during pregnancy
- levels of abstinence are high in pregnancy but the impact of this is diminished due to
high rates of relapse postpartum
- maternal relapse happens at a time of high childcare needs
Adverse effects of substance use in pregnancy
alcohol
- heavy alcohol use associated with: increased risk of miscarriage, stillbirth and infant
mortality, congenital anomalies, low birthweight, reduced gestational age, preterm
delivery, small-for-gestational age
- low to moderate drinking: inconclusive or no risk
- most well established adverse fetal effects
- associated with fetal alcohol spectrum (FAS) disorders and adverse
neurodevelopmental outcomes
- long-term cognitive and behavioral challenged, adverse speech and language
outcomes, executive functioning deficits, psychosocial consequences as an adult
smoking
- damage to umbilical cord structure, miscarriage, increased risk for ectopic pregnancy,
low birthweight, placental abruption, preterm birth, increased infant mortality
- health effects of second-hand smoke on newborns: higher rates of respiratory and
ear infections, sudden infant death syndrome, behavioral dysfunction and cognitive
impairment
- women who used to be smokers might stop breastfeeding early to stat smoking again
cannabis
- preterm labor, low birthweight, small-for-gestational age, admission to neonatal ICU
- consequences on the growth of fetal and adolescent brains, reduced attention,
executive functioning skills, poorer academic achievement, behavioral problems
- adverse effects of marijuana are frequently observed with comorbid substance use,
and are greatest in heavy users
cocaine
- extent of effects has been overestimated
, - premature rupture of membranes, placental abruption, preterm birth, low
birthweight, small-for-gestational age
- inconsistent report on long-term effects, confounding effects of postnatal
environment like unsteady and disordered home, dysfunctional parenting etc.
- methamphetamine also related to similar outcomes
opioid
- greater risk of low-birth weight, respiratory problems, third trimester bleeding,
toxemia, mortality
- increased risk of neonatal abstinence syndrome (NAS)
o symptoms: irritability, feeding difficulties, tremors, hypertonia, emesis, loose
stools, seizures, respiratory stress
- also: postnatal growth deficiency, microcephaly, neurobehavioral problems, sudden
infant death syndrome
- cigarette smoking, very common together with opioid use, may confound the effects
important to remember:
- confounding effects of coexisting substance use and comorbid psychiatric illnesses
- women with SUDs often experience inadequate prenatal care, poor nutrition, chronic
medical problems, poverty and domestic violence
- SUD in pregnancy may also result in early dysfunctional maternal-infant relationship
that potentiates the negative effects of drug exposure
treatment of substance use in pregnancy
- primarily behavioral counseling
- reduce prenatal alcohol use:
o brief interventions that utilize motivational interviewing
o screening via non-healthcare community workers
o counseling by midwives
o multimedia and educational efforts
- smoking cessation:
o mainly behavioral counseling
o psychotherapeutic interventions only led to moderate success
o pharmacological treatment not yet evaluated for safety and efficacy
o nicotine replacement therapy only shows limited efficacy
o most successful: contingency management (CM) with financial incentives
- cannabis:
o lacking
o screening of pregnant women to increase early identification of cannabis use
o motivational interviewing (MI), CBT, and CM show some success for women
but not known for pregnant women
- cocaine:
o CBT, MI, CM
o CM shows most potential, associated with much longer duration of
abstinence compared to reinforcement approach and 12-step facilitation
o currently no evidence based pharmacological treatments
o 1 study shows promise of using progesterone in postpartum to reduce use
