3/31/2015. Objectives. Alcohol. Long term effects. Substance abuse increases the risk of: Substance Abuse in Pregnancy

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1 Objectives Substance Abuse in Pregnancy Basics of screening and counseling Minako Watabe, MD Obstetrics and Gynecology Ventura County Medical Center 1) Discuss the risks of alcohol, tobacco, and drug use during pregnancy 2) Discuss screening methods for substance abuse during pregnancy 3) Provide useful tips on how to provide effective counseling and support to women who are using, or are at risk of using alcohol, tobacco, or drugs during pregnancy Substance abuse increases the risk of: Miscarriage Preterm Delivery Preterm Labor Abruption Placenta Birth Defects Low Birth Weight Infant Mortality Fetal Death Long term effects Sudden Infant Death Syndrome (SIDS) Growth Retardation/Developmental Delay Central Nervous System (CNS) damage Brain damage/small brain Alcohol CDC says no amount of alcohol is safe in pregnancy Drinking alcohol while pregnant is the leading preventable cause of mental and physical birth defects and childhood disabilities Alcohol readily crosses the placental barrier and reaches higher concentrations in the fetus blood and remains elevated for a longer time than in the mother s blood Fetal alcohol spectrum disorder (FASD) is an umbrella term describing the range of effects that can occur when alcohol is consumed prenatally 1

2 Fetal Alcohol Syndrome Fetal Alcohol Syndrome Fetal alcohol syndrome -congenital syndrome characterized by at least one feature from each of three categories Prenatal and postnatal growth restriction Central nervous system disorders- abnormal brain function, delays in behavioral development, and/or intellectual impairment Abnormal craniofacial features (2): Small head, small eyes or short eye openings, poorly developed philtrum, thin upper lip, short nose or flattened midfacial area Opiates Examples: heroine, morphine, methadone, vicodin, norco, oxycontin Some risks are related to route of administration i.e. intravenous drug use (hepatitis B/C, HIV, endocarditis, skin infections) Neonatal Abstinence Syndrome- lasting up to 10 weeks post-delivery Neonatal abstinence syndrome Withdrawal of a drug addicted baby Opiates cause NAS in over 50% of mothers who are using opiates prenatally Trembling, excessive crying, sleep problems, high pitched crying, seizures, poor feeding, vomiting/diarrhea, dehydration, sweating, unstable temperature Cocaine Stimulant that causes blood vessels to constrict Can cause maternal arrhythmias, vascular injuries, headaches Can mimic pre-eclampsia/seizures Increases risk of placental abruption, premature birth Can have interactions with certain blood pressure medications Methamphetamines Stimulant Very high risk of small babies, premature birth, placental abruption Some risk of birth defects Risks related to route of administration 2

3 Marijuana Not associated with birth defects Associated with long term issues Cognitive delay (learning disabilities Lack of attention/hyperactivity Depressive symptoms Tobacco Carbon monoxide readily crosses the placenta Pregnancy complications: Most commonly: growth restriction, abruption, miscarriage After delivery: SIDS Screening for substance abuse Most commonly used in our county is 4P s It is a screening, not a diagnostic tool Not everyone who screens positive has a problem It gives us the opportunity to provide help if there is a problem 4ps screen Refer to handout How to handle positive screens Research proves that brief interventions with primary health providers help Non-threatening, inexpensive, beneficial Low key approach Pre-treatment curriculum One on-one intervention in the safety of prenatal care visit Gives pregnant woman accurate information about alcohol and other drugs on herself and child Tone: supportive and educational Presents importance of avoiding alcohol and other drug use Brief: 10 minutes Can lead to referral to substance abuse treatment 3

4 The Stigma of substance abuse among women Drinking-related behaviors among men may be seen as proof of masculinity Excessive drinking by a woman is met with severe social disapproval Internalize the social stigma Despair, self hatred for her inability to control her behavior Guilt/shame Fear they will lose their children to child welfare officials History of Violence/Sexual Abuse Studies of women in substance abuse tx have rates of sexual trauma/incest ranging from % Rape, physical and sexual abuse, and incest are dominant themes in their childhoods High risk of domestic violence Window of opportunity Desire to have a healthy child may be motivating Stopping substance abuse at any point can increase the chance of a baby to be born healthy Moment of Truth Screen + If woman s use is more than very light use.. Brief Intervention State medical concern I am concerned because I know that alcohol use during pregnancy can cause a child to have mental retardation or severe learning problems Advise to abstain: And I know that the best think you can do is to stop using Discuss Agree- may be over multiple visits Refer Situation A Woman has a positive screen but negative field assessment Low risk of substance abuse Action: Finish history and then congratulate the woman on her healthy approach to pregnancy May provide brochure 4

5 Situation B: Screen positive. Assessment positive Patient asks a question about drug use The marijuana helps me with the nausea and my friends say it doesn t harm the baby-that s right isn t it? Level of risk is high/interested in information Action : Go to pre-treatment Situation C Positive 4p s, Positive field assessment, no request for information High risk/no interest in information Action: I am concerned. Recommend referral. If patient does not accept, provide pre-treatment Situation D Positive 4ps, positive field assessment, does NOT want information High risk for substance use Resistaance to info Express concern try pre-treatment but may give brochure. Do not push so hard that she feels threatened. Pre-treatment Procedure 1) I am glad you mentioned that you are using. We know a few things about the effects of use during pregnancy and I d like to tell you about some of my concerns 2) Share info in binder 3) Discuss. Listen to the patient 4) Close: support her for choosing to discuss her drug use. Offer treatment opportunities/phn referral. Chasnoff, Ira J. Pre-Treatment: A Brief Intervention for the Primary Prental Care Setting How to make an PHN referral See form Maintain a tone of encouragement/support Stay positive Provide information/education Be understanding Maintain a positive relationship with the patient 5

6 Conclusion Tobacco, alcohol, and elicit drugs can have detrimental effects on a mother and her fetus Providing screening for substance use can provide opportunity for intervention Pre-treatment method may be used for patients who will not receive formal treatment Be your patient s advocate Thank you! Questions??? 6

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