Substance Abuse During Pregnancy: Moms on Meds. Jennifer Anderson Maddron, M.D LeConte Womens Healthcare Associates

Transcription

1 Substance Abuse During Pregnancy: Moms on Meds Jennifer Anderson Maddron, M.D LeConte Womens Healthcare Associates

2 2010 National Survey on Drug Use and Health An estimated 4.4% of pregnant women reported use of an illicit substance within the past 30 days Substance Abuse and Mental Health Services Administration. Results from the 2010 National Survey on Drug Use and Health: summary of national findings. NSDUH Series H-41. HHS Publication No. (SMA) Rockville (MD) SAHMSA: 2011

3 Deliveries at LeConte Medical Center

4 NICU Transfers To East Tennessee Childrens Hospital

5 Maternal Complications of Substance Abuse Many barriers exist for pregnant substance abusers Lifestyle issues may result in pregnant women engaging in high risk behavior Prostitution Sharing of IV needles Intimate Partner Violence Theft and other criminal activities

6 Maternal Complications of Substance Abuse Confounding variables of substance abuse Socioeconomic status Ethnicity Access to prenatal care Poly-substance abuse

7 Substances Most Commonly Abused During Pregnancy Tobacco Alcohol Marijuana Opiates Cocaine Benzodiazepines Amphetamines Hallucinogens

8 Tobacco 20-25% of pregnant patients report using tobacco during their pregnancy

9 Alcohol Estimated that 19% of pregnant women admit to alcohol use during pregnancy Link to Fetal Alcohol Syndrome

10 Marijuana Reported use among 10-15% of pregnant women Marijuana use in pregnancy has not been associated with birth defects Withdrawl symptoms are present in many exposed neonates Abel EL, Sokol RJ: Marijuana and cocaine use during pregnancy. In Niebyl J (ed): Drug Use in Pregnancy, 2 nd ed. Philadelphia, Lea and Febiger, 1988

11 Cocaine Antenatal Complications Neonatal Effects Maternal Hypertension Maternal Stroke Miscarriage Preterm Delivery Fetal Strokes Placental Abruption Fetal Growth Restriction Low Birth Weight 4 Fold Increase in SIDS Reported birth defects include Renal malformations Intestinal system defects Terminal Limb Defects

12 Amphetamines Antenatal Complications Maternal Hypertension Preterm Delivery Growth Restriction Fetal Demise Neonatal Effects Not known to be associated with birth defects Neonatal Withdrawl Symptoms often present.

13 Benzodiazepines Antenatal Complications Increased risk of Preterm delivery Inconclusive regarding birth defects Neonatal Effects Neonatal Withdrawl

14 Opioid Addiction Oxycodone Hydrocodone Methadone Roxicodone Heroin Fentanyl Meperidine Hydromorphone Propoxyphene

15 Opioid use in Pregnancy: Maternal Complications Altered Mental Status Somnolence Respiratory Depression Death IV Use may result in Hepatitis B & C HIV Skin infections Endocarditis Sepsis

16 Opioid Effects on Pregnancy Antenatal Complications Preterm Delivery Growth Restriction Low Birth Weight Placental Abruption `Fetal Death `` Low risk of birth defects Neonatal Effects Neonatal Abstinence Syndrome (NAS) Irritability Poor Feeding Diarrhea Tremors Respiratory Compromise Seizures

17 Treatment of Substance Abuse During Pregnancy

18 Screening Universal Screening of all women before and during pregnancy Identify women currently using illicit substances & women at risk Toxicology testing: Urine Drug Screens

19 Intervention Multidisciplinary approach needed to address Physical, Psychological and social issues Obstetrical and Neonatal Care Addiction Medicine Specialist Mental Health Services Social Services

20 Treatment of Opioid Addiction in Pregnancy For Opioid addicted Pregnant patients: Detoxification Relapse Rates are high Opioid Replacement Therapy Methadone versus Buprenorphine Alcohol and Drug Counseling Treatment of Co-existing Mental Health Disorders

21 Comprehensive care provided at one location is cost effective and produces better outcomes for both mother and child. Early Start Program at Kaiser Permanente, California Patients who were screened, assessed and treated had lower rates of preterm delivery, low birth weight, and neonatal-assisted ventilation

22 American College of Obstetrics & Gynecology Committee Opinion in 2004 wrote that using a protocol for universal screening, brief intervention, and referral to treatment results in a mean net savings of $4644 in medical expenses per mother/ infant pair.

23 Treatment Cost Considerations Annual treatment cost for a person with drug addiction One year in prison $51-$73/day $25,900 Outpatient $15/day x 120 days $1,800 Intensive Outpatient 9 hrs/week x 6 months maintenance Methadone Maintenance Short term residential treatment Long term residential treatment $2,500 $13/day x 300 days $3,900 $130/day x 30 days + $400 x 25 weeks $4,400 $49/day x 140 days $6,800 Reference: Position Paper on Drug Policy published by the Physician Leadership on National Drug Policy January, Data source: Center for Substance Abuse Treatment, Federal Bureau of Prisons National Treatment Improvement Evaluation Study

24 Pregnancy is the ideal time to provide intervention to women with substance abuse problems, as motivation to modify harmful behavior is increased.

25 MOMS on Meds Uniting hearts to save lives Help us HEAL our community.