CHILD CARE HEALTH CONSULTATION PROGRAM Sources cited Missouri Dept of Health amp Senior Services State Health Assessment 2013 March of Dimes 2007 American Pregnancy Association wwwamericanpregnancyorg ID: 569030
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EFFECTS OF USING SUBSTANCES DURING PREGNANCY
CHILD CARE HEALTH CONSULTATION PROGRAM
Sources cited: Missouri Dept. of Health & Senior Services, State Health Assessment, 2013
March of Dimes, 2007
American Pregnancy Association:
www.americanpregnancy.org
Slide2
oBJECTIVES
BECOME FAMILIAR WITH SUBSTANCES THAT CAUSE HARM IF USED DURING PREGNANCY
BE AWARE AND PREPARED TO MAKE REFERRALS TO COMMUNITY RESOURCESSlide3
Some of the ‘numbers’
Missouri’s smoking rate at 23 percent
is slightly higher
than the
U.S rate of 21.2 percent.
The smoking
rate in the Southeast region is higher than the state rate.The life expectancy at birth for Missourians (76.9 years) is lower than for all Americans (78.1). The life expectancy at birth for residents in the Southeast region is nearly two years less than that for the state.
Missouri Dept. of Health & Senior Services, State Health Assessment, 2013Slide4
“Numbers” con’t
Missouri’s infant death
rate is
significantly greater than the U.S
. rate
but the infant death rate
for African Americans is more than double the rate for all Missourians.The impact of drug use in Missouri is felt in families, communities, the criminal justice system and the public health system. The Missouri drug arrest rate is significantly higher than the U.S. rate.
Missouri Dept. of Health & Senior Services, State Health Assessment, 2013Slide5
Substance abuse during pregnancy
Pregnant
women are less likely to use substances than their peers
.
The exception is pregnant women aged 15 to 17; this substance use rate is 26 percent for pregnant women, compared with 19.6 percent for
non-pregnant
women.March of Dimes, 2007Slide6
Substance abuse during pregnancy
Women more prone to substance abuse:
Earn below poverty level
Were exposed to violence as a child
Have a history of domestic abuse
Suffer depression or other mental health problems
Have less than a high school educationAre unmarriedAre unemployedAre involved with the criminal justice systemMarch of Dimes, 2007Slide7
Substance abuse during pregnancy
Substance use is highest in the first trimester
. (they may not know they’re pregnant)
The most common form of substance use in pregnancy is smoking among White women
.
Tobacco,
alcohol and drug use in pregnancy occurs across all demographic groups.March of Dimes, 2007Slide8
TobaccoSlide9
Tobacco Use in Pregnancy: Maternal Effects
Cigarette smoking is the most common form of substance abuse in pregnancy. It is linked to
:
Decreased fertility
Spontaneous abortion
Placenta
praeviaPlacental abruptionEctopic pregnancyPreterm premature rupture of membranes (PPROM)Preeclampsia
March of Dimes, 2007Slide10
Tobacco Use in Pregnancy: Fetal Effects
Impaired transfer of oxygen and nutrition
Long-term cognitive function and increased risk of brain damage
Chronic low-level hypoxia
Intrauterine growth restriction (IUGR)
Preterm delivery
Low birth weight (LBW) in term infantsMarch of Dimes, 2007Slide11
© 2007, March of Dimes
Tobacco Use in Pregnancy: Neonatal Effects
Impaired respiratory function in premature infants
Low neurobehavior scores and higher withdrawal-symptom scores
Asthma, respiratory illness and pneumonia
Infections of the middle ear
Increased risk of cancer and SIDS Slide12
alcoholSlide13
© 2007, March of Dimes
Alcohol Use in Pregnancy
There is no safe amount of alcohol consumption during pregnancy
(Jones &
Chambers
, 1999).Slide14
© 2007, March of Dimes
Alcohol Use in Pregnancy: Maternal Effects
Cardiovascular and liver disease
Breast and gynecological cancer
Osteoporosis
Menstrual symptoms
Neurological and mental health problems
Compromised ability to conceive
Spontaneous abortionSlide15
© 2007, March of Dimes
Alcohol Use in Pregnancy:
Fetal Effects
Abnormalities in brain and neuron development
Growth deficiency
Structural changes
PrematurityLBW
Decreased length and head circumferenceSlide16
© 2007, March of Dimes
Alcohol Use in Pregnancy: Neonatal Effects
Fetal Alcohol Spectrum Disorders (FASD)
Fetal
alcohol syndrome (FAS)
Fetal alcohol effects (FAE)Slide17
fetal alcohol spectrum disorders (FASD)
FASD = All problems that result from fetal exposure to alcohol
Fetal Alcohol Syndrome (FAS)—Most common
Fetal Alcohol Effect
Alcohol-related
Neuro
-Development DisorderAlcohol-related Birth DefectsSlide18
Fetal alcohol syndrome
Effects are irreversible but 100% preventable!
Mental retardation
Malformation of bones and major organs
Central nervous system problems, poor motor skills
Death
Problems with growth & development/speech & hearingMay have distinct facial featuresSlide19
Fetal alcohol effects
Alcohol-related
Neuro
-Development Disorder
--mental
and behavioral impairments such as learning disabilities, poor school performance, poor impulse control, and problems with memory, attention and/or judgment.
Alcohol-related Birth Defects
--malformations
of the skeletal system and major organ systems such as defects of the heart, kidneys, bones, and/or auditory systemSlide20
How is Fetal Alcohol Syndrome different from Fetal Alcohol
Effects?
Fetal Alcohol Syndrome is a result of
high
doses
of
alcohol consumption during pregnancy such as binge drinking and/or drinking on a regular basis. Fetal Alcohol Effects are a result of moderate drinking throughout pregnancy. The effects of FAE are still irreversible and lifelong.Slide21
Illicit drugsSlide22
© 2007, March of Dimes
Marijuana: Maternal Effects
Is
the illicit drug most commonly used during pregnancy, although only 3.6 percent of pregnant women report using it
(SAMSHA, 2005)
Does
not cause a defined physical withdrawal syndromeHeavy use linked to lung problemsSlide23
© 2007, March of Dimes
Marijuana: Fetal and Neonatal Effects
Does not appear to cause anomalies or serious effects on the fetus
Does
not appear to decrease intelligence
Newborns
may show increased startle response, tremors, hand-to-mouth behavior and disturbed sleep patterns.Slide24
© 2007, March of Dimes
Cocaine: Maternal Effects
Hypertension
Tachycardia
Cardiac events and maternal death
Spontaneous abortion
Placental abruption Premature rupture of membranes (PROM)Slide25
© 2007, March of Dimes
Cocaine: Fetal Effects
Fetal
effects of cocaine are caused by the drug’s direct effects (vasoconstriction and
neuro
-excitation
) and by lifestyle issues that maternal drug use brings, including poor nutrition and avoidance of prenatal care.Slide26
© 2007, March of Dimes
Cocaine: Neonatal Effects
Jitteriness
Hyperactivity
Inconsolability
Poor feeding and state regulation
No physiological withdrawal: Neonates are not dependent on cocaine and do not need medication to lessen withdrawal.Slide27
© 2007, March of Dimes
Amphetamines: Maternal Effects
Stroke
Cardiac problems
Psychiatric emergencies
Growth restriction
Placental abruptionPreterm deliverySlide28
© 2007, March of Dimes
Amphetamines: Fetal and Neonatal Effects
Similar effects to cocaine, with decreased fetal growth
Some
researchers expect
that as
with cocaine, effects can be seen early in life but are quickly overpowered by environmental factors. Slide29
© 2007, March of Dimes
MDMA (Ecstasy): Maternal Effects
Anxiety
Twitching
Depression
Impaired cognitive processing and memory performanceSlide30
© 2007, March of Dimes
MDMA: Fetal and Neonatal Effects
Animal
studies do not show an increase in harmful fetal effects.
A small, uncontrolled, retrospective study suggests a possible increase in
heart defects
.Nurses should treat infants and families based on demonstrated health needs.Slide31
© 2007, March of Dimes
Heroin: Maternal Effects
Heroin
can cause severe physiological withdrawal symptoms, including fatal seizures when withheld for 12 to 48 hours.Slide32
© 2007, March of Dimes
Heroin: Treatment
Methadone
The most common treatment for heroin abuse in pregnant women
During pregnancy, brings addicted women into agencies that promote prenatal care
Buprenorphine
Linked to better treatment adherence with fewer side effects and overdoses than methadoneSlide33
© 2007, March of Dimes
Heroin: Fetal Effects
Opiates
, such as heroin, methadone and
buprenorphine
, have not been linked to fetal anomalies.
Fetal withdrawal responses include arrhythmias, seizure activity and fetal demise.Slide34
© 2007, March of Dimes
Heroin: Neonatal Effects
Drug withdrawal
Suck-swallow difficulties
Central nervous system (CNS) irritability
Gastrointestinal upset
YawningSneezing
Frantic sucking with uncoordinated feeding
High-pitched cry
Increased or decreased muscle toneSlide35
Providers’ roleSlide36
How can you help
Support children in your care who may have special needs as a result of some of these effects on them
Seek further training on children with special health care needs
Know your community resourcesSlide37
How you can help
Be aware of community resources for families that may need referral for help
Have information available to educate/inform (posters, flyers, brochures) in areas where adults gather.Slide38
Referrals and resourcesSlide39
© 2007, March of Dimes
Addiction Recovery
(Kearney, 1998)
Recovery
involves:
Abstinence
Self and psychological issuesConnections and relationships with men and women, family, community and cultureSlide40
Community resources
Local health departmentMedical providers
Mental health professionals
Associations (March of Dimes)
Web resources:
National Council on Alcoholism and Drug Dependence
https://ncadd.org National Institute on Drug Abuse: www.drugabuse.govSlide41
Thank you