Maternal Drug Use

How to Create the Best Offspring or Not …

Alison Freeman, Geleen Antonio, Jae Eun Kim, Matthew White, and Sydney Shera

Overview

• Development– Babies and mommies

• Cocaine– Moms– Babies

• Heroin– Moms– Babies

• Other bad decisions

Review

• You take a drug– Hopefully feel good

• Brain notices NT difference– Brain adapts to this

• Up-regulation• Down-regulation

• Life decision– Rehab / withdrawal

http://www.google.com/imgres?imgurl=http://katemoller.com/wp-content/uploads/2010/10/iStock_000008922315XSmall.jpg&imgrefurl=http://katemoller.com/a-healthy-dose-of-ecstacy/&usg=__QHNfRMMCwiyeLhkGP4vL7x2_toQ=&h=282&w=425&sz=60&hl=en&start=31&sig2=I_1y8wDSHPTtjCrN8KrPTA&zoom=1&tbnid=gethF2oCyfBCDM:&tbnh=117&tbnw=183&ei=0ghoTYPDL42ssAPOp92mBA&prev=/images%3Fq%3Dbabies%2Band%2Becstasy%26hl%3Den%26gbv%3D2%26biw%3D1003%26bih%3D564%26tbs%3Disch:10%2C869&itbs=1&iact=hc&vpx=701&vpy=117&dur=4328&hovh=183&hovw=276&tx=215&ty=101&oei=ywhoTbzGH4GssAPh7eCoBA&page=3&ndsp=16&ved=1t:429,r:4,s:31&biw=1003&bih=564

Pregnancy Basics

• Consists of a Mom and a growing ‘baby’• ‘baby’ development

– Genes, embryos, development• Average duration 42 weeks

– One cell a mini-person• 10 – 25 % of recognized pregnancies

miscarriages• Birth defects occur in 150,000 America babies

per year

http://www.google.com/imgres?imgurl=http://www.cerebralpalsychildren.com/CP1.jpg&imgrefurl=http://www.cerebralpalsychildren.com/CPFetal.html&usg=__0-oqJOJ9ROBuxUo59HhmaH1W3_o=&h=606&w=894&sz=91&hl=en&start=0&sig2=o1wSmbVQveFriw9-8kseFQ&zoom=1&tbnid=M6kLfgXXVJNokM:&tbnh=111&tbnw=164&ei=hSdoTbbOFIHAsAP5tuioBA&prev=/images%3Fq%3Dfetal%2Bdevelopment%26hl%3Den%26gbv%3D2%26biw%3D1003%26bih%3D564%26tbs%3Disch:1&itbs=1&iact=hc&vpx=603&vpy=124&dur=266&hovh=185&hovw=273&tx=120&ty=73&oei=hSdoTbbOFIHAsAP5tuioBA&page=1&ndsp=15&ved=1t:429,r:3,s:0

Effects of Cocaine and Heroin on Effects of Cocaine and Heroin on the Pregnant Woman and Co.the Pregnant Woman and Co.

Effects of Cocaine and Heroin on Effects of Cocaine and Heroin on the Pregnant Woman and Co.the Pregnant Woman and Co.

http://www.google.com/imgres?imgurl=http://www.onlinenewsreporters.com

The Effects of Heroin & Cocaine on the Normal Physiology of Pregnancy

The Effects of Heroin & Cocaine on the Normal Physiology of Pregnancy

• Placental abruption:-Placental lining has separated from the mother’s uterus , causing late pregnancy bleeding within uterus, which can ultimately result in maternal mortality. -Fetal membranes prematurely rupture, triggering pre-term labor.

How Drugs Cross the Placenta

http://www.merckmanuals.com/home/sec22/ch259/ch259a.html

Cocaine

http://www.google.com/imgres?imgurl=http://www.topnews.in/usa/files/pregnant-lady http://www.google.com/imgres?imgurl=http://www.drugnet.net

The Effects of Cocaine on the Normal Physiology of Pregnancy

The Effects of Cocaine on the Normal Physiology of Pregnancy

• Pre-term labor, Pre-term delivery: -Cocaine use during pregnancy may cause the down-regulation of myometrial (middle layer of uterine wall) beta-adrenergic receptors

HOW?

http://www.google.com/imgres?imgurl=http://www.epigee.org

MechanismMechanism

(Cocaine inhibits the reuptake of 5-HT, NE, and E)Normally NE and E bind to Beta-2 adrenergic receptors in the smooth muscles of the uterine walluterine relaxation Cocaine Use An increase in NE and E in the synapse over-activates the myometrial Beta-2 adrenergic receptors

-Over time, down-regulation of these receptorsprevent over-activation-Down-regulation of myometrial Beta-2 adrenergic

receptors prevents normal uterine relaxation, prolonging the contraction state and inducing pre-term labor and pre-term delivery

Cocaine Norepinephrine Epinephrine

http://www.google.com/imgres?imgurl=http://www.edinformatics.com

http://www.google.com/imgres?imgurl=http://images.wikia.com/psychology/images

http://www.google.com/imgres?imgurl=http://3.bp.blogspot.com

The Effects of Cocaine on the Normal Physiology of Pregnancy

The Effects of Cocaine on the Normal Physiology of Pregnancy

• Normal pregnancy: Vasodilation occurs due to increased levels of progesterone. This vasodilation may be counteracted by cocaine-induced vasoconstriction

• Hyperthermia caused by vasoconstriction– An increase in [E]synaptic from cocaine

usevasoconstriction, resulting in the retention of heathyperthermia

– Cocaine-induced maternal hyperthermiafetal prematurity, low birth weight, and fetal death.

--May also alter the mother’s mental status

Epinephrine Causes Vasoconstriction and Progesterone Causes VasodilationEpinephrine Causes Vasoconstriction

and Progesterone Causes Vasodilation

http://www.google.com/imgres?imgurl=http://www.pgbeautygroomingscience.com/assets/images

The Socio-political Effects of Cocaine on the Pregnant Woman

The Socio-political Effects of Cocaine on the Pregnant Woman

• The Anti-Drug Abuse Act of 1986 –mandatory minimum sentencing time for cocaine use/possession– A negative unforeseen affect: pregnant woman who

abuse cocaine are less likely to seek prenatal care, drug treatment, and other social services; may lead to unnecessary abortions

– Very few US drug treatment programs will admit pregnant women

– Minority women constitute 80% of those prosecuted for delivering drug-abused babies, regardless of equal levels of drug use in pregnant Caucasian women.

How a drug affects a fetus depends on…

• The fetus’s stage of development– Early in pregnancy (within 20 days after

fertilization)– Between 3rd and 8th week after fertilization– After organ development

• The strength & dose of the drug

http://adoption.families.com/blog/considerations-in-adoption-prenatal-drug-and-alcohol-exposure

What are the risks with use of cocaine during pregnancy?

• Increased risk of miscarriage• Preterm labor• Premature & low-birth weight

– 3 to 6 times more likely to be born at a low birth weight (less than 5.5 pounds)

• Smaller heads

More problems…• Placental & urinal tracts problems• Physical condition & overall responsiveness• Sudden Infant Death Syndrome (SIDS)• Dependence & withdrawal symptoms

http://www.thepanamadigest.com/2010/04/daddys-baby-grabs-1400-kilos-of-cocaine/ http://www.drugcouncil.tc/cocaine.html

What is the long-term outlook for babies who were exposed to

cocaine before birth?

• Negative effects of cocaine exposure is permanent– Normal intelligence but subtle learning &

behavioral problems• Lower IQ• Language delays & attention problems

– Deficits in cognitive & emotional development

http://www.google.com/imgres?imgurl=http://tothewire.files.wordpress.com/2008/12/heroin.gif&imgrefurl=http://tothewire.wordpress.com/2008/12/01/swiss-approve-pioneering-legal-heroin-program/&usg=__ZPbm9ae-kHUSTu0LygOHtm7uy2E=&h=400&w=400&sz=49&hl=en&start=0&sig2=R7FaNkAz2UskHWdzraYiqg&zoom=1&tbnid=cL3i26vnbAlUiM:&tbnh=122&tbnw=121&ei=FC5oTbLvBZOssAP0w9SoBA&prev=/images%3Fq%3Dheroin%26hl%3Den%26biw%3D1020%26bih%3D564%26gbv%3D2%26tbs%3Disch:1&itbs=1&iact=hc&vpx=752&vpy=105&dur=94&hovh=225&hovw=225&tx=172&ty=88&oei=FC5oTbLvBZOssAP0w9SoBA&page=1&ndsp=17&ved=1t:429,r:5,s:0

Heroin Addicts and Pregnancy

Pregnant heroin addicts tend to be:– younger than non-addicted pregnant patients– unmarried or separated from spouses– disproportionately large number are members of minority ethnic groups

http://www.ncbi.nlm.nih.gov/pubmed/2304039

Injection drug use during pregnancy

-Increases risk of contracting HIV and the Hepatitis C virus

-These infections can be passed on to the infant during pregnancy or at birth

Photo: http://www.topnews.in/law/australian-woman-who-hid-heroin-stomach-held-235974

Complications

Pregnancy Maternal Fetal

Poor Fetal Growth Malnutrition Retardation

Premature rupture of membranes( water breaks too soon)

STDs Fetal death

Premature birth Hepatitis or HIV Intrauterine growth restriction

Stillbirth Preeclampsia Prematurity

Breech birth Third-Trimester Bleeding

Withdrawal Symptoms

Placenta: can separate too soon, or not have enough blood

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1272838/

http://www.ireta.org/sbirt/pdf/Heroin_in_Pregnancy.pdf

Significant medical and obstetrical complications resulting in acute and chronic abnormalities in neonates:

Treatment Options

Prenatal care and comprehensive drug treatment program

– -Detoxification– -Methadone– -Buprenorphine

(2002)

Photo: http://www.whatwinnersdo.com/recommended-addiction-recovery-books/

Heroin Withdrawal SymptomsShame and embarrassment deters pregnant women from seeking help with addiction

Women who become pregnant while addicted to heroin should not stop using heroin without the advice of a doctor.

Severe effects and death may occur in both mothers and unborn babies.

Health effects resulting from Heroin withdrawals:Diarrhea Restlessness Vomiting Muscle or bone pain Insomnia Cold flashes

Detoxification-For women who do not want or are not able to receive

pharmacotherapy for heroin addiction-Medical supervision necessary-Potential risk to fetus and likelihood of relapse-Pregnant women advised not to detoxify from opiates

because of increased risk of spontaneous abortion or premature delivery

Methadone Treatment for a Healthy Pregnancy

Methadone: long-acting opioid drug used with counseling and other services to help people to stop using heroin

Methadone Maintenance Treatment(MMT): • Helps with a healthy pregnancy and birth(increased birth weight,

gestational age of infant, and increased prenatal and antenatal visits)

• Safe for babies but has resulting side effects: Fussiness Not eating or sleeping well Fever Vomiting Trembling

Symptoms go away after a few weeks

http://www.recoveryconnection.org/blog/2010/08/addiction-treatment-over-suboxone-or-methadone-clinic/

BuprenorphineIn the United States, several studies have found buprenorphine to be equally

effective and as safe as methadone in the adult outpatient treatment of opioid dependence.

Given this efficacy among adults, current studies are attempting to establish the safety and effectiveness of buprenorphine in opioid-dependent pregnant women.

http://arch1design.com/blog/2010/06/03/cold-turkey-obesity-and-sterilization/

Buprenorphine Side Effects:

Dysphoric mood Piloerection

Nausea or vomiting Diarrhea

· Muscle aches/cramps Yawning · Lacrimation · Mild fever

Rhinorrhea Insomnia

Pupillary dilation Craving

Sweating Distress/irritability

Buprenorphine-An opioid partial agonist-Although an opioid that can produce the typical side effects of euphoria and

respiratory depression, it is less effective than full agonists like heroin and methadone.

-At low doses, can produce an agonist effect that enables opioid-addicted individuals to discontinue opioid misuse without withdrawals.

-”Ceiling effect”: at moderate doses, plateau is reached and effects do not increase with dosage(safer in overdose)

-Max effects occur around the 16-32 mg range for sublingual tablets.-Lower risk of abuse, addiction, and side effects compared to full opioid

agonists.-No evidence of organ damage with chronic use-No evidence of significant disruption of cognitive or psychomotor

performance with buprenorphine maintenance dosing

Effect of Heroin Use on Newborns

• Increased chance of:– Low birth weight– Small Head Circumference– Breathing difficulties– Hypoglycemia– Intracranial Hemorrhage– Sudden Infant Death Syndrome

Effect of Heroin Use on Fetal Development•Unborn baby can develop drug dependence•Withdrawal Symptoms in Babies of Heroin Users:

FeverSneezing

TremblingIrritabilityDiarrheaVomiting

Continual cryingSeizures

Sleep abnormalitiesJoint stiffness

Thrombocytosis-High platelet counts in the bloodStudy by Calderon et al.:

» Thrombocytosis observed in infants exposed to in-utero to illicit drugs, has been assoc. with methadone exposure

» Took a retrospective look at medical records of newborns with intrauterine drug exposure admitted to San Juan City Hospital (1999-2001)

» Found 96% of these infants had thrombocytosis.» Of these 75% were exposed to methadone, heroin and

cocaine» Began at ten days of life and resolution seen in 3-4

weeks without complications

Breastfeeding-Social drug use in pregnant and breastfeeding mothers

-Breastfeeding nourishment for baby

-Transfer of heroin

-Not absorbed well by infant because of poor oral

bioavailability from the milk

- Risk of HIV and Hepititis C.

-Acute Stages of Illness

http://www.wellsphere.com/wellpage/neonatal-withdrawal-syndrome-from-methadone-while-pregnanthttp://www.health-e-learning.com/articles/Social_Drugs_and_Breastfeeding.pdf

Breastfeeding and Methadone

• The American Academy of Pediatricians states that methadone use of 20 mg or less per day is compatible with breast-feeding.– However, no dose information or other guidelines

are included.

Heroin and Its Effect on Children After Birth

• Low Birth weight linked to:• Language, visual-motor and other learning disabilities• Behavior problems• Suffered performance in school

Inconclusive data relating to long-term effects to prenatal exposure to heroin/methadone

Other Drugs

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Marijuana and your ‘Baby’

• Gestation Age• Birth Weight• Head Circumference• Birth Length

• However, the # of joints in the third trimester does not correlate

•http://www.google.com/imgres?imgurl=http://gal.darkervision.com/wp-content/uploads/2008/07/baby.jpg&imgrefurl=http://gal.darkervision.com/2008/07/25/teen-jailed-for-8-years-for-giving-a-toke-to-2-and-4-year-old-nephews-who-are-then-placed-into-care-just-another-fine-day-in-the-war-on-drugs-madhouse/&usg=__zBgv4Xcn3kwwpcPgbEThg8GlT44=&h=377&w=398&sz=18&hl=en&start=0&sig2=p0l8_v8OIZV_ZmPZ32jwHw&zoom=1&tbnid=s2WKF-2oEM3FFM:&tbnh=120&tbnw=135&ei=cAhoTZq5KIu4sQOR1fyoBA&prev=/images%3Fq%3Dmarijuana%2Bbabies%26hl%3Den%26biw%3D1020%26bih%3D564%26gbv%3D2%26tbs%3Disch:1&itbs=1&iact=hc&vpx=658&vpy=104&dur=15&hovh=218&hovw=231&tx=118&ty=121&oei=cAhoTZq5KIu4sQOR1fyoBA&page=1&ndsp=18&ved=1t:429,r:4,s:0

Your Bab

• Impaired brain development

• MDMA interferes with neuronal differentiation– Atg5 gene on overdrive

• Severe teratogenesis• Fetal brain damage• Persistent alteration in

brain – Changes in DA and 5-HT

metabolism

http://www.google.com/imgres?imgurl=http://www.motifake.com/image/demotivational-poster/1003/crack-meth-ecstasy-crack-meth-ecstasy-demotivational-poster-1267977486.jpg&imgrefurl=http://www.motifake.com/crack-meth-ecstasy-crack-meth-ecstasy-demotivational-posters-93079.html&usg=__Y3lmUHtYC0KZn6n_dafcszDHfN4=&h=844&w=640&sz=100&hl=en&start=0&sig2=JdgWUoD_nGoCukjdwYukfg&zoom=0&tbnid=VanbHMJzDalAbM:&tbnh=128&tbnw=97&ei=UiJoTdqZOoT2swPV6N2oBA&prev=/images%3Fq%3Decstasy%2Bmeth%2Bcrack%26hl%3Den%26gbv%3D2%26biw%3D1003%26bih%3D564%26tbs%3Disch:1&itbs=1&iact=hc&vpx=135&vpy=112&dur=31&hovh=145&hovw=110&tx=67&ty=55&oei=UiJoTdqZOoT2swPV6N2oBA&page=1&ndsp=15&ved=1t:429,r:0,s:0

Other Things to be Scared of …

• Terbutaline treatment (medication)– Increased incidence of autism spectrum disorder

• Organophosphates (pesticides)– Inhibit cholinesterase; produce cholinergic

overstimulation

• Manganese (naturally occurring heavy metal)– Manganism – similar to Parkinson’s– Childhood behavioral disinhibition

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Works Cited Chae, Myounghee, and Gyu-Seek Rhee. "ATG5 Expression Induced by MDMA (Ecstasy), Interferes with Neuronal Differentiation of Nueroblastoma Cells." Molecules and Cells 27 (2009): 571-75. Springer. Web. 15 Feb. 2011. <http://moleculesandcells.org>.

Frederick, Aliya L., and Gregg D. Stanwood. "Drugs, Biogenic Amine Targets and the Developing Brain." Developmental Neuroscience 31 (2009): 7-22. Karger. Web. 13 Feb. 2011. <http://www.karger.com/dne>.

Frost, Elizabeth A., Richard S. Gist, and Elizabeth Adriano. "Drugs, Alcohol, Pregnancy, and the Fetal Alcohol Syndrome." Wolters Kluwer Health 49.1 (2011): 119-33. Ovid. Web. 15 Feb. 2011. <http://ovidsp.tx.ovid.com>.

Gray, Teresa R., Rina D. Eiden, Kenneth E. Leonard, Gerard J. Connors, Shannon Shisler, and Marilyn A. Huestis. "Identifying Prenatal Cannabis Exposure and Effects of Concurrent Tobacco Exposure on Neonatal Growth." Clinical Chemistry 56 (2010):

1442-450. PubMed. Web. 15 Feb. 2011. <http://www.clinichem.org/cgi/content/full/56/9/1442>.

Websites: http://www.americanpregnancy.org/pregnancyhealth/illegaldrugs.html

http://www.marchofdimes.com/pregnancy/alcohol_illicitdrug.htmlhttp://www.teach-nology.com/tutorials/teaching/abuse/print.htm

http://www.drugpolicy.org/library/research/cocaine.cfm?printpage=1&printpage=1http://www.mayoclinic.com/health/medical/IM03117

http://www.ncbi.nlm.nih.gov/pubmed/7862372http://www.tgorski.com/Prevention/cocaine_use_during_pregnancy.html

http://www.americanpregnancy.org/pregnancyhealth/illegaldrugs.htmlhttp://www.marchofdimes.com/pregnancy/alcohol_illicitdrug.htmlhttp://www.merckmanuals.com/home/sec22/ch259/ch259a.htm

www.drugpolicy.org/library/research/cocaine.cfm?printpage=1&printpage=1http://www.mayoclinic.com/health/medical/IM03117

http://www.ncbi.nlm.nih.gov/pubmed/7862372