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Pregnancy and Drug Abuse
Eva Janecek-Rucker
Learning Objectives
1. To develop a knowledge base of the effects of substances of abuse (e.g., alcohol, cocaine, nicotine et al.) during pregnancy.
2. To examine the pharmacist’s role and develop a comfort level with respect to prevention, counselling and referral of women planning pregnancy as well as those who are pregnant and using psychoactive substances.
Drugs in Pregnancy
• CNS depressants– alcohol– benzodiazepines– barbiturates– inhalants
(toluene; often combined with alcohol)
• CNS stimulants
–cocaine
–caffeine
–nicotine
Drugs in Pregnancy
•Hallucinogens– cannabis– LSD
•Opioids– codeine, morphine– heroin
Interpretation of Results
• Animal studies• Prenatal drug exposure
(dose, timing, duration)
• Withdrawal• Breastfeeding
Issues with Illicit Drug Use During Pregnancy
• Drug– authenticity– dose– additives
• Pharmacological effects• Multiple drug use• Injection drug use• Effect of father’s drug use
Issues (cont’d)
• Lack of prenatal care• Poor diet• Smoking• Drinking• Violence
AlcoholFetal Alcohol Spectrum Disorder
(FASD)• High risk: woman drinking 6 standard
drinks/day during the first trimester• Signs of FAS:
– prenatal and postnatal growth retardation– CNS dysfunction (often including mental
retardation)
• Facial dysmorphology• Other congenital abnormalities• Fetal alcohol effects (FAE)
Alcohol (cont’d)
• No safe level established– a Canadian committee
recommended abstinence ‘or at least to limit consumption to less than 4 drinks per week’
Alcohol (cont’d)
• Treatment of a pregnant alcoholic– diazepam loading for alcohol
withdrawal
• Disulfiram -contraindicated in pregnancy• Naltrexone ?
Solvents
• Effects similar to FAS:– CNS dysfunction– Attentional deficits– Growth deficiency– Development delay– Facial dysmorphology
Benzodiazepines
• Likely not teratogenic; cleft lip/palate???
• Neonatal withdrawal symptoms
Barbiturates and other hypno-sedatives
• No evidence of teratogenicity• Neonatal withdrawal syndrome
• Treatment: phenobarbital
Cocaine
• Spontaneous abortion• Prematurity• Intrauterine growth retardation• Abruptio placentae• Perinatal cerebral infarction• Structural CNS abnormalities• Urogenital abnormalities• Concomitant use of other drugs (alcohol
and benzodiazepines)
Nicotine
• Spontaneous abortion• Low birth weight• Perinatal mortality• Prematurity• Abruptio placentae• Congenital malformations (most
studies show lack of)• Sudden infant death syndrome (SIDS)
Caffeine
• Low dose - no effect• High dose:
– in animals - adverse effects– in humans - ?
Heroin
• Fetal distress or death during withdrawal in utero
• Decreased birth weight• Higher incidence of
Infectionsmedical complicationsobstetrical complications
• Neonatal withdrawal• SIDS
Heroin (cont’d)
Treatment of pregnant woman
• methadone
Cannabis
• Decreased birth weight• Prematurity• Effect of tar• No congenital abnormalities
LSD
• Limb defects• CNS abnormalities• Ocular abnormalities
Pharmacist’s Role
• Identification• Information• Referral
Resources• Alcohol and Drug Assessment and Treatment
Services• Motherisk: www.motherisk.org (416) 813-
6780• www.pregnets.org• Information sources
–Textbooks Drugs in Pregnancy and Lactation 6th Edition, GG Briggs, RK Freeman, SJ Yaffe (eds), 2001Maternal-Fetal Toxicology: A Clinician’s Guide 2nd Edition, G Koren (ed), 1994–Journals