Post on 24-Feb-2016
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IMPACT OF SUBSTANCE ABUSE ON THE MOTHER AND FETUS
Siva Thiagarajah, M.D.Gary D. Helmbrecht, M.D.Prenatal Diagnosis Center
Charlottesville, VA
DRUG ADDICTION IS A COMPLEX ILLNESS
www.drugabuse.gov
Gary D. Helmbrecht, M.D.www.Prenataldiagnosiscenter.com
The drug dominates control of the reward center.
Continued use of the drug makes the body rely on the presence of the drug to maintain rewarding feelings and other normal behaviors. The person is no longer able to • feel the benefits of natural rewards (food, water, sex) • can't function normally without the drug present.
This brain has been hijacked!
How Does Drug Abuse Affect Pregnancy?
• Cocaine and other stimulants– Maternal catecholamine release– Direct effect on vascular smooth muscle
• Maternal hypertensive crisis• Placental hypoxia
• Opiates– Withdrawal leads to maternal catecholamine release– Trauma
• Alcohol– FASD– IUGR
Gary D. Helmbrecht, M.D.www.Prenataldiagnosiscenter.com
Common Medical Problems Among Opiate Addicted Gravidas
Anemia STD’sBacteremia/Septicemia ChlamydiaEndocarditis Condyloma acuminataCellulitis GonorrheaDepression/Mental disorders HerpesEdema HIV/AIDSGestational Diabetes SyphilisHepatitis (acute and chronic) TetanusHypertension/Tachycardia TuberculosisPhlebitis Urinary tract infectionsPneumonia CystitisPoor dental hygeine Pyelonephritis
Gary D. Helmbrecht, M.D.www.Prenataldiagnosiscenter.com
Obstetric Complications in the Opiate Addicted Gravida
Abruptio placentae Premature rupture of membranes
Post partum hemorrhage Premature labor and delivery
Placental insufficiency Chorioamnionitis
Intrauterine growth restriction Septic thrombophlebitis
Meconium passage Spontaneous abortion
Low Apgar scores Preeclampsia
Intrauterine fetal demise
Gary D. Helmbrecht, M.D.www.Prenataldiagnosiscenter.com
Obstetric Complications in the Opiate Addicted Gravida
Placental insufficiencyIUGR/IUFDAbruption
Preterm labor
Hypoxia
Infectious complications
Spontaneous abortionPreterm rupture of membranesPreterm labor and deliveryChorioamnionitisPost partum hemorrhage
Inflammatory
Cytokines
Repeated withdrawalConcurrent Stimulant abuseHypertensive crisis
Gary D. Helmbrecht, M.D.www.Prenataldiagnosiscenter.com
Placental Abruption and Infarction
Gary D. Helmbrecht, M.D.www.Prenataldiagnosiscenter.com
Intrauterine Growth Restriction
Umbilical Artery Middle Cerebral Artery
PRINCIPLES OF EFFECTIVE TREATMENT
• Non judgmental approach to the patient.• Open communication between providers.• Effective case management.• Positive reinforcement with the patient.• Appropriate antepartum testing and timing of
delivery.
PRINCIPLES OF EFFECTIVE TREATMENT
• Medication assisted treatment options– Opiate addictions
• Methadone• Buprenorphine (Subutex)
– Cocaine• Topamax• Baclofen
PRINCIPLES OF EFFECTIVE TREATMENT
– Alcohol• Detoxification
– Benzodiazepines (Librium, Klonopin)– Carbemazepam (Tegretol)
• Maintenance – Disulfiram (Antibuse)– Topiramate (Topamax)– Naltrexone (Vivitrol)
PRINCIPLES OF EFFECTIVE TREATMENT
1. Appropriate antepartum testing– Non Stress Test– Biophysical Profile– Doppler
• Umbilical artery• Middle cerebral artery
2. Timing of delivery
Gary D. Helmbrecht, M.D.www.Prenataldiagnosiscenter.com
PERINATAL ADDICTIONIf you learn nothing else today, remember this:
Addiction is a genetic disease. Like diabetes, the addict did not choose to become addicted.Good people can do some very bad things while in the active phase of their disease.
The disease drives the behavior; the behavior does NOT drive the disease.
No matter what, these patients deserve our compassion and respect.
Gary D. Helmbrecht, M.D.www.Prenataldiagnosiscenter.com
www.drugabuse.gov
www.drugabuse.gov
www.drugabuse.gov
Positron Emission Tomography(PET)
www.drugabuse.gov
control on cocaine
www.drugabuse.gov
Gary D. Helmbrecht, M.D.www.Prenataldiagnosiscenter.com
Dopamine
Dopamine receptor
Release signal
Gary D. Helmbrecht, M.D.www.Prenataldiagnosiscenter.com
www.drugabuse.gov
www.drugabuse.gov
www.drugabuse.gov