IMPACT OF SUBSTANCE ABUSE ON THE MOTHER AND FETUS

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


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


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


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


Placental Abruption and Infarction


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.


• Medication assisted treatment options– Opiate addictions

• Methadone• Buprenorphine (Subutex)

– Cocaine• Topamax• Baclofen


– Alcohol• Detoxification

– Benzodiazepines (Librium, Klonopin)– Carbemazepam (Tegretol)

• Maintenance – Disulfiram (Antibuse)– Topiramate (Topamax)– Naltrexone (Vivitrol)


1. Appropriate antepartum testing– Non Stress Test– Biophysical Profile– Doppler

• Umbilical artery• Middle cerebral artery

2. Timing of delivery


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.

www.drugabuse.gov

Positron Emission Tomography(PET)

www.drugabuse.gov

control on cocaine

www.drugabuse.gov


Dopamine

Dopamine receptor

Release signal

www.drugabuse.gov

IMPACT OF SUBSTANCE ABUSE ON THE MOTHER AND FETUS

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