The Detrimental Effects of The Detrimental Effects of Substance Abuse in Substance Abuse in

PregnancyPregnancy

Jeianti AminJeianti Amin

University of Central FloridaUniversity of Central Florida

BackgroundBackground

For the purpose of this presentation, substance abuse is For the purpose of this presentation, substance abuse is defined in terms of using tobacco or cigarettes, alcohol, defined in terms of using tobacco or cigarettes, alcohol, and illicit drugs such as cocaine, marijuana, heroine and and illicit drugs such as cocaine, marijuana, heroine and methamphetamines. methamphetamines.

The use of alcohol, cigarettes, and illicit drugs are The use of alcohol, cigarettes, and illicit drugs are among the leading cause of mortality and morbidity in among the leading cause of mortality and morbidity in the US, and is a growing epidemic in pregnancy. the US, and is a growing epidemic in pregnancy.

Over 16.5% of women reported smoking prenatally, Over 16.5% of women reported smoking prenatally, 11.8% of pregnant women reported current alcohol 11.8% of pregnant women reported current alcohol usage, and over 4% stated using illicit drugs during usage, and over 4% stated using illicit drugs during pregnancy. pregnancy.

(Floyd et al., 2008)(Floyd et al., 2008)

Background Continues…Background Continues…Women who partake in health-compromising Women who partake in health-compromising behaviors such as the use of illicit drugs, alcohol behaviors such as the use of illicit drugs, alcohol consumption, and cigarette smoking during consumption, and cigarette smoking during pregnancy are not only endangering their own lives pregnancy are not only endangering their own lives but their unborn fetus.but their unborn fetus.

Individual’s the consume alcohol, other illicit drugs Individual’s the consume alcohol, other illicit drugs and smoked cigarettes were at an increased risk for and smoked cigarettes were at an increased risk for cancer, cardiovascular and pulmonary events which cancer, cardiovascular and pulmonary events which included hypertension, obesity, gastrointestinal included hypertension, obesity, gastrointestinal ulcers, cardiomyopathy, anemia related to poor ulcers, cardiomyopathy, anemia related to poor health and nutrition, asthma, bronchitis, pneumonia, health and nutrition, asthma, bronchitis, pneumonia, and were likely to contract HIV and other blood and were likely to contract HIV and other blood borne viruses and sexual transmitted diseases.borne viruses and sexual transmitted diseases.

(Rassool &Villar-Luis, 2006) (Rassool &Villar-Luis, 2006)

Background Cont…Background Cont…

Tobacco Exposure on Tobacco Exposure on Fetus/NeonateFetus/Neonate IUGR, SIDS, PROMIUGR, SIDS, PROM PrematurityPrematurity Low birth weight Low birth weight Placenta previaPlacenta previa Placenta abruption Placenta abruption Ectopic pregnancyEctopic pregnancy Oro-facial cleft Oro-facial cleft Asthma, BronchitisAsthma, Bronchitis

(Rassool & Villar-Luis, 2006)(Rassool & Villar-Luis, 2006)

Alcohol Exposure on Alcohol Exposure on Fetus/NeonateFetus/Neonate Neurodevelopment Neurodevelopment

disorder i.e. mental disorder i.e. mental retardation, CNS retardation, CNS disruptiondisruption

FASD, FASFASD, FAS Growth deficienciesGrowth deficiencies Cognitive, emotional, Cognitive, emotional,

and behavioral and behavioral disabilitiesdisabilities

(Handmaker et al, 2006)(Handmaker et al, 2006)

Illicit Drugs Exposure on Illicit Drugs Exposure on Fetus/NeonateFetus/Neonate

Ectopic pregnancy and Ectopic pregnancy and miscarriagesmiscarriages

Perinatal cerebral Perinatal cerebral infarctionsinfarctions

Placenta abruptionPlacenta abruption PROM, IUGR, SIDSPROM, IUGR, SIDS Reduced head Reduced head

circumference and circumference and congenital malformationscongenital malformations

Preterm delivery and Preterm delivery and neurobehavioral neurobehavioral abnormalities abnormalities

(Rassool &Villar-Luis, 2006) (Rassool &Villar-Luis, 2006)

Background Continues…Background Continues…

Problem StatementProblem Statement

Substance abuse such as tobacco use, alcohol Substance abuse such as tobacco use, alcohol consumption, and illicit drug use in pregnant consumption, and illicit drug use in pregnant women creates significant short-term and long-women creates significant short-term and long-term health problems for both the unborn fetus term health problems for both the unborn fetus and neonate. and neonate.

Careful nursing assessments is imperative to not Careful nursing assessments is imperative to not only identify and recognize those pregnant only identify and recognize those pregnant mothers at risk or currently abusing substances mothers at risk or currently abusing substances but also implement various interventions but also implement various interventions necessary to prevent and decrease further necessary to prevent and decrease further complications seen in this population group. complications seen in this population group.

SignificanceSignificance

Substance abuse is a chronic dilemma that creates Substance abuse is a chronic dilemma that creates dangerous health problems due to its addictive effects dangerous health problems due to its addictive effects which can cause dependence throughout an individual’s which can cause dependence throughout an individual’s life span. life span.

Increase in healthcare cost related to hospital care Increase in healthcare cost related to hospital care accrued as a result from delivery, NICU, special care accrued as a result from delivery, NICU, special care nursery, medication/drug treatments, life saving nursery, medication/drug treatments, life saving surgeries or procedures, nursing hours and other surgeries or procedures, nursing hours and other supportive staff including specialists (peri-natologist, supportive staff including specialists (peri-natologist, neonatologist, respiratory therapist, case management neonatologist, respiratory therapist, case management workers, and surgery consults etc) and emotional cost. workers, and surgery consults etc) and emotional cost.

Significance Continues..Significance Continues..

Cost related to low birth weight due to smoking Cost related to low birth weight due to smoking was $263 million annually was $263 million annually Other direct medical cost during pregnancy until Other direct medical cost during pregnancy until delivery was $1.4 billion delivery was $1.4 billion NICU cost increased to $367 million nationally NICU cost increased to $367 million nationally Infants born with FASD increased from 0.5 to 2 Infants born with FASD increased from 0.5 to 2 cases of 1000 live births with a $2 million lifetime cases of 1000 live births with a $2 million lifetime cost of care per each diagnosed case cost of care per each diagnosed case

(Floyd et al., 2008; Petrou, Hockley, Mehta, & Goldacre, 2005)(Floyd et al., 2008; Petrou, Hockley, Mehta, & Goldacre, 2005)

Significance Continues…Significance Continues…

Cigarette smoke causes vasoconstriction in placenta, Cigarette smoke causes vasoconstriction in placenta, reduces uterine blood flow by 38% and causing fetal reduces uterine blood flow by 38% and causing fetal hypoxia, distress, malnutrition due to poor feeding and hypoxia, distress, malnutrition due to poor feeding and sucking patterns (orofacial cleft), and infant neurological sucking patterns (orofacial cleft), and infant neurological excitability.excitability.

Illicit drugs causes neonatal abstinence syndrome (NAS) Illicit drugs causes neonatal abstinence syndrome (NAS) with common signs and symptoms of withdrawals such with common signs and symptoms of withdrawals such as poor feeding due to gastrointestinal dysfunction, sleep as poor feeding due to gastrointestinal dysfunction, sleep disturbances, tremors, CNS hypertonia or excitability, disturbances, tremors, CNS hypertonia or excitability, difficulties in regulating newborn behaviors, autonomic difficulties in regulating newborn behaviors, autonomic signs of yawing, mottling, fever, dehydration, convulsions signs of yawing, mottling, fever, dehydration, convulsions and fetal distress or hypoxia.and fetal distress or hypoxia.

(Law, Stroud, LaGasse, Niaura, Liu, & Lester, 2003) (Law, Stroud, LaGasse, Niaura, Liu, & Lester, 2003)

Specific AimsSpecific Aims

1.1. The theory of self-efficacy will be applied to pregnant The theory of self-efficacy will be applied to pregnant women as a means of preventing and decreasing women as a means of preventing and decreasing substance abuse during their pregnancy, consequently substance abuse during their pregnancy, consequently reducing the numerous detrimental health reducing the numerous detrimental health consequences or complications experienced by the consequences or complications experienced by the fetus or neonate.fetus or neonate.

2.2. Application of theory of self-efficacy will guide nurses Application of theory of self-efficacy will guide nurses in developing and implementing various interventions in developing and implementing various interventions as a means of promoting healthy behaviors and as a means of promoting healthy behaviors and changing negative lifestyle habits, such as refraining changing negative lifestyle habits, such as refraining from the use of tobacco, alcohol and illicit drugs during from the use of tobacco, alcohol and illicit drugs during pregnancy. pregnancy.

Theory of Self-EfficacyTheory of Self-Efficacy

Based on Bandura’s social cognitive theory and the Based on Bandura’s social cognitive theory and the interaction of personal, behavioral and environmental interaction of personal, behavioral and environmental influences on an individual's self-efficacy and expected influences on an individual's self-efficacy and expected outcome.outcome.

Later designed by Barbara Resnick to help understand human Later designed by Barbara Resnick to help understand human behaviors and guide in developing interventions to change behaviors and guide in developing interventions to change behaviors through a variety of health promotional activities.behaviors through a variety of health promotional activities.

Individual’s thoughts are based on four sources of Individual’s thoughts are based on four sources of experiences: direct, vicarious, judgments by others and experiences: direct, vicarious, judgments by others and deviation of knowledge by inference.deviation of knowledge by inference.

(Resnick, 2008)(Resnick, 2008)

Theory of Self-Efficacy Cont…Theory of Self-Efficacy Cont…

Self-efficacy is an individual’s judgment of their capabilities to Self-efficacy is an individual’s judgment of their capabilities to organize and implement a course of action under the assumption organize and implement a course of action under the assumption that they can influence their own actions/decisions.that they can influence their own actions/decisions.

Two major components:Two major components: Self-efficacy expectationsSelf-efficacy expectations (judgment about personal ability to (judgment about personal ability to

accomplish a given task)accomplish a given task)

Outcome expectationsOutcome expectations (judgment about what will happen if a (judgment about what will happen if a given task is successfully met)given task is successfully met)

Self-efficacy judgment is based on four fundamental sources: (1) Self-efficacy judgment is based on four fundamental sources: (1) enactive attainment, which is the actual performance of a behavior; enactive attainment, which is the actual performance of a behavior; (2) vicarious experience or visualizing other similar people perform a (2) vicarious experience or visualizing other similar people perform a behavior; (3) verbal persuasion or exhortation; and (4) physiological behavior; (3) verbal persuasion or exhortation; and (4) physiological state or physiological feedbackstate or physiological feedback

(Resnick, 2008)(Resnick, 2008)

Application of TheoryApplication of Theory

Nurses play a keen role in assessment, obtaining a good Nurses play a keen role in assessment, obtaining a good health history, identifying individuals at risk and providing health history, identifying individuals at risk and providing the necessary support and resources to help these the necessary support and resources to help these individuals refrain from using substances such as individuals refrain from using substances such as tobacco, alcohol and illicit drugs during their pregnancy. tobacco, alcohol and illicit drugs during their pregnancy.

Although there were limited evidence in the literature to Although there were limited evidence in the literature to support this patient population, parallel studies of self-support this patient population, parallel studies of self-efficacy can be applied as a guide for nurses to efficacy can be applied as a guide for nurses to implement several methods that that has been proven to implement several methods that that has been proven to be effective in motivating and changing individual’s be effective in motivating and changing individual’s health-compromising behaviors of substance use. health-compromising behaviors of substance use.

Application of TheoryApplication of Theory

At the core of each intervention geared towards cessation and At the core of each intervention geared towards cessation and reduction of substances used during pregnancy, was an individual’s reduction of substances used during pregnancy, was an individual’s self-efficacy or increase in their confidence level and their ability to self-efficacy or increase in their confidence level and their ability to carry out a given action such as motivating behavior changes for carry out a given action such as motivating behavior changes for abstinence in alcohol usage, tobacco cessation, and illicit drug use.abstinence in alcohol usage, tobacco cessation, and illicit drug use.

Educating, encouraging, decreasing the negative social stigma Educating, encouraging, decreasing the negative social stigma associated with substance use during pregnancy and discussing the associated with substance use during pregnancy and discussing the harmful effects substance use has on the fetus or neonate during harmful effects substance use has on the fetus or neonate during pregnancy are some strategies used during counseling sessions.pregnancy are some strategies used during counseling sessions.

Other interventions to help mothers refrain from substance use and Other interventions to help mothers refrain from substance use and deliver positive outcome for all involved include stress management deliver positive outcome for all involved include stress management techniques (biofeedback, deep breathing, muscle relaxation, regular techniques (biofeedback, deep breathing, muscle relaxation, regular exercises, healthy eating), discussion of medications and referral to exercises, healthy eating), discussion of medications and referral to treatment centers such as Alcohol Anonymous.treatment centers such as Alcohol Anonymous.

(Buchanan, 2002) (Buchanan, 2002)

SummarySummary

The consequences of substance abuse prenatally have a huge The consequences of substance abuse prenatally have a huge impact on the fetus, mothers, caregivers and society as a whole impact on the fetus, mothers, caregivers and society as a whole because of the associated costs both emotionally and financially. because of the associated costs both emotionally and financially.

Nurse’s play a key role in implementing various interventions as a Nurse’s play a key role in implementing various interventions as a means of reducing the different health disparities or adverse means of reducing the different health disparities or adverse outcomes associated with substances during pregnancy.outcomes associated with substances during pregnancy.

By applying the theory of self-efficacy nurses are able to provide By applying the theory of self-efficacy nurses are able to provide interventions such as supportive resources, counseling sessions, interventions such as supportive resources, counseling sessions, stress management techniques, referrals to treatment centers as a stress management techniques, referrals to treatment centers as a way of assisting mothers to refrain from substance abuse and way of assisting mothers to refrain from substance abuse and engage in positive lifestyle and behavior changes, consequently engage in positive lifestyle and behavior changes, consequently having a beneficial outcome for all involved. having a beneficial outcome for all involved.

ReferencesReferencesBuchanan, L. (2002). Evidence based practice. Implementing a smoking cessation Buchanan, L. (2002). Evidence based practice. Implementing a smoking cessation

program for pregnant women based on current clinical practice guidelines. program for pregnant women based on current clinical practice guidelines. Journal of the American Academy of Nurse PractitionersJournal of the American Academy of Nurse Practitioners , , 1414(6), 243-250. (6), 243-250.

Floyd, R., Jack, B., Cefalo, R., Atrash, H., Mahoney, J., Herron, A., et al. (2008). The Floyd, R., Jack, B., Cefalo, R., Atrash, H., Mahoney, J., Herron, A., et al. (2008). The clinical content of preconception care: alcohol, tobacco, and illicit drug clinical content of preconception care: alcohol, tobacco, and illicit drug

exposures. exposures. American Journal of Obstetrics & GynecologyAmerican Journal of Obstetrics & Gynecology, , 199199(6 Suppl 2), (6 Suppl 2), S333-339.S333-339.Handmaker, N.S., Rayburn, W.F., Meng, C., Bell, J.B., Rayburn, B.B., & Rappaport, Handmaker, N.S., Rayburn, W.F., Meng, C., Bell, J.B., Rayburn, B.B., & Rappaport,

V.J. (2006). Impact of alcohol exposure after pregnancy recognition on V.J. (2006). Impact of alcohol exposure after pregnancy recognition on ultrasonographic feta growth measures. ultrasonographic feta growth measures. Alcoholism: Clinical and Experimental Alcoholism: Clinical and Experimental ResearchResearch, 30(5), 892-898., 30(5), 892-898.Law, K., Stroud, L., LaGasse, L., Niaura, R., Liu, J., & Lester, B. (2003). Smoking Law, K., Stroud, L., LaGasse, L., Niaura, R., Liu, J., & Lester, B. (2003). Smoking

during pregnancy and newborn neurobehavior. during pregnancy and newborn neurobehavior. PediatricsPediatrics, , 111111(6), (6), 1318-1323. 1318-1323.

Petrou, S., Hockley, C., Mehta, Z., & Goldacre, M. (2005). The association between Petrou, S., Hockley, C., Mehta, Z., & Goldacre, M. (2005). The association between smoking during pregnancy and hospital inpatient costs in childhood. smoking during pregnancy and hospital inpatient costs in childhood. Social Social Science & MedicineScience & Medicine, , 6060(5), 1071-1085. (5), 1071-1085.

Rassool, G., & Villar-Luís, M. (2006). Reproductive risks of alcohol and illicit drugs:Rassool, G., & Villar-Luís, M. (2006). Reproductive risks of alcohol and illicit drugs:an overview. an overview. Journal of Addictions NursingJournal of Addictions Nursing, , 1717(4), 211-213.(4), 211-213.

Resnick, B. (2008). Theory of self-efficacy. In M. J. Smith, & P. R. Liehr (Eds.), Resnick, B. (2008). Theory of self-efficacy. In M. J. Smith, & P. R. Liehr (Eds.), Middle range theory for nursing (2nd ed. p. 183-204). New York: Springer Middle range theory for nursing (2nd ed. p. 183-204). New York: Springer

Publishing Publishing Company, Inc.Company, Inc.