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

Alcohol

Fetal 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 per week ’ ‘ or at least to limit consumption to less than 4 drinks

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  Infections  medical complications  obstetrical 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 6 (eds), 2001 th Edition, GG Briggs, RK Freeman, SJ Yaffe  Maternal-Fetal Toxicology: A Clinician’s Guide 2 nd Edition, G Koren (ed), 1994 –Journals