Substance Abuse During Pregnancy: Essay

Substance abuse during pregnancy is when an expecting mother takes in harmful chemicals such as prescribed drugs or street drugs. It’s a relatively poorly researched topic due to underreporting of this condition. This paper will describe possible signs and symptoms as well as treatments used to treat this condition. It is also vitally important for the nurse to understand her role and what they can do to help with this condition for positive outcomes.

Substance Abuse during Pregnancy

Substance abuse during pregnancy can be described as when the expecting woman takes in harmful chemicals into the body, which can cause harm to the developing fetus. The most common misused chemicals are usually easily accessible street drugs such as cocaine, amphetamines, barbiturates, hallucinogens, heroin, and other narcotics. These chemicals can then affect the fetus by crossing the placenta and interrupting the growth and development of the fetus. Over the years we have learned how easily things can cross the placenta. Therefore the FDA came up with pregnancy risk categories on prescribed and over-the-counter medication given to patients for conditions such as high blood pressure, diabetes, or acute pain, to help categorize the safety of taking such medications while pregnant. Infants born from mothers who abused these substances during pregnancy have shown to have deformities, developmental delays, low birth weight, or can be stillbirth. In most cases, these expecting mothers suffer from complications such as preterm labor, placental previa, or placenta abruption.

It is difficult to determine the occurrence of substance abuse during pregnancy due to the underreporting of this condition. Underreporting causes a barrier to obtaining adequate statistical research. We mostly become aware of substance abuse until the infant is born, because many of these infants will suffer from Neonatal Abstinence Syndrome in which the infant suffers withdrawals from opioids or other harmful substances. According to research published in 2015, “of the 1,502 infants who were born at the study site, 137 (9.1 %) were identified by the health records department as matching the inclusion criteria of having been scored for NAS and had documented maternal substance use….More than 85 % of the infants in the study had Apgar scores of eight or higher at both one and 5 min after birth. A total of 103 (78.6 %) infants were admitted to the Neonatal Intensive Care Unit (NICU) and 95 (72.5 %) received pharmacologic treatment for NAS.” (Desaulniers, 2015) As of today, there is no national law punishing substance abuse during pregnancy, but there are several states with rules and regulations that will consider this child abuse and have the infant taken from the mother or open up a case to further investigate the situation.

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There are many factors that may contribute to a person's problems with substance abuse. It was noted to be “a complex, multifactorial process that involves a combination of biological, genetic, psychologic, and sociocultural factors. These factors and others may affect the process of recovery. For example, the craving that an individual has for a particular substance may be heightened by a phenomenon known as the kindling effect. Kindling refers to long-term changes in brain neurotransmission that occur after repeated detoxifications” (Laura S. Horowitz, 2019). This increases a sensitive response resulting in the obsessive craving of a substance that the individual feels. It means that every woman is affected differently, as they are all unique with different genetics inherited by each parent. On top of having genetic predispositions to substance abuse, there are also risk factors that can make the substance abuse worse such as having a family history of addiction. This is a part of the genetic pathophysiology that predisposes an individual to this condition. The presence of a mental disorder can further contribute to substance abuse, as well as using drugs as a form of a coping mechanism to manage anxiety or depression.

As stated before there is minimal research regarding substance abuse in pregnancy. Signs and symptoms of this condition would be part of recognizing the effects of each drug as well as prenatal screening done for pregnant women who are suspected of the use of drugs. If a woman is suspected of using drugs while pregnant, they most often refer them to addiction services. It would be up to the nurse to identify abnormal vital signs or behavior in the obstetric patient and report it to her provider. It is most important to understand what effects these substances can have on the pregnant woman, such as psychostimulants causing euphoria. Opiates are narcotic analgesics that can cause hyperalgesia, hypogonadism, and sexual dysfunction. Depressants such as benzodiazepines and barbiturates can cause respiratory depression in the patient and they can also appear with some mild to moderate sedation. After the infant is born they can be monitored for signs and symptoms of withdrawal which include high pitched cry, abnormal sucking reflex, fever, irritability, hyperactive reflexes, poor feeding, seizures, and increased muscle tone. Expecting mothers can be tested with either a urine drug screen or a blood drug screen. “The length of time that drugs can be found in blood and urine varies from 24 hours to 30 days according to dosage and metabolic properties of the drug. THC, the psychoactive substance found in marijuana, is stored in fatty tissues (especially the brain and reproductive system) and can be detected in the body for up to 6 weeks.” (Laura S. Horowitz, 2019). A urine drug screen is a noninvasive preferred way to test these patients, and it can detect several substances such as opioids, benzodiazepines, marijuana, and amphetamines to name a few.

Treatment for this condition depends on severity and substance. If the patient is experiencing an overdose then the adequate antidote for the substance of excess must be given. Some medications like methadone and buprenorphine can improve outcomes for expecting mothers struggling with drug abuse. “Methadone management throughout pregnancy has improved obstetric attention, reduced illegal drug consumption, and promoted fetal outcomes. However, methadone usage has remained correlated with the amplified occurrence of NAS.” (Kamaledin Alaedini, 2017) Other nonpharmacological treatments can include referring the pregnant woman to specific programs and making sure she is receiving adequate prenatal care. Most often these women need support for handling their daily stresses of home care, work, child care, and other responsibilities.

The nurse’s role is very crucial for positive patient outcomes. They can provide resources available to the patient as well as determine who is at risk for this condition. Nurses are often the first to see and screen the patient before the doctor does, so obtaining medical history and current medications the patient is taking can help the doctor determine as well if they need medication adjustments, as not all harmful substances are street drugs, rather prescribed medication the patient needs for certain conditions they may have such as hypertension, epilepsy, or chronic pain. Education is also an important role for the nurse to take on this situation. Educating the patient on the side effects it can have on the fetus, as well as on herself. Substance abuse in pregnancy has negative effects on the fetus as well as the mother, which can cause death to both. It is also important to talk to the patient in a nonjudgmental manner due to the fact that many women may be afraid to seek help during or after pregnancy due to fear of legal action or social fear of being judged.

References

1. Desaulniers, K. A.-O. (2015). Maternal Substance Use and Neonatal Abstinence Syndrome: 11.
2. Kamaledin Alaedini, K. H. (2017). A Review of Neurobehavioral Challenges in Children Exposed. 7.
3. Laura S. Horowitz, A. R. (2019). Nursing: a concept-based approach to learning. Hoboken, New Jersey: Pearson Education, Inc.