What risks are associated w/ intranasal and IV drug use?
- HBV
- HCV
- HIV
- DVT
- thrombophlebitis
- endocarditis
What factors of substance use affect the fetus?
1) type of substance
2) timing of use during embyrogenesis and fetal development
3) duration and amount of substance
caffeine
- no evidence of teratogenicity
- may decrease Fe absorption –> anemia
What are risks associated w/ alcohol in early pregnancy?
- miscarriage
- embryopathy
- visible physical defects
What are risks associated w/ alcohol in later pregnancy?
- developmental disabilities
- cognitive disabilities
- behavioral disabilities
What demographic has the highest rate of late trimester alcohol consumption?
white, college-educated women >35yo
Describe fetal alcohol syndrome
most severe of fetal alcohol spectrum disorders
- growth deficiency
- CNS dysfunction w/ developmental disability/brain damage
- characteristic facial dysmorphology
List 3 fetal alcohol spectrum disorders
1) fetal alcohol syndrome
2) partial fetal alcohol syndrome
3) alcohol-related birth defects
What are pregnancy risks associated w/ nicotine use?
- reduced fertility
- increased risk ectopic
- SAB
- reduced infant response to hypoxic events
What effect does nicotine have on placenta?
vasoconstriction –> compromised function
What demographic of people are more likely to smoke during pregnancy?
- <25yo
- unmarried
- Caucasian
- <12 years education
- low-income
- underweight
- unintended pregnancy
What neonatal risks are associated w/ nicotine use?
- cleft lip/palate
- musculoskeletal effects
- GI defects
- asthma
- atopic diseases
- otitis media
- SIDS
- neuro developmental delay
- reduced head circumference
- altered brain stem development
- altered lung structure
- cerebral palsy
What risks are associated w/ marijuana use?
- congenital defects
- neurobehavioral changes
- +/- childhood leukemia
- IUGR, small head circumference
What are risks associated w/ opiate use?
- IUGR
- placental insufficiency
- preeclampsia
- PROM
- PTB
- perinatal mortality
What effect does opiate use have on the neonate?
neonatal abstinence syndrome –> prolonged hospitalization
What are effects of acute opioid withdrawal?
- tachycardia
- HTN
- GI distress
- increased risk fetal mortality
medication-assisted tx recommended
Describe management w/ methadone
- full agonist w/ long 1/2 life
- dispensed in federally licensed tx centers
- pregnant people often require higher doses that should be split into 2
Describe management w/ buprenorphine
- partial agonist
- not FDA approved for tx of opioid dependence in pregnancy
- can be accessed in office visit
- often require higher doses in pregnancy
List 3 validated screening instruments
1) T-ACE
2) TWEAK
3) AUDIT C
T-ACE
Tolerance
Annoyed
Cut down
Eye opener
score 2+ = positive screen
TWEAK
Tolerance Worry from family in past year Eye opener Amnesia K(C)ut down
AUDIT-C
1) How often to you have a drink containing alcohol?
2) How many drinks containing alcohol do you have on a typical day?
3) How often do you have 6+ drinks in one occasion?
3+ = positive
What are the 5 As of smoking cessation?
1) Ask about smoking
2) Advise to stop
3) Assess willingness to quit
4) Assist by providing resources
5) Arrange f/u
What are the 5 Rs of smoking cessation?
1) Relevance
2) Risks
3) Rewards
4) Roadblocks
5) Repetition
