SUBSTANCE ABUSE
DURING PREGNANCY
Kristina Gatmaitan
Anna Lutz
Marvie Ramos
Reuben Ramos
Rosheena Robles
Substance Abuse
Pregnancy...
• “The fetus grows & develops d/t
the nourishment from the
mother via the placenta.
• Toxins in the mother's system
may be delivered to the fetus.
• Can cause damage to the
fragile, developing fetal organs.
• Long-term effects = mental
problems such as retardation
and seizures.”
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Drugs and the Stages of Pregnancy
• The stage of organ formation
– First ten weeks: Most of the body organs and systems of the
baby-to-be are formed. During this stage, some drugs—and
alcohol in particular—can cause malformations of such parts
of the developing fetus as the heart, the limbs, and the facial
features
•The stage of prenatal growth
–After about the tenth week,
•Eyes
•Nervous system
• risk of miscarriage & premature delivery
•IUGR
•Low birthweight
•Death
Baby Jonah
Jonah’s mother was a heroin
addict. Shortly after birth, it
was obvious Jonah was in
withdrawal. His jittery
movements and crying
persisted for the next 2 days
and there was little anyone
could do to console him. He
scratched his face trying to
get his hands to his mouth.
His knees and elbows were
rubbed raw from his agitated
movements, and the
muscles in his tiny legs were
so stiff that it was difficult to
straighten his legs to diaper
him.
• The full extent of the effects of
prenatal drug exposure on a child is
not known, however studies show
that various drugs of abuse may
result in premature birth,
miscarriage, low birth weight,
and a variety of behavioral and
cognitive problems.
Drugs that may have adverse
prenatal effects:
•
•
•
•
Cocaine
Tobacco
Heroin
Inhalants
• Marijuana
• MDMA (Ecstasy)
• Methamphetamin
e
• Nicotine
Two most common drugs:
&
•
The active Ingredients in Cigarette smoke are
nicotine, tar, and harmful gases, such as carbon
monoxide and cyanide.
•
Indirect effects of cigarette smoking include
decreased maternal appetite.
•
Can cause neonatal prematurity and low birth
weights.
• The degree of restriction of fetal growth
varies with the number of cigarettes
smoked daily (2009, McKinney).
• The active constituent of marijuana is tetrahydrocannabinol
(THC), which crosses the placenta and accumulates in the fetus.
• Marijuana is the most commonly used illicit drug (2009,
McKinney).
Factors that affect maternal
smoking
Maternal age
VS
Education Level
VS
Marital Status
VS
Poverty Status
VS
Health Insurance coverage
before conception
VS
Statistics
• Studies from the US Department of Health and
Human Services, Substance Abuse and Mental
Health Services Administration report that 3.3%
of America women use illicit drugs during
gestation and 80% of whom use marijuana.
• The National Household Survey on Drug abuse
state 2.8% of pregnant women use illicit drugs.
Marijuana is used by 75% during gestation and
more than 50% also use tobacco.
Statistics cont.
• A study in Seattle was done on 396
females. Of them 77% reported
smoking cigarettes and 50% said they
smoked marijuana during pregnancy
• In the UK 15-20% of women continue to
smoke throughout their pregnancy.
Statistics cont.
•A study done in the U.S. from 2002-2006 on
94,483 women found that cigarette use was
reported by nearly a quarter of pregnant
women in their first trimester and that 1 in 7
reported cigarette smoking in the second or
third trimester.
•According to the CDC approximately 13% of
women smoke during the last 3 months of
pregnancy
Maternal Effects of tobacco
Decreases Nutrition
Tobacco
Inability to absorb oxygen
Maternal Effects of Marijuana
Lack of coordination
Marijuana
Increased Heart Rate/decreased
BP
Marijuana
Decreased oxygen
Effects of Tobacco and
Marijuana on the Child
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Tobacco - Effects
•Prematurity
•Low birth weight
•Sudden infant death syndrome (SIDS)
•Stillbirth
•Neurodevelopmental problems
•Neurobehavioral problems
•Increased risk for some types of cancers
•Childhood obesity
Article: Tobacco and Pregnancy: Overview of Exposures
and Effects
Maternal-Child Nursing
Marijuana - Effects
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•  risk of low birth
weight & IUGR
•  risk of miscarriage,
premature labor &
ectopic pregnancy
• Affects memory
• Developmental delays
• Jitteriness
• Withdrawal-like
symptoms
• Behavioral problems
Research Study: EXPOSURE TO MARIJUANA DURING PREGNANCY ALTERS NEUROBEHAVIOR IN THE EARLY
NEONATAL PERIOD - Carvalho de Moraes Barros et al
Research Study: Prenatal Marijuana Exposure and Intelligence Test Performance at Age 6
RN INTERVENTIONS
RN INTERVENTIONS
•
•
•
•
4 A’S
Educate mother
Be supportive
Increase self-esteem
4 A’s
• According to a research article
“Smoking Cessation in Pregnant
Women Utilizing Evidence-Based
Interventions” the rate of smoking
cessation increased 30-70% when
interventions (ie.4 A’s) were
implemented compared to no
interventions
Research Study:
Albrecht, S., PhD, RN, FAAN. “Smoking cessation in pregnant women utilizing evidence-based” Strategies in women’s
health care. 2007
4 A’s
• AVOID high
temptation situations
-- these are
situations where you
know you will be
tempted to smoke,
or situations where
you regularly
smoked.
• ALTER those situations you can't avoid
-- make a plan to change your behavior
or some aspect of the situation so that
you'll be less likely to smoke.
• ALTERNATIVES -- find other things to
do besides smoking. Think ahead:
What activities can you do that will
distract you from wanting that cigarette?
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• ACTIVE - Get active to help you cope with
urges to smoke. That's right! Get moving! Go
for a short walk to clear your head and
remind yourself why you want to stay smokefree.
http://www.psychiatry.emory.edu/PROGRAMS/GADrug/Factsheets/smoking%20cessation%202.pdf
EDUCATE
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Would you let your child do this?
• Ask what they know
• You as RN need to
educate the mother
about the dangers &
side effects of their
actions.
• The more informed pts
are = the better
educated = the more
they will change their
behavior
• Assess readiness to
learn
RN SUPPORT
•
•
•
•
Do not threaten or frighten pt
Give positive feedback
State facts not opinions
Refer to support groups
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Self-esteem
•  self-esteem = successful outcomes
(smoking cessation)
• “Low self-esteem is a frequent
characteristic in women who abuse
drugs”
Bowie. B. H., RN, PhC, MBA “Interventions to Improve Interactions between Drug Abusing
Mothers and Their Drug-Exposed Infants: A Review of the Research Literature” Journal of
Addictions Nursing,161, 2005
Consequences
Conclusion
When you are pregnant, you
are not just "eating for two."
You also breathe and drink for
two, so it is important to
carefully consider what you
give to your baby. If you smoke,
use alcohol or take illegal
drugs, so does your unborn
baby
Watch this video!!!
http://www.youtube.com/watch?v=A2JUuQ
OlEzs
• First, don't smoke.
– Smoking during pregnancy
passes nicotine and cancercausing drugs to your baby.
Smoke also keeps your baby
from getting nourishment and
raises the risk of stillbirth or
premature birth.
•Don't use illegal
drugs.
– Using illegal
drugs may cause
underweight
babies, birth
defects or
withdrawal
symptoms after
birth
ATI:
1) What week is the unborn baby most risk for
malformation?
a) first 10 weeks
b) 25 Wks
c) 30 Wks
d) 40 Wks
1) The active ingredients in Cigarette smoke are?
a. Nicotine
b. Tar
c. THC
d. A and B
3) All of the following systems are significantly impacted in
marijuana smokers except
a. cardiovascular
b. neurological
c. genitourinary
d. Respiratory
4) Children born to women who use tobacco during
pregnancy are likely to be:
a. premature
b. have low birth weight
c. at increased risk for SIDS
d. all of the above
5) The 4 A's include all except:
a) Avoid
b) Accept
c) Alter
d) Alternative
e) Active
If you are pregnant and you
smoke, drink alcohol or do drugs,
get help. Your health care
provider can recommend
programs to help you quit. You
and your baby will be better off.
Numbers that can help you locate a
treatment center include:
•National Drug Help Hotline
1-800-662-4357
•National Alcohol & Drug Dependence
Hopeline
1-800-622-2255