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IMPACT OF SUBSTANCE ABUSE ON THE MOTHER AND FETUS Siva Thiagarajah, M.D. Gary D. Helmbrecht, M.D. Prenatal Diagnosis Center Charlottesville, VA.

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Presentation on theme: "IMPACT OF SUBSTANCE ABUSE ON THE MOTHER AND FETUS Siva Thiagarajah, M.D. Gary D. Helmbrecht, M.D. Prenatal Diagnosis Center Charlottesville, VA."— Presentation transcript:

1 IMPACT OF SUBSTANCE ABUSE ON THE MOTHER AND FETUS Siva Thiagarajah, M.D. Gary D. Helmbrecht, M.D. Prenatal Diagnosis Center Charlottesville, VA

2 DRUG ADDICTION IS A COMPLEX ILLNESS

3 Gary D. Helmbrecht, M.D. The drug dominates control of the reward center. Continued use of the drug makes the body rely on the presence of the drug to maintain rewarding feelings and other normal behaviors. The person is no longer able to feel the benefits of natural rewards (food, water, sex) can't function normally without the drug present. This brain has been hijacked!

4 How Does Drug Abuse Affect Pregnancy? Cocaine and other stimulants – Maternal catecholamine release – Direct effect on vascular smooth muscle Maternal hypertensive crisis Placental hypoxia Opiates – Withdrawal leads to maternal catecholamine release – Trauma Alcohol – FASD – IUGR

5 Gary D. Helmbrecht, M.D. Common Medical Problems Among Opiate Addicted Gravidas AnemiaSTD’s Bacteremia/Septicemia Chlamydia Chlamydia Endocarditis Condyloma acuminata Condyloma acuminata Cellulitis Gonorrhea Gonorrhea Depression/Mental disorders Herpes Herpes Edema HIV/AIDS HIV/AIDS Gestational Diabetes Syphilis Syphilis Hepatitis (acute and chronic) Tetanus Hypertension/TachycardiaTuberculosis Phlebitis Urinary tract infections Pneumonia Cystitis Cystitis Poor dental hygeine Pyelonephritis Pyelonephritis

6 Gary D. Helmbrecht, M.D. Obstetric Complications in the Opiate Addicted Gravida Abruptio placentae Premature rupture of membranes Post partum hemorrhage Premature labor and delivery Placental insufficiency Chorioamnionitis Intrauterine growth restriction Septic thrombophlebitis Meconium passage Spontaneous abortion Low Apgar scores Preeclampsia Intrauterine fetal demise

7 Gary D. Helmbrecht, M.D. Obstetric Complications in the Opiate Addicted Gravida Placental insufficiency IUGR/IUFD Abruption Preterm labor Hypoxia Infectious complications Spontaneous abortion Preterm rupture of membranes Preterm labor and delivery Chorioamnionitis Post partum hemorrhage Inflammatory Cytokines Repeated withdrawal Concurrent Stimulant abuse Hypertensive crisis

8 Gary D. Helmbrecht, M.D. Placental Abruption and Infarction

9 Gary D. Helmbrecht, M.D. Intrauterine Growth Restriction Umbilical ArteryMiddle Cerebral Artery

10 PRINCIPLES OF EFFECTIVE TREATMENT Non judgmental approach to the patient. Open communication between providers. Effective case management. Positive reinforcement with the patient. Appropriate antepartum testing and timing of delivery.

11 PRINCIPLES OF EFFECTIVE TREATMENT Medication assisted treatment options – Opiate addictions Methadone Buprenorphine (Subutex) – Cocaine Topamax Baclofen

12 PRINCIPLES OF EFFECTIVE TREATMENT – Alcohol Detoxification – Benzodiazepines (Librium, Klonopin) – Carbemazepam (Tegretol) Maintenance – Disulfiram (Antibuse) – Topiramate (Topamax) – Naltrexone (Vivitrol)

13 PRINCIPLES OF EFFECTIVE TREATMENT 1.Appropriate antepartum testing – Non Stress Test – Biophysical Profile – Doppler Umbilical artery Middle cerebral artery 2.Timing of delivery

14 Gary D. Helmbrecht, M.D. PERINATAL ADDICTION If you learn nothing else today, remember this: Addiction is a genetic disease. Like diabetes, the addict did not choose to become addicted. Good people can do some very bad things while in the active phase of their disease. The disease drives the behavior; the behavior does NOT drive the disease. No matter what, these patients deserve our compassion and respect.

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19 Positron Emission Tomography (PET)

20 control on cocaine

21 Gary D. Helmbrecht, M.D. Dopamine receptor Release signal

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