2. SUBSTANCE ABUSE DURING PREGNANCY Kristina Gatmaitan Anna Lutz Marvie Ramos Reuben Ramos Rosheena Robles

3. 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.” http://images.google.com/imgres?imgurl=http://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/21728.jpg&imgrefurl=http://www.nlm.nih.gov/medlineplus/ency/imagepages/1 9847.htm&usg=__YzKC9B1g74Fy3ZyJbVc8SPNHh3s=&h=320&w=400&sz=29&hl=en&start=1&um=1&itbs=1&tbnid=4tIHMaix__OzoM:&tbnh=99&tbnw=124&prev=/images%3Fq%3 Dsubstance%2Babuse%2Bduring%2Bpregnancy%26um%3D1%26hl%3Den%26client%3Dsafari%26sa%3DN%26rls%3Den%26tbs%3Disch:1

4. 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

5. 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.

6. 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.

7. Drugs that may have adverse prenatal effects: Cocaine Tobacco Heroin Inhalants Marijuana MDMA (Ecstasy) Methamphetamin e Nicotine

8. Two most common drugs: &

10. 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).

11. 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).

12. Factors that affect maternal smoking

13. Maternal age VS

14. Education Level VS

15. Marital Status VS

16. Poverty Status VS

17. Health Insurance coverage before conception VS

18. 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.

19. 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.

20. 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

21. Maternal Effects of tobacco Decreases Nutrition

22. Tobacco Inability to absorb oxygen

23. Maternal Effects of Marijuana Lack of coordination

24. Marijuana Increased Heart Rate/decreased BP

25. Marijuana Decreased oxygen

26. Effects of Tobacco and Marijuana on the Child

27. Prematurity Low birth weight Sudden infant death syndrome (SIDS) Stillbirth Neurodevelopmental problems Neurobehavioral problems Increased risk for some types of cancers Childhood obesity Tobacco - Effects Article: Tobacco and Pregnancy: Overview of Exposures and Effects Maternal-Child Nursing

28. Marijuana - Effects 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  risk of low birth weight & IUGR  risk of miscarriage, premature labor & ectopic pregnancy Affects memory Developmental delays Jitteriness Withdrawal-like symptoms Behavioral problems

29. RN INTERVENTIONS

30. 4 A’S Educate mother & be accurate Be supportive, listen to pt concerns Increase self-esteem Be both Pts advocate

31. 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

32. 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.

33. 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.

34. ALTERNATIVES -- find other things to do besides smoking. Think ahead: What activities can you do that will distract you from wanting that cigarette?

35. 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 smoke- free. http://www.psychiatry.emory.edu/PROGRAMS/GADrug/Factsheets/smoking%20cessation%202.pdf

36. EDUCATE 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 Would you let your child do this?

37. RN SUPPORT Do not threaten or frighten pt Give positive feedback State facts not opinions Refer to support groups LISTEN to pt

38. 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

39. PT Advocate Be both pt’s advocate –You have a right to speak up for the fetus inside According to a research article by Mullen, “A woman is more likely to quit smoking during pregnancy than at any other time in her life” “Mullen PD. Maternal smoking during pregnancy and evidence-based intervention to promote cessation. Prim Care1999;26(3):577-589”

40. Consequences

41. 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

42. Watch this video!!! http://www.youtube.com/watch?v=A2JUu QOlEzs

43. First, don't smoke. –Smoking during pregnancy passes nicotine and cancer- causing 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

44. 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

45. 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

46. 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.

47. 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