LISBON ADDICTIONS OCTOBER 2017 DRUG USE AND REPRODUCTIVE CHOICES Dr Mary Hepburn Glasgow

DRUG USE IS CLOSELY ASSOCIATED WITH POVERTY AND INEQUALITY

SOCIOECONOMIC DEPRIVATION is associated with POORER HEALTH LESS EFFECTIVE SERVICE USE

Maternal deaths by National Statistics Socio-Economic Classification 2000-02

SOCIOECONOMIC DEPRIVATION OUTCOMES FOR BABY Increased preterm delivery Increased low birthweight Increased small for gestational age Increased perinatal mortality / morbidity Increased SIDS Increased consequent adult ill health Reduced life expectancy

DRUG USE OUTCOMES FOR BABY Increased preterm delivery Increased low birthweight Increased small for gestational age Increased perinatal mortality / morbidity Increased SIDS Increased adult ill health Reduced life expectancy Few direct effects – more from legal drugs Most adverse outcomes due to poverty Drug use exacerbates effects of poverty

ASSOCIATED PROBLEMS Use of tobacco / alcohol / other drugs Poor diet / malnourishment Blood borne virus infection / affection Mental illness Violence / abuse Involvement in prostitution Experience of inadequate parenting Young maternal age Homelessness / chaotic lifestyles / isolation (Asylum / BME issues)

DRUG AND ALCOHOL USE SOCIAL OUTCOMES A risk factor for inadequate parenting Not incompatible with adequate parenting May not be cause of inadequate parenting Babies best cared for in the family if possible Poor parenting can suffer long term damage

ASSESSMENT OF RISK (1) No reliable indicators Severity of NAS not indicative Unreliable indicators often used as proxy Inconsistent interpretation of indicators Attendance at ANC not legal requirement in UK Inconsistent approach to different maternal issues

PARENTING AND DRUG USE Parenting more challenging – sicker babies Need for increased / more intensive support Need for integrated multidisciplinary care

ASSESSMENT OF RISK (2) Clear transparent approach Multidisciplinary approach Agreed shared goals Evidence based approach If no evidence don’t make it up Include discussion and planning re future pregnacies Need planned, optimally timed pregnancies

WOMEN’S EXPECTATIONS Non judgemental services Understanding and compassion High standard of care

REPRODUCTIVE HEALTHCARE Protect fertility Control fertility Planned, intended pregnancies Optimal timing of pregnancies Contraception before postnatal discharge Supervised parenting Role of supported accommodation Continuity of reproductive healthcare Ideally pre-pregnancy, otherwise antenatally

FUTURE PREGNANCIES Mother has custody of baby: - early unplanned pregnancy could destabilise situation - needs time to concentrate on existing child Mother does not have custody: - early unplanned pregnancy likely to have similar outcome - needs time to address issues to improve chance of good outcome next time

CONTRACEPTIVE CHOICE LARC (Long acting reversible contraception) Progestagen containing intrauterine device Progestagen implant Cu containing intrauterine device Depot progesterone injection Ease of initiation v side effects Early discontinuation reduced by prior discussion about side effects – repeated discussion before and during pregnancy

GLASGOW SERVICE: OUTCOMES From 1985: LARC within addiction services and at maternity p/n interval appointments 1995: 300 pregnancies among drug using women From 2001: LARC also provided in p/n ward 2001 – 2005: 100 – 150 pregnancies pa. (other factors contributed to fall)