Pregnancy and Drug Abuse Eva Janecek-Rucker

Learning Objectives 1.To develop a knowledge base of the effects of substances of abuse (e.g., alcohol, cocaine, nicotine et al.) during pregnancy. 2.To examine the pharmacist’s role and develop a comfort level with respect to prevention, counselling and referral of women planning pregnancy as well as those who are pregnant and using psychoactive substances.

Drugs in Pregnancy CNS depressants –alcohol –benzodiazepines –barbiturates –inhalants (toluene; often combined with alcohol) CNS stimulants –cocaine –caffeine –nicotine

Drugs in Pregnancy Hallucinogens –cannabis –LSD Opioids –codeine, morphine –heroin

Interpretation of Results Animal studies Prenatal drug exposure (dose, timing, duration) Withdrawal Breastfeeding

Issues with Illicit Drug Use During Pregnancy Drug –authenticity –dose –additives Pharmacological effects Multiple drug use Injection drug use Effect of father’s drug use

Issues (cont’d) Lack of prenatal care Poor diet Smoking Drinking Violence

Alcohol Fetal Alcohol Spectrum Disorder (FASD) High risk: woman drinking 6 standard drinks/day during the first trimester Signs of FAS: –prenatal and postnatal growth retardation –CNS dysfunction (often including mental retardation) Facial dysmorphology Other congenital abnormalities Fetal alcohol effects (FAE)

Alcohol (cont’d) No safe level established –a Canadian committee recommended abstinence ‘ or at least to limit consumption to less than 4 drinks per week ’

Alcohol (cont’d) Treatment of a pregnant alcoholic –diazepam loading for alcohol withdrawal Disulfiram -contraindicated in pregnancy Naltrexone ?

Solvents Effects similar to FAS: –CNS dysfunction –Attentional deficits –Growth deficiency –Development delay –Facial dysmorphology

Benzodiazepines Likely not teratogenic; cleft lip/palate??? Neonatal withdrawal symptoms

Barbiturates and other hypno-sedatives No evidence of teratogenicity Neonatal withdrawal syndrome Treatment: phenobarbital

Cocaine Spontaneous abortion Prematurity Intrauterine growth retardation Abruptio placentae Perinatal cerebral infarction Structural CNS abnormalities Urogenital abnormalities Concomitant use of other drugs (alcohol and benzodiazepines)

Nicotine Spontaneous abortion Low birth weight Perinatal mortality Prematurity Abruptio placentae Congenital malformations (most studies show lack of) Sudden infant death syndrome (SIDS)

Caffeine Low dose - no effect High dose: –in animals - adverse effects –in humans - ?

Heroin Fetal distress or death during withdrawal in utero Decreased birth weight Higher incidence of  Infections  medical complications  obstetrical complications Neonatal withdrawal SIDS

Heroin (cont’d) Treatment of pregnant woman methadone

Cannabis Decreased birth weight Prematurity Effect of tar No congenital abnormalities

LSD Limb defects CNS abnormalities Ocular abnormalities

Pharmacist’s Role Identification Information Referral

Resources Alcohol and Drug Assessment and Treatment Services Motherisk: (416) Information sources –Textbooks  Drugs in Pregnancy and Lactation 6 th Edition, GG Briggs, RK Freeman, SJ Yaffe (eds), 2001  Maternal-Fetal Toxicology: A Clinician’s Guide 2 nd Edition, G Koren (ed), 1994 –Journals