1. Specific issues in drug use and pregnancy

2. Pregnant women who use drugs (RCOG, 2010) One of the challenges for pregnant women who use drugs is that they face a number of barriers to services: One of the key issues leading to a poor pregnancy outcome is that women misusing substances do not access or maintain contact with maternity services and are likely to experience other social disadvantages. In some cases, maternal deaths (antenatal and postnatal) are attributed to poor access to services. Pregnant women who misuse drugs should be identified as ‘vulnerable’.

3. Key issues (DoH, 2007) Drug using women may not realise they are pregnant as amenorrhea (absent periods) is common in opiate users and, if withdrawing, withdrawal symptoms can mimic signs of early pregnancy. Some women may not want to continue their pregnancy. They may not know when they became pregnant so gestation is difficult to establish without ultrasound.

4. Key issues (cont.) (DoH, 2007) All pregnant drug using women will need some form of treatment for their drug use while pregnant to reduce the harm from continuing use of street drugs and self-injecting. This may include: Substitute prescribing with methadone. Withdrawal management if using alcohol. Cessation support if using cocaine. Smoking cessation support. Symptom treatment for depression, infection, sleeplessness, etc. Also, social support for families and planning for after the birth.

5. Maternal wellbeing issues (DoH, 2007) Drug-using mothers may have additional health and wellbeing issues such as: –Poor nutrition. –Alcohol, nicotine and other drug use (as well as the main drug used). –Poor health (HIV+, Hep B & C, chronic or acute infections). –Poor social conditions, lack of social support. –Higher risk of mental health problems during and after pregnancy.

6. Key issues: the effects on the baby (DoH, 2007) The foetus of an opiate using mother will also be ‘addicted’ to the substance. The baby will need to withdraw from the opiates or substitute methadone following birth. Birth represents a sudden withdrawal for the baby.

7. During labour (DoH, 2007) Opiate using mothers may have low pain thresholds. There should be a low threshold for consideration of epidural use. There is a greater likelihood of foetal distress during birth and the baby may display withdrawal symptoms (neonatal abstinence syndrome (NAS)). Mother and baby should therefore be monitored closely in the intra- partum period, supported with the use of cardiotochography (CTG) monitoring. A distressed baby makes maternal bonding more difficult.

8. References British Medical Association (2007) Fetal Alcohol Spectrum Disorders. London, BMA Board of Science. Goodman A (2009) Social work with Drug and Substance Misusers. Exeter, Learning Matters. Heather N Peters T & Stockwell T (2001) International Handbook of Alcohol Dependence and Problems. Chichester, Wiley. Knight R (2001). Neurological consequences of alcohol use. In: Heather et al (Eds) International Handbook of Alcohol Dependence and Problems. Chichester, Wiley. Mattson S N & Riley E P (1998) A review of the neurobehavioural deficits in children with fetal alcohol syndrome or prenatal exposure to alcohol. Alcoholism: Clinical & Experimental Research. 22; 279-294. NICE (2008) Ante Natal Care. Clinical Guideline 62. available at: http://www.nice.org.uk/guidance/cg62/chapter/1-recommendations#lifestyle- considerations http://www.nice.org.uk/guidance/cg62/chapter/1-recommendations#lifestyle- considerations RCOG (2015) Information for you: Alcohol & Pregnancy. Available at: https://www.rcog.org.uk/globalassets/documents/patients/patient-information- leaflets/pregnancy/pi-alcohol-and-pregnancy.pdf https://www.rcog.org.uk/globalassets/documents/patients/patient-information- leaflets/pregnancy/pi-alcohol-and-pregnancy.pdf