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

2. DRUG USE IS CLOSELY ASSOCIATED WITH POVERTY AND INEQUALITY

3. SOCIOECONOMIC DEPRIVATION is associated with
POORER HEALTH
LESS EFFECTIVE SERVICE USE

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

5. 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

6. 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

7. 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)

8. 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

9. 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

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

11. 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

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

13. 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

14. 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

15. 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

16. 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)