Transcript Dopaminergic Characteristics of Monkeys

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
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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: www.motherisk.org
(416) 813-6780
• www.pregnets.org
• Information sources
–Textbooks
Drugs in Pregnancy and Lactation 6th
Edition, GG Briggs, RK Freeman, SJ Yaffe
(eds), 2001
Maternal-Fetal Toxicology: A Clinician’s
Guide 2nd Edition, G Koren (ed), 1994
–Journals