Transcript Crack Babies - UCSD Cognitive Science

Maternal Drug Use
How to Create the Best Offspring or Not …
Alison Freeman, Geleen Antonio,
Jae Eun Kim, Matthew White, and Sydney Shera
Overview
• Development
– Babies and mommies
• Cocaine
– Moms
– Babies
• Heroin
– Moms
– Babies
• Other bad decisions
Review
• You take a drug
– Hopefully feel good
• Brain notices NT difference
– Brain adapts to this
• Up-regulation
• Down-regulation
• Life decision
– Rehab / withdrawal
http://www.google.com/imgres?imgurl=http://katemoller.com/wp-content/uploads/2010/10/iStock_000008922315XSmall.jpg&imgrefurl=http://katemoller.com/a-healthy-dose-ofecstacy/&usg=__QHNfRMMCwiyeLhkGP4vL7x2_toQ=&h=282&w=425&sz=60&hl=en&start=31&sig2=I_1y8wDSHPTtjCrN8KrPTA&zoom=1&tbnid=gethF2oCyfBCDM:&tbnh=117&tbnw=183&ei=0ghoTYPDL42ssAPOp92mBA&p
rev=/images%3Fq%3Dbabies%2Band%2Becstasy%26hl%3Den%26gbv%3D2%26biw%3D1003%26bih%3D564%26tbs%3Disch:10%2C869&itbs=1&iact=hc&vpx=701&vpy=117&dur=4328&hovh=183&hovw=276&tx=215&ty=10
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Pregnancy Basics
• Consists of a Mom and a growing ‘baby’
• ‘baby’ development
– Genes, embryos, development
• Average duration 42 weeks
– One cell  a mini-person
• 10 – 25 % of recognized pregnancies 
miscarriages
• Birth defects occur in 150,000 America babies
per year
http://www.google.com/imgres?imgurl=http://www.cerebralpalsychildren.com/CP1.jpg&imgrefurl=http://www.cerebralpalsychildren.com/CPFetal.html&usg=__0-oqJOJ9ROBuxUo59HhmaH1W3_o=&h=606&w=894&sz=91&hl=en&start=0&sig2=o1wSmbVQveFriw98kseFQ&zoom=1&tbnid=M6kLfgXXVJNokM:&tbnh=111&tbnw=164&ei=hSdoTbbOFIHAsAP5tuioBA&prev=/images%3Fq%3Dfetal%2Bdevelopment%26hl%3Den%26gbv%3D2%26biw%3D1003%26bih%3D564%26tbs%3Disch:1&itbs=1&iact=hc&vpx=603&vpy=124&dur=266&hovh=185&hovw
=273&tx=120&ty=73&oei=hSdoTbbOFIHAsAP5tuioBA&page=1&ndsp=15&ved=1t:429,r:3,s:0
Effects of Cocaine and Heroin on
the Pregnant Woman and Co.
http://www.google.com/imgres?imgurl=http://www.onlinenewsreporters.com
The Effects of Heroin & Cocaine on the
Normal Physiology of Pregnancy
• Placental abruption:
-Placental lining has separated from the mother’s uterus ,
causing late pregnancy bleeding within uterus, which can
ultimately result in maternal mortality.
-Fetal membranes prematurely rupture, triggering pre-term
labor.
How Drugs Cross the Placenta
http://www.merckmanuals.com/home/sec22/ch259/ch259a.html
Cocaine
http://www.google.com/imgres?imgurl=http://www.topnews.in/usa/files/pregnant-lady http://www.google.com/imgres?imgurl=http://www.drugnet.net
The Effects of Cocaine on the Normal
Physiology of Pregnancy
• Pre-term labor, Pre-term delivery:
-Cocaine use during pregnancy may cause the downregulation of myometrial (middle layer of uterine wall) betaadrenergic receptors
HOW?
http://www.google.com/imgres?imgurl=http://www.epig
ee.org
Mechanism
(Cocaine inhibits the reuptake of 5-HT, NE, and E)
Normally NE and E bind to Beta-2 adrenergic receptors in the
smooth muscles of the uterine walluterine relaxation
Cocaine Use An increase in NE and E in the synapse overactivates the myometrial Beta-2 adrenergic receptors
-Over time, down-regulation of these receptorsprevent
over-activation
-Down-regulation of myometrial Beta-2 adrenergic receptors
prevents normal uterine relaxation, prolonging the contraction
state and inducing pre-term labor and pre-term delivery
Cocaine
http://www.google.com/imgres?imgurl=h
ttp://www.edinformatics.com
Norepinephrine
http://www.google.com/imgres?imgurl=ht
tp://images.wikia.com/psychology/images
Epinephrine
http://www.google.com/imgres?imgurl=http://3.bp.blogs
pot.com
The Effects of Cocaine on the Normal
Physiology of Pregnancy
•
Normal pregnancy: Vasodilation occurs due to increased
levels of progesterone. This vasodilation may be counteracted
by cocaine-induced vasoconstriction
• Hyperthermia caused by vasoconstriction
– An increase in [E]synaptic from cocaine
usevasoconstriction, resulting in the retention of
heathyperthermia
– Cocaine-induced maternal hyperthermiafetal prematurity,
low birth weight, and fetal death.
--May also alter the mother’s mental status
Epinephrine Causes Vasoconstriction
and Progesterone Causes Vasodilation
http://www.google.com/imgres?imgurl=http://www.pgbeautygroomingscience.com/assets/images
The Socio-political Effects of Cocaine on the
Pregnant Woman
• The Anti-Drug Abuse Act of 1986 –mandatory minimum
sentencing time for cocaine use/possession
– A negative unforeseen affect: pregnant woman who abuse
cocaine are less likely to seek prenatal care, drug
treatment, and other social services; may lead to
unnecessary abortions
– Very few US drug treatment programs will admit pregnant
women
– Minority women constitute 80% of those prosecuted for
delivering drug-abused babies, regardless of equal levels of
drug use in pregnant Caucasian women.
How a drug affects a fetus depends
on…
• The fetus’s stage of development
– Early in pregnancy (within 20 days after
fertilization)
– Between 3rd and 8th week after fertilization
– After organ development
• The strength & dose of the
drug
http://adoption.families.com/blog/considerations-in-adoption-prenatal-drug-and-alcohol-exposure
What are the risks with use of
cocaine during pregnancy?
• Increased risk of miscarriage
• Preterm labor
• Premature & low-birth weight
– 3 to 6 times more likely to be born at a low birth
weight (less than 5.5 pounds)
• Smaller heads
More problems…
•
•
•
•
Placental & urinal tracts problems
Physical condition & overall responsiveness
Sudden Infant Death Syndrome (SIDS)
Dependence & withdrawal symptoms
http://www.thepanamadigest.com/2010/04/daddys-baby-grabs-1400-kilos-of-cocaine/
http://www.drugcouncil.tc/cocaine.html
What is the long-term outlook
for babies who were exposed to
cocaine before birth?
• Negative effects of cocaine exposure is
permanent
– Normal intelligence but subtle learning &
behavioral problems
• Lower IQ
• Language delays & attention problems
– Deficits in cognitive & emotional development
http://www.google.com/imgres?imgurl=http://tothewire.files.wordpress.com/2008/12/heroin.gif&imgrefurl=http://tothewire.wordpress.com/2008/12/01/swiss-approve-pioneering-legalheroin-program/&usg=__ZPbm9aekHUSTu0LygOHtm7uy2E=&h=400&w=400&sz=49&hl=en&start=0&sig2=R7FaNkAz2UskHWdzraYiqg&zoom=1&tbnid=cL3i26vnbAlUiM:&tbnh=122&tbnw=121&ei=FC5oTbLvBZOssAP0w9SoBA&p
rev=/images%3Fq%3Dheroin%26hl%3Den%26biw%3D1020%26bih%3D564%26gbv%3D2%26tbs%3Disch:1&itbs=1&iact=hc&vpx=752&vpy=105&dur=94&hovh=225&hovw=225&tx=172&ty=88
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Heroin Addicts and Pregnancy
Pregnant heroin addicts tend to be:
–
younger than non-addicted pregnant patients
–
unmarried or separated from spouses
–
disproportionately large number are members of minority ethnic groups
Injection drug use during pregnancy
-Increases risk of contracting HIV and the Hepatitis
C virus
-These infections can be passed on to the infant
during pregnancy or at birth
http://www.ncbi.nlm.nih.gov/pubmed/2304039
Photo: http://www.topnews.in/law/australian-woman-who-hid-heroin-stomach-held-235974
Complications
Significant medical and obstetrical complications resulting in acute and chronic
abnormalities in neonates:
Pregnancy
Maternal
Fetal
Poor Fetal Growth
Malnutrition
Retardation
Premature rupture of
membranes( water
breaks too soon)
STDs
Fetal death
Premature birth
Hepatitis or HIV
Intrauterine growth
restriction
Stillbirth
Preeclampsia
Prematurity
Breech birth
Third-Trimester Bleeding Withdrawal Symptoms
Placenta: can separate
too soon, or not have
enough blood
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1272838/
http://www.ireta.org/sbirt/pdf/Heroin_in_Pregnancy.pdf
Treatment Options
Prenatal care and comprehensive drug
treatment program
– -Detoxification
– -Methadone
– -Buprenorphine
(2002)
Photo: http://www.whatwinnersdo.com/recommended-addictionrecovery-books/
Heroin Withdrawal Symptoms
Shame and embarrassment deters pregnant women from seeking help with
addiction
Women who become pregnant while addicted to heroin should not stop using
heroin without the advice of a doctor.
Severe effects and death may occur in both mothers and unborn babies.
Health effects resulting from Heroin withdrawals:
Diarrhea
Restlessness
Vomiting
Muscle or bone pain
Insomnia
Cold flashes
Detoxification
-For women who do not want or are not able to receive
pharmacotherapy for heroin addiction
-Medical supervision necessary
-Potential risk to fetus and likelihood of relapse
-Pregnant women advised not to detoxify from opiates
because of increased risk of spontaneous abortion or
premature delivery
Methadone Treatment for a
Healthy Pregnancy


Methadone: long-acting opioid drug used with counseling and other services to help people
to stop using heroin
Methadone Maintenance Treatment(MMT):
•
Helps with a healthy pregnancy and birth(increased birth weight,
gestational age of infant, and increased prenatal and antenatal
visits)
•

Safe for babies but has resulting side effects:

Fussiness

Not eating or sleeping well

Fever

Vomiting

Trembling
Symptoms go away after a few weeks
http://www.recoveryconnection.org/blog/2010/08/addiction-treatment-over-suboxone-or-methadone-clinic/
Buprenorphine
In the United States, several studies have found buprenorphine to be equally
effective and as safe as methadone in the adult outpatient treatment of
opioid dependence.
Given this efficacy among adults, current studies are attempting to establish
the safety and effectiveness of buprenorphine in opioid-dependent
pregnant women.
Buprenorphine Side Effects:

Dysphoric mood

Piloerection

Nausea or vomiting

Diarrhea
·
Muscle aches/cramps

Yawning
·
Lacrimation
·
Mild fever

Rhinorrhea

Insomnia

Pupillary dilation

Craving

Sweating

Distress/irritability
http://arch1design.com/blog/2010/06/03/cold-turkey-obesity-and-sterilization/
Buprenorphine
-An opioid partial agonist
-Although an opioid that can produce the typical side effects of euphoria and
respiratory depression, it is less effective than full agonists like heroin and
methadone.
-At low doses, can produce an agonist effect that enables opioid-addicted
individuals to discontinue opioid misuse without withdrawals.
-”Ceiling effect”: at moderate doses, plateau is reached and effects do not
increase with dosage(safer in overdose)
-Max effects occur around the 16-32 mg range for sublingual tablets.
-Lower risk of abuse, addiction, and side effects compared to full opioid
agonists.
-No evidence of organ damage with chronic use
-No evidence of significant disruption of cognitive or psychomotor
performance with buprenorphine maintenance dosing
Effect of Heroin Use on Newborns
• Increased chance of:
– Low birth weight
– Small Head Circumference
– Breathing difficulties
– Hypoglycemia
– Intracranial Hemorrhage
– Sudden Infant Death Syndrome
Effect of Heroin Use on Fetal Development
•Unborn baby can develop drug dependence
•Withdrawal Symptoms in Babies of Heroin Users:
Fever
Sneezing
Trembling
Irritability
Diarrhea
Vomiting
Continual crying
Seizures
Sleep abnormalities
Joint stiffness
Thrombocytosis
-High platelet counts in the blood
Study by Calderon et al.:
»
Thrombocytosis observed in infants exposed to in-utero
to illicit drugs, has been assoc. with methadone exposure
»
Took a retrospective look at medical records of newborns
with intrauterine drug exposure admitted to San Juan
City Hospital (1999-2001)
»
Found 96% of these infants had thrombocytosis.
»
Of these 75% were exposed to methadone, heroin and
cocaine
»
Began at ten days of life and resolution seen in 3-4 weeks
without complications
Breastfeeding
-Social drug use in pregnant and breastfeeding mothers
-Breastfeeding  nourishment for baby
-Transfer of heroin
-Not absorbed well by infant because of poor oral
bioavailability from the milk
- Risk of HIV and Hepititis C.
-Acute Stages of Illness
http://www.wellsphere.com/wellpage/neonatal-withdrawal-syndrome-from-methadone-while-pregnant
http://www.health-e-learning.com/articles/Social_Drugs_and_Breastfeeding.pdf
Breastfeeding and Methadone
• The American Academy of Pediatricians
states that methadone use of 20 mg or
less per day is compatible with breastfeeding.
– However, no dose information or other guidelines
are included.
Heroin and Its Effect on Children After Birth
• Low Birth weight linked to:
• Language, visual-motor and other learning
disabilities
• Behavior problems
• Suffered performance in school
Inconclusive data relating to long-term effects
to prenatal exposure to heroin/methadone
Other Drugs
http://www.google.com/imgres?imgurl=http://images.paraorkut.com/img/funnypics/images/l/like_father_like_son11995.jpg&imgrefurl=http://www.graphicshunt.com/funny/search/1/babies.htm&usg=__2kYUuD04iTirE1tbn8zLvY7OYGE=&h=300&w=440&sz=25&hl=en&start=0&sig2=VAkSm3iypeUh7akVF
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Marijuana and your ‘Baby’
•
•
•
•
Gestation Age
Birth Weight
Head Circumference
Birth Length
• However, the # of joints in the third trimester does not
correlate
•http://www.google.com/imgres?imgurl=http://gal.darkervision.com/wp-content/uploads/2008/07/baby.jpg&imgrefurl=http://gal.darkervision.com/2008/07/25/teen-jailed-for-8-years-for-giving-a-toke-to-2-and-4-year-old-nephews-who-are-then-placed-into-care-just-another-fine-day-in-the-war-on-drugsmadhouse/&usg=__zBgv4Xcn3kwwpcPgbEThg8GlT44=&h=377&w=398&sz=18&hl=en&start=0&sig2=p0l8_v8OIZV_ZmPZ32jwHw&zoom=1&tbnid=s2WKF2oEM3FFM:&tbnh=120&tbnw=135&ei=cAhoTZq5KIu4sQOR1fyoBA&prev=/images%3Fq%3Dmarijuana%2Bbabies%26hl%3Den%26biw%3D1020%26bih%3D56 4%26gbv%3D2%26tbs%3Disch:1&itbs=1&iact=hc&vpx=658&vpy=104&dur=15&hovh=218&hovw=231&tx=118&ty=121&oei=cAhoTZq5KIu4sQOR1fyoBA&page=1&ndsp=18&ved=1t:429,r:4,s:0
http://www.google.com/imgres?imgurl=http://www.motifake.com/image/demotivational-poster/1003/crack-meth-ecstasy-crack-meth-ecstasy-demotivational-poster-1267977486.jpg&imgrefurl=http://www.motifake.com/crack-meth-ecstasy-crack-meth-ecstasy-demotivational-posters93079.html&usg=__Y3lmUHtYC0KZn6n_dafcszDHfN4=&h=844&w=640&sz=100&hl=en&start=0&sig2=JdgWUoD_nGoCukjdwYukfg&zoom=0&tbnid=VanbH MJzDalAbM:&tbnh=128&tbnw=97&ei=UiJoTdqZOoT2swPV6N2oBA&prev=/images%3Fq%3Decstasy%2Bmeth%2Bcrack%26hl%3Den%26gbv%3D2%26biw%3D1003 %26bih%3D564%26tbs%3Disch:1&itbs=1&iact=hc&vpx=135&vpy=112&dur=31&hovh=1
45&hovw=110&tx=67&ty=55&oei=UiJoTdqZOoT2swPV6N2oBA&page=1&ndsp=15&ved=1t:429,r:0,s:0
– Changes in DA and 5-HT
metabolism
• Severe teratogenesis
• Fetal brain damage
• Persistent alteration in
brain
– Atg5 gene on overdrive
• Impaired brain
development
• MDMA interferes with
neuronal differentiation
Your Bab
Other Things to be Scared of …
• Terbutaline treatment (medication)
– Increased incidence of autism spectrum disorder
• Organophosphates (pesticides)
– Inhibit cholinesterase; produce cholinergic
overstimulation
• Manganese (naturally occurring heavy metal)
– Manganism – similar to Parkinson’s
– Childhood behavioral disinhibition
http://www.google.com/imgres?imgurl=http://inigobautista.files.wordpress.com/2010/01/vaccination-comic2.jpg&imgrefurl=http://inigobautista.wordpress.com/2010/01/28/&usg=__g5SqawA_Cjv2rrifApH6fcL6Drg=&h=370&w=530&sz=52&hl=en&start=17&sig2=Fqrtr6L7ZwVIKY1zxP-V2Q&zoom=1&tbnid=eCs4gVGEMZUUM:&tbnh=110&tbnw=158&ei=pending&prev=/images%3Fq%3Ddoctor%2Band%2Bbaby%2Bcomic%26hl%3Den%26gbv%3D2%26biw%3D1003%26bih%3D564%26tbs%3Disch:10%2C4350%2C435&itbs=1&iact=rc&dur=156&oei=YB9oTYj_BtS2twfYsoXoAw&page=2&ndsp
=18&ved=1t:429,r:14,s:17&tx=79&ty=54&biw=1003&bih=564
Works Cited
Chae, Myounghee, and Gyu-Seek Rhee. "ATG5 Expression Induced by MDMA (Ecstasy), Interferes with Neuronal Differentiation of
Nueroblastoma Cells." Molecules and Cells 27 (2009): 571-75. Springer. Web. 15 Feb. 2011. <http://moleculesandcells.org>.
Frederick, Aliya L., and Gregg D. Stanwood. "Drugs, Biogenic Amine Targets and the Developing Brain." Developmental
Neuroscience 31 (2009): 7-22. Karger. Web. 13 Feb. 2011. <http://www.karger.com/dne>.
Frost, Elizabeth A., Richard S. Gist, and Elizabeth Adriano. "Drugs, Alcohol, Pregnancy, and the Fetal Alcohol Syndrome." Wolters
Kluwer Health 49.1 (2011): 119-33. Ovid. Web. 15 Feb. 2011. <http://ovidsp.tx.ovid.com>.
Gray, Teresa R., Rina D. Eiden, Kenneth E. Leonard, Gerard J. Connors, Shannon Shisler, and Marilyn A. Huestis. "Identifying
Prenatal Cannabis Exposure and Effects of Concurrent Tobacco Exposure on Neonatal Growth." Clinical Chemistry 56 (2010): 1442450. PubMed. Web. 15 Feb. 2011. <http://www.clinichem.org/cgi/content/full/56/9/1442>.
Websites:
http://www.americanpregnancy.org/pregnancyhealth/illegaldrugs.html
http://www.marchofdimes.com/pregnancy/alcohol_illicitdrug.html
http://www.teach-nology.com/tutorials/teaching/abuse/print.htm
http://www.drugpolicy.org/library/research/cocaine.cfm?printpage=1&printpage=1
http://www.mayoclinic.com/health/medical/IM03117
http://www.ncbi.nlm.nih.gov/pubmed/7862372
http://www.tgorski.com/Prevention/cocaine_use_during_pregnancy.html
http://www.americanpregnancy.org/pregnancyhealth/illegaldrugs.html
http://www.marchofdimes.com/pregnancy/alcohol_illicitdrug.html
http://www.merckmanuals.com/home/sec22/ch259/ch259a.htm
www.drugpolicy.org/library/research/cocaine.cfm?printpage=1&printpage=1
http://www.mayoclinic.com/health/medical/IM03117
http://www.ncbi.nlm.nih.gov/pubmed/7862372