Transcript The Detrimental Effects of Substance Abuse in Pregnancy

The Detrimental Effects of
Substance Abuse in
Pregnancy
Jeianti Amin
University of Central Florida
Background
For the purpose of this presentation, substance abuse is
defined in terms of using tobacco or cigarettes, alcohol,
and illicit drugs such as cocaine, marijuana, heroine and
methamphetamines.
The use of alcohol, cigarettes, and illicit drugs are
among the leading cause of mortality and morbidity in
the US, and is a growing epidemic in pregnancy.
Over 16.5% of women reported smoking prenatally,
11.8% of pregnant women reported current alcohol
usage, and over 4% stated using illicit drugs during
pregnancy.
(Floyd et al., 2008)
Background Continues…
Women who partake in health-compromising
behaviors such as the use of illicit drugs, alcohol
consumption, and cigarette smoking during
pregnancy are not only endangering their own lives
but their unborn fetus.
Individual’s the consume alcohol, other illicit drugs
and smoked cigarettes were at an increased risk for
cancer, cardiovascular and pulmonary events which
included hypertension, obesity, gastrointestinal
ulcers, cardiomyopathy, anemia related to poor
health and nutrition, asthma, bronchitis, pneumonia,
and were likely to contract HIV and other blood
borne viruses and sexual transmitted diseases.
(Rassool &Villar-Luis, 2006)
Background Cont…
Tobacco Exposure on
Fetus/Neonate
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IUGR, SIDS, PROM
Prematurity
Low birth weight
Placenta previa
Placenta abruption
Ectopic pregnancy
Oro-facial cleft
Asthma, Bronchitis
(Rassool & Villar-Luis, 2006)
Alcohol Exposure on
Fetus/Neonate
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Neurodevelopment
disorder i.e. mental
retardation, CNS
disruption
FASD, FAS
Growth deficiencies
Cognitive, emotional,
and behavioral
disabilities
(Handmaker et al, 2006)
Background Continues…
Illicit Drugs Exposure on
Fetus/Neonate
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Ectopic pregnancy and
miscarriages
Perinatal cerebral
infarctions
Placenta abruption
PROM, IUGR, SIDS
Reduced head
circumference and
congenital malformations
Preterm delivery and
neurobehavioral
abnormalities
(Rassool &Villar-Luis, 2006)
Problem Statement
Substance abuse such as tobacco use, alcohol
consumption, and illicit drug use in pregnant
women creates significant short-term and longterm health problems for both the unborn fetus
and neonate.
Careful nursing assessments is imperative to not
only identify and recognize those pregnant
mothers at risk or currently abusing substances
but also implement various interventions
necessary to prevent and decrease further
complications seen in this population group.
Significance
Substance abuse is a chronic dilemma that creates
dangerous health problems due to its addictive effects
which can cause dependence throughout an individual’s
life span.
Increase in healthcare cost related to hospital care
accrued as a result from delivery, NICU, special care
nursery, medication/drug treatments, life saving
surgeries or procedures, nursing hours and other
supportive staff including specialists (peri-natologist,
neonatologist, respiratory therapist, case management
workers, and surgery consults etc) and emotional cost.
Significance Continues..
Cost related to low birth weight due to smoking
was $263 million annually
Other direct medical cost during pregnancy until
delivery was $1.4 billion
NICU cost increased to $367 million nationally
Infants born with FASD increased from 0.5 to 2
cases of 1000 live births with a $2 million lifetime
cost of care per each diagnosed case
(Floyd et al., 2008; Petrou, Hockley, Mehta, & Goldacre, 2005)
Significance Continues…
Cigarette smoke causes vasoconstriction in placenta,
reduces uterine blood flow by 38% and causing fetal
hypoxia, distress, malnutrition due to poor feeding and
sucking patterns (orofacial cleft), and infant neurological
excitability.
Illicit drugs causes neonatal abstinence syndrome (NAS)
with common signs and symptoms of withdrawals such
as poor feeding due to gastrointestinal dysfunction, sleep
disturbances, tremors, CNS hypertonia or excitability,
difficulties in regulating newborn behaviors, autonomic
signs of yawing, mottling, fever, dehydration, convulsions
and fetal distress or hypoxia.
(Law, Stroud, LaGasse, Niaura, Liu, & Lester, 2003)
Specific Aims
1.
The theory of self-efficacy will be applied to pregnant
women as a means of preventing and decreasing
substance abuse during their pregnancy, consequently
reducing the numerous detrimental health
consequences or complications experienced by the
fetus or neonate.
2.
Application of theory of self-efficacy will guide nurses
in developing and implementing various interventions
as a means of promoting healthy behaviors and
changing negative lifestyle habits, such as refraining
from the use of tobacco, alcohol and illicit drugs during
pregnancy.
Theory of Self-Efficacy
Based on Bandura’s social cognitive theory and the
interaction of personal, behavioral and environmental
influences on an individual's self-efficacy and expected
outcome.
Later designed by Barbara Resnick to help understand human
behaviors and guide in developing interventions to change
behaviors through a variety of health promotional activities.
Individual’s thoughts are based on four sources of
experiences: direct, vicarious, judgments by others and
deviation of knowledge by inference.
(Resnick, 2008)
Theory of Self-Efficacy Cont…
Self-efficacy is an individual’s judgment of their capabilities to
organize and implement a course of action under the assumption
that they can influence their own actions/decisions.
Two major components:

Self-efficacy expectations (judgment about personal ability to
accomplish a given task)
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Outcome expectations (judgment about what will happen if a
given task is successfully met)
Self-efficacy judgment is based on four fundamental sources: (1)
enactive attainment, which is the actual performance of a behavior;
(2) vicarious experience or visualizing other similar people perform a
behavior; (3) verbal persuasion or exhortation; and (4) physiological
state or physiological feedback
(Resnick, 2008)
Application of Theory
Nurses play a keen role in assessment, obtaining a good
health history, identifying individuals at risk and providing
the necessary support and resources to help these
individuals refrain from using substances such as
tobacco, alcohol and illicit drugs during their pregnancy.
Although there were limited evidence in the literature to
support this patient population, parallel studies of selfefficacy can be applied as a guide for nurses to
implement several methods that that has been proven to
be effective in motivating and changing individual’s
health-compromising behaviors of substance use.
Application of Theory
At the core of each intervention geared towards cessation and
reduction of substances used during pregnancy, was an individual’s
self-efficacy or increase in their confidence level and their ability to
carry out a given action such as motivating behavior changes for
abstinence in alcohol usage, tobacco cessation, and illicit drug use.
Educating, encouraging, decreasing the negative social stigma
associated with substance use during pregnancy and discussing the
harmful effects substance use has on the fetus or neonate during
pregnancy are some strategies used during counseling sessions.
Other interventions to help mothers refrain from substance use and
deliver positive outcome for all involved include stress management
techniques (biofeedback, deep breathing, muscle relaxation, regular
exercises, healthy eating), discussion of medications and referral to
treatment centers such as Alcohol Anonymous.
(Buchanan, 2002)
Summary
The consequences of substance abuse prenatally have a huge
impact on the fetus, mothers, caregivers and society as a whole
because of the associated costs both emotionally and financially.
Nurse’s play a key role in implementing various interventions as a
means of reducing the different health disparities or adverse
outcomes associated with substances during pregnancy.
By applying the theory of self-efficacy nurses are able to provide
interventions such as supportive resources, counseling sessions,
stress management techniques, referrals to treatment centers as a
way of assisting mothers to refrain from substance abuse and
engage in positive lifestyle and behavior changes, consequently
having a beneficial outcome for all involved.
References
Buchanan, L. (2002). Evidence based practice. Implementing a smoking cessation
program for pregnant women based on current clinical practice guidelines.
Journal of the American Academy of Nurse Practitioners, 14(6), 243-250.
Floyd, R., Jack, B., Cefalo, R., Atrash, H., Mahoney, J., Herron, A., et al. (2008). The
clinical content of preconception care: alcohol, tobacco, and illicit drug
exposures. American Journal of Obstetrics & Gynecology, 199(6 Suppl 2),
S333-339.
Handmaker, N.S., Rayburn, W.F., Meng, C., Bell, J.B., Rayburn, B.B., & Rappaport,
V.J. (2006). Impact of alcohol exposure after pregnancy recognition on
ultrasonographic feta growth measures. Alcoholism: Clinical and Experimental
Research, 30(5), 892-898.
Law, K., Stroud, L., LaGasse, L., Niaura, R., Liu, J., & Lester, B. (2003). Smoking
during pregnancy and newborn neurobehavior. Pediatrics, 111(6),
1318-1323.
Petrou, S., Hockley, C., Mehta, Z., & Goldacre, M. (2005). The association between
smoking during pregnancy and hospital inpatient costs in childhood. Social
Science & Medicine, 60(5), 1071-1085.
Rassool, G., & Villar-Luís, M. (2006). Reproductive risks of alcohol and illicit drugs:
an overview. Journal of Addictions Nursing, 17(4), 211-213.
Resnick, B. (2008). Theory of self-efficacy. In M. J. Smith, & P. R. Liehr (Eds.),
Middle range theory for nursing (2nd ed. p. 183-204). New York: Springer
Publishing
Company, Inc.