Maternal Drug Use

1
Maternal Drug Use

• How to Create the Best Offspring or Not
• Alison Freeman, Geleen Antonio,
• Jae Eun Kim, Matthew White, and Sydney Shera

2
Overview

• Development
• Babies and mommies
• Cocaine
• Moms
• Babies
• Heroin
• Moms
• Babies
• Other bad decisions

3
Review

• You take a drug
• Hopefully feel good
• Brain notices NT difference
• Brain adapts to this
• Up-regulation
• Down-regulation
• Life decision
• Rehab / withdrawal

4
Pregnancy
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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

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Effects of Cocaine and Heroin on the Pregnant
Woman and Co.
http//www.google.com/
imgres?imgurlhttp//www.onlinenewsreporters.com
8
The Effects of Heroin Cocaine on the Normal
Physiology of Pregnancy

• Placental abruption
• -Placental lining has separated from the
  mothers uterus , causing late pregnancy bleeding
  within uterus, which can ultimately result in
  maternal mortality.
• -Fetal membranes prematurely rupture, triggering
  pre-term labor.

9
How Drugs Cross the Placenta
http//www.merckmanuals.com/home/sec22/ch259/ch259
a.html
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Cocaine
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news.in/usa/files/pregnant-lady
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gnet.net
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The Effects of Cocaine on the Normal Physiology
of Pregnancy

• Pre-term labor, Pre-term delivery
• -Cocaine use during pregnancy may cause the
  down-regulation of myometrial (middle layer of
  uterine wall) beta-adrenergic receptors
• HOW?

http//www.google.com/imgres?imgurlhttp//www.epi
gee.org
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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 over-activates 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

Norepinephrine
Epinephrine
Cocaine
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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 Esynaptic 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 mothers mental status

14
Epinephrine Causes Vasoconstriction and
Progesterone Causes Vasodilation
http//www.google.com/imgres?imgurlhttp//www.pgb
eautygroomingscience.com/assets/images
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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.

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How a drug affects a fetus depends on

• The fetuss 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-i
n-adoption-prenatal-drug-and-alcohol-exposure
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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

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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.drugcoun
cil.tc/cocaine.html
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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

20
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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
Photo http//www.topnews.in/law/australian-woman-
who-hid-heroin-stomach-held-235974
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Complications
Significant medical and obstetrical complications
resulting in acute and chronic abnormalities in
neonates
http//www.ncbi.nlm.nih.gov/pmc/articles/PMC127283
8/ http//www.ireta.org/sbirt/pdf/Heroin_in_Pregna
ncy.pdf
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Treatment Options

• Prenatal care and comprehensive drug treatment
  program
• -Detoxification
• -Methadone
• -Buprenorphine
• (2002)

Photo http//www.whatwinnersdo.com/recommended-ad
diction-recovery-books/
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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

25
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

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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/add
iction-treatment-over-suboxone-or-methadone-clinic
/
27
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.

http//arch1design.com/blog/2010/06/03/cold-turkey
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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

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Effect of Heroin Use on Newborns

• Increased chance of
• Low birth weight
• Small Head Circumference
• Breathing difficulties
• Hypoglycemia
• Intracranial Hemorrhage
• Sudden Infant Death Syndrome

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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

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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

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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-withdr
awal-syndrome-from-methadone-while-pregnant http/
/www.health-e-learning.com/articles/Social_Drugs_a
nd_Breastfeeding.pdf
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Breastfeeding and Methadone

• The American Academy of Pediatricians states that
  methadone use of 20 mg or less per day is
  compatible with breast-feeding.
• However, no dose information or other guidelines
  are included.

34
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

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Other Drugs
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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
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Your Bab
E

• Impaired brain development
• MDMA interferes with neuronal differentiation
• Atg5 gene on overdrive
• Severe teratogenesis
• Fetal brain damage
• Persistent alteration in brain
• Changes in DA and 5-HT metabolism

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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 Parkinsons
• Childhood behavioral disinhibition

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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.
lthttp//moleculesandcells.orggt. 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. lthttp//www.karger.com/
dnegt. 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. lthttp//ovidsp.tx.ovid.comgt. 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)
1442-450. PubMed. Web. 15 Feb. 2011.
lthttp//www.clinichem.org/cgi/content/full/56/9/14
42gt. Websites http//www.americanpregnancy.org
/pregnancyhealth/illegaldrugs.htmlhttp//www.marc
hofdimes.com/pregnancy/alcohol_illicitdrug.htmlht
tp//www.teach-nology.com/tutorials/teaching/abuse
/print.htmhttp//www.drugpolicy.org/library/resea
rch/cocaine.cfm?printpage1printpage1http//www
.mayoclinic.com/health/medical/IM03117http//www.
ncbi.nlm.nih.gov/pubmed/7862372http//www.tgorski
.com/Prevention/cocaine_use_during_pregnancy.html
http//www.americanpregnancy.org/pregnancyhealth/i
llegaldrugs.htmlhttp//www.marchofdimes.com/pregn
ancy/alcohol_illicitdrug.htmlhttp//www.merckmanu
als.com/home/sec22/ch259/ch259a.htmwww.drugpolicy
.org/library/research/cocaine.cfm?printpage1prin
tpage1http//www.mayoclinic.com/health/medical/I
M03117http//www.ncbi.nlm.nih.gov/pubmed/7862372