Substance Misuse in Pregnancy - NHS Lothian

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prematurity (BHIVA 2001). The majority of vertical transmission occurs during the intrapartum period. There is a close correlation between maternal viral load and risk of transmission: the higher the viral load the greater risk of transmission. Breastfeeding is also an important route of transmission. The additional risk of transmission through breastfeeding, over and above the intrauterine and intrapartum contribution, is estimated to be between 7-22% (BHIVA 2001). Without treatment, the transmission rate is approximately 15%-25%. The prevalence of HIV among pregnant women in Scotland has increased recently. In 2002, unlinked anonymous testing found a prevalence of 5.8 per 10,000 population (SCIEH 2003). Without treatment, HIV-infected children develop chronic disease and about 20% develop AIDS or die in the first year of life. By the age of 6 years, about 25% will have died and most surviving children will have some illness because of their infection. The long-term picture is unknown, but all children with HIV benefit from early life-prolonging treatment (Scottish Executive 2002). The aim of the antenatal screening programme is to reduce the number of babies born with HIV and to improve the health of infected women and their babies. Diagnosis in pregnancy means that women can be offered advice, treatment and interventions to reduce the likelihood of motherto-baby (vertical) transmission of the virus. If appropriate interventions are accepted, the risk of vertical transmission can be reduced to below 2%. The recommended interventions are set out in the British HIV Association (BHIVA) ‘Guidelines for the management of HIV infection in pregnant women and the prevention of mother-to-child transmission’ (2001). Interventions include: � The use of antiretroviral drugs for both mother and baby � Careful obstetric management during pregnancy and delivery � Delivery by pre-labour caesarean section � Bottle feeding An expanded version of the BHIVA guidelines, with an appendix on safety and toxicity data is available on the BHIVA website: www.bhiva.org Substance Misuse in Pregnancy: Appendix 1 2
Management of HIV positive pregnant women The care offered to HIV positive pregnant women in Lothian is jointly managed by specialists from Midwifery, Obstetrics, HIV, Paediatrics, Primary Care and other services (e.g. social work, drug and HIV services). Health care staff should refer to the agreed management protocol and care pathway. The approach to treatment is individualised, according to the needs and choices of each mother. Good liaison is required between all professionals to ensure that the pregnancy and birth plan proceed appropriately and that the views and wishes of the woman are respected. There are two scenarios in which HIV infection may be identified during pregnancy. The first is where HIV infection is diagnosed during pregnancy, normally at the antenatal clinic. The second is where a known HIV positive woman falls pregnant. Antiretroviral drug therapy (ART) for the mother aims to reduce her viral load to ‘undetectable’. ART is given according to the mother’s HIV health status. Normally it is avoided in the 1 st trimester. If possible, treatment will be deferred until just before the 3 rd trimester (20-24 weeks) in order to reduce fetal exposure. Women who become pregnant whilst taking ART that is successfully suppressing viral load, will normally continue with their ART throughout pregnancy. The recommended mode of delivery is also dependent on viral load. Caesarean section is recommended if the viral load result is >1000. If the viral load is
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Substance Substance misuse misuse i
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This pack has been approved by Loth
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Page Drugs and their effects on the
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Appendices ........................
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Introduction Welcome to the ‘Subs
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Please note: 1. The terminology use
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Introduction Key points Setting the
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Pre-conceptual care � Agencies in
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Substance Misuse in Pregnancy 14
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Setting the scene The extent of the
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Organisational difficulties Profess
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• Financial problems (including d
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The important role of partners need
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ecognises that a woman’s needs ar
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Guidelines on good practice This se
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An assessment of the partner’s dr
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Care management Some women with sub
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Introduction Information and guidel
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anxiety related problems and can in
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Drugs and their effects on the deve
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Effects of tobacco The significant
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Effects of drugs (illicit and presc
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• fetal death in-utero (miscarria
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Introduction Key points Setting Neo
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• poor feeding ability (hungry bu
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monitored. Any drug treatment admin
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� Swaddling of the baby will help
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Babies with severe symptoms usually
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Management of substance use in preg
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Scottish Executive advice recommend
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If a ‘hazardous’ drinking score
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Assessing drug related problems It
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Substitute prescribing Lothian has
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drug use should be the first goal t
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A final word: Over the years, much
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Amenorrhoea does not necessarily me
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Pre-conceptual advice on drug use c
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Antenatal care Receiving good quali
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the antenatal ward, labour ward, an
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usually possible to be quite reassu
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can be more serious in women with s
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Introduction Key Risk points assess
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for the women and can make attendan
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These documents contain important i
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Intrapartum care (labour and childb
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There may be placental insufficienc
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states she is taking the baby home
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Page 103 and 104: Women who are Hepatitis B positive
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Page 107 and 108: Postnatal care The care of a pregna
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Page 111 and 112: Introduction Assessing and managing
Page 113 and 114: A number of childcare problems have
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Page 117 and 118: Finally, it is important to remembe
Page 119 and 120: Services List Services providing ma
Page 121 and 122: with a drug dependency who are on s
Page 123 and 124: Drug services in Lothian Most speci
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Page 127 and 128: Alcohol services in Lothian Most sp
Page 129 and 130: Other services in Lothian A variety
Page 131 and 132: Introduction Key points Setting Fur
Page 133 and 134: � Royal College of Obstetricians
Page 135 and 136: General � Scottish Executive webs
Page 137 and 138: References Abel EL, (1998) ‘Fetal
Page 139 and 140: NICE (National Institute for Clinic
Page 141 and 142: Introduction Key points Setting the
Page 143 and 144: Drug/Alcohol related problem: refer
Page 147 and 148: INDEX Alcohol, 37-38, 52-56, 84 scr
Page 149 and 150: Introduction Key Appendices points
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Page 157 and 158: east fed after these are given. The
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Page 165 and 166: Introduction Appendix 4: Model Care
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Page 169 and 170: Introduction Key points Setting App
Page 175 and 176: Appendix 9: Introduction Midwifery
Page 177 and 178: Alcohol use (tick average weekly co
Page 179 and 180: Community Baby developed NAS sympto
Page 181 and 182: Neonatal Abstinence Syndrome Assess
Page 183 and 184: Drug Drug use use in in pregnancy p
Page 185 and 186: aby. If you want to come off, it is
Page 187 and 188: Labour Labour and and childbirth ch
Page 189 and 190: Midwifery Midwifery care care staff
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Page 193 and 194: Produced by NHS Lothian © 2003
Page 195 and 196: This leaflet provides you with info
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Page 199: Breastfeeding Breastfeeding and and
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Substance Misuse in Pregnancy - NHS Lothian

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