Substance Misuse in Pregnancy - NHS Lothian

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encourages them to share their concerns. Allowing them to voice anxieties about poor outcome and their ambivalence about their current situation, including their substance use, treatment and so on can be therapeutic. Parents often complain that they are not ‘told enough’ and professionals comment that parents are ‘ill prepared’ or ‘ill informed’. In Lothian, an information booklet called ‘Pregnant… and using alcohol or drugs?’ is available (see appendix 11). This can be given to any woman with a drug and/or alcohol related problem in the antenatal period. The booklet is ‘user friendly’, outlining the general effects associated with drug use and advice about how to manage drug use during pregnancy. Women (and their partners) should be advised to read the booklet then discuss it with their midwife or other professional involved in their care. Evidence base It has been difficult to establish clear and reliable information about the effects of specific drugs on the developing fetus and baby. Much of the research is methodologically flawed and findings are inconsistent and contradictory. This is because well controlled studies are difficult to conduct and pregnancy outcome is multifactorial. It is the result of an interplay of genetic factors, physical and psychological health, nutrition, health and social care, social deprivation and other environmental influences as well as the effects of tobacco, alcohol and drug use. These confounding factors have made it difficult to establish cause-and-effect relationships. This is particularly true when relating specific intrauterine fetal drug exposure to long-term behavioural effects as the child grows up (Johnstone 1998). Drug and alcohol related problems are associated with poverty, unemployment, chaotic lifestyle, violence, poor physical and psychological health and poor uptake of health and social care. These other factors may therefore account for many of the findings reported in the research literature. There is also a moral dimension to what purports to be objective scientific evidence (Mounteney 1999). Reports of adverse effects are more likely to be published than research reporting no adverse effects, irrespective of the scientific validity of the research (Koren et al 1989). The following information on specific drug effects should be read with these limitations in mind. Substance Misuse in Pregnancy 36
Effects of tobacco The significant risks associated with maternal use of tobacco are particularly well established. There are many harmful substances contained in cigarettes. Nicotine, carbon monoxide and cyanide are thought to have the greatest adverse effects, reducing blood flow and oxygen to the fetus. Maternal smoking in the first 12 weeks of pregnancy (until the end of the 1 st trimester) is responsible for up to 25% of all low birth weight babies (Scottish Executive 2001). Smoking tobacco causes a reduction in birth weight greater than that from heroin and is a major risk factor in Sudden Infant Death Syndrome (Scottish Executive 2003). Although there is no convincing evidence that smoking cigarettes causes congenital birth defects, many other pregnancy complications are associated with smoking (Johnstone 1998). These include: • miscarriage • pre-term (premature) delivery • stillbirth • intrauterine growth restriction (IUGR) or ‘small for dates’ • low birth weight • placental abruption • reduction in breast milk production • Sudden Infant Death Syndrome (SIDS or ‘cot death’). Babies born to heavy smokers may also exhibit minor signs of withdrawal, including ‘jitteriness’ in the perinatal period (Scottish Executive 2003). Children of smokers also suffer more respiratory infections in childhood and adolescence. Effects of alcohol Alcohol use during pregnancy may potentially affect fetal brain development at any gestation. At all points along the continuum from occasional light drinking to regular heavy drinking there is conflicting evidence as to the possibility of damaging effects on the fetus (Mounteney 1999). It is important to remember that a ‘safe’ level of alcohol use in pregnancy has not been established. Substance Misuse in Pregnancy 37
Page 1 and 2: Substance Substance misuse misuse i
Page 3 and 4: This pack has been approved by Loth
Page 5 and 6: Page Drugs and their effects on the
Page 7 and 8: Appendices ........................
Page 9 and 10: Introduction Welcome to the ‘Subs
Page 11 and 12: Please note: 1. The terminology use
Page 13 and 14: Introduction Key points Setting the
Page 15 and 16: Pre-conceptual care � Agencies in
Page 17 and 18: Substance Misuse in Pregnancy 14
Page 19 and 20: Setting the scene The extent of the
Page 21 and 22: Organisational difficulties Profess
Page 23 and 24: • Financial problems (including d
Page 27 and 28: The important role of partners need
Page 29 and 30: ecognises that a woman’s needs ar
Page 31 and 32: Guidelines on good practice This se
Page 33 and 34: An assessment of the partner’s dr
Page 35 and 36: Care management Some women with sub
Page 37 and 38: Introduction Information and guidel
Page 39 and 40: anxiety related problems and can in
Page 41 and 42: Substance Misuse in Pregnancy 34
Page 43: Drugs and their effects on the deve
Page 47 and 48: Effects of drugs (illicit and presc
Page 49 and 50: • fetal death in-utero (miscarria
Page 51 and 52: Introduction Key points Setting Neo
Page 53 and 54: • poor feeding ability (hungry bu
Page 55 and 56: monitored. Any drug treatment admin
Page 57 and 58: � Swaddling of the baby will help
Page 59 and 60: Babies with severe symptoms usually
Page 61 and 62: Management of substance use in preg
Page 63 and 64: Scottish Executive advice recommend
Page 65 and 66: If a ‘hazardous’ drinking score
Page 67 and 68: Assessing drug related problems It
Page 69 and 70: Substitute prescribing Lothian has
Page 71 and 72: drug use should be the first goal t
Page 73 and 74: A final word: Over the years, much
Page 77 and 78: Amenorrhoea does not necessarily me
Page 79 and 80: Pre-conceptual advice on drug use c
Page 81 and 82: Antenatal care Receiving good quali
Page 83 and 84: the antenatal ward, labour ward, an
Page 85 and 86: usually possible to be quite reassu
Page 87 and 88: can be more serious in women with s
Page 89 and 90: Introduction Key Risk points assess
Page 91 and 92: for the women and can make attendan
Page 93 and 94: 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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Introduction Key points Setting the
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Women who are Hepatitis B positive
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Substance Misuse in Pregnancy 90
Page 107 and 108:
Postnatal care The care of a pregna
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Relapse prevention support work can
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Introduction Assessing and managing
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A number of childcare problems have
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� Report your concerns to the Chi
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Finally, it is important to remembe
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Services List Services providing ma
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with a drug dependency who are on s
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Drug services in Lothian Most speci
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Local drug services � Locality Cl
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Alcohol services in Lothian Most sp
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Other services in Lothian A variety
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Introduction Key points Setting Fur
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� Royal College of Obstetricians
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General � Scottish Executive webs
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References Abel EL, (1998) ‘Fetal
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NICE (National Institute for Clinic
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Drug/Alcohol related problem: refer
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Page 147 and 148:
INDEX Alcohol, 37-38, 52-56, 84 scr
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Introduction Key Appendices points
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Page 153 and 154:
Blood Borne Viruses and Pregnancy H
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Management of HIV positive pregnant
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east fed after these are given. The
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It is good practice therefore to of
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Introduction Appendix 4: Model Care
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Introduction Appendix 5: Key Consen
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Introduction Key points Setting App
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Page 175 and 176:
Appendix 9: Introduction Midwifery
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Alcohol use (tick average weekly co
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Community Baby developed NAS sympto
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Neonatal Abstinence Syndrome Assess
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Drug Drug use use in in pregnancy p
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aby. If you want to come off, it is
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Labour Labour and and childbirth ch
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Midwifery Midwifery care care staff
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Helpful Helpful numbers numbers My
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Produced by NHS Lothian © 2003
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This leaflet provides you with info
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Parents are encouraged to keep a cl
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Breastfeeding Breastfeeding and and
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Substance Misuse in Pregnancy - NHS Lothian

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