Substance Misuse in Pregnancy - NHS Lothian

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Neonatal Abstinence Syndrome (NAS) A group of drug withdrawal symptoms referred to as Neonatal Abstinence Syndrome (NAS) can occur in infants born to mothers dependent on certain drugs. NAS occurs because, at birth, the infant is cut off from the maternal drug supply to which it has been exposed in utero. NAS is the most commonly reported adverse effect of dependent drug use in pregnancy. In Lothian, approximately 40 babies present with NAS each year and this number is likely to increase with the increasing prevalence of substance misuse. The classes of drugs that are known to cause NAS include the opioids, benzodiazepines, alcohol, and barbiturates. Classical symptoms of NAS have not been consistently reported with solvents, hallucinogens, cannabis and most stimulants (Scottish Executive 2003). NAS symptoms are generally non-specific to the class of drug and differ from drug withdrawal symptoms seen in adults. NAS is well described in babies born to opiate dependent women. The majority of infants born to dependent mothers (60-90%) will show varying symptoms of NAS. Signs and symptoms of NAS NAS is characterised by central nervous system irritability, gastrointestinal dysfunction and autonomic hyperactivity. The following signs and symptoms have been reported in babies born to opiate and benzodiazepine dependent women (including polydrug users) and describe the more severe range of symptoms that a baby may display: • irritability (marked tremor, easily startled, increased reflexes and excessive crying) • hyperactivity (excessive body movements, face scratching) • hypertonicity (increased muscle tone and rigidity) • a fairly continuous high-pitched cry • inability to settle or sleep after feeds • excessive sucking (including fist sucking) • increased appetite Substance Misuse in Pregnancy 43
• poor feeding ability (hungry but difficulty in sucking, swallowing and successfully completing a feed) • regurgitation and vomiting • frequent loose stools or diarrhoea (which cause peri-anal excoriation) • poor weight gain or weight loss • repetitive sneezing, yawning, hiccoughs, nasal stuffiness • tachypnoea (rapid shallow breathing) • respiratory depression • increased pulse and heart rate • temperature instability, fever (>37.5 C), sweating and dehydration • mottling (discolouration of skin) • excoriation (skin abrasions) from excessive movement (usually seen around the buttocks, back of the head, shoulders, and heels) • seizures (fits) Seizures occur rarely (in approximately 5% of infants) and may manifest up to 30 days after birth (mean age of onset is 10 days). The onset, duration and severity of NAS symptoms vary greatly and depend on many factors, including the: • type of drugs used • duration of mother’s dependency • timing and amount of the mother’s last dose • metabolism and elimination of the drug by the infant, as well as the • gestational age of the infant. Data on possible dose related effects of methadone are inconclusive (Johnstone 1998). Some studies show no correlation between maternal methadone dose and the development or severity of NAS. Others have found a weak positive correlation. Little data exists on the dose related effects of maternal benzodiazepine use. Symptoms normally present within the first 24 - 72 hours of birth (in approximately 75% of cases). Methadone withdrawal in the neonate can present later than heroin withdrawal. Methadone withdrawal symptoms can also last longer and be more severe (Sparey & Wilkinshaw 1999). The onset of benzodiazepine withdrawal in neonates can also be delayed (due Substance Misuse in Pregnancy 44
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
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Page 43 and 44: Drugs and their effects on the deve
Page 45 and 46: Effects of tobacco The significant
Page 47 and 48: Effects of drugs (illicit and presc
Page 49 and 50: • fetal death in-utero (miscarria
Page 51: Introduction Key points Setting Neo
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
Page 95 and 96: Intrapartum care (labour and childb
Page 97 and 98: There may be placental insufficienc
Page 99 and 100: states she is taking the baby home
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Women who are Hepatitis B positive
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Substance Misuse in Pregnancy 90
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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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Introduction Key points Setting the
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Drug/Alcohol related problem: refer
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INDEX Alcohol, 37-38, 52-56, 84 scr
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Introduction Key Appendices points
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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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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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