Substance Misuse in Pregnancy - NHS Lothian

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Routine antenatal screening at booking At the booking appointment, the community midwife will also offer ‘routine antenatal screening’. Blood samples are taken for: HIV, hepatitis B, rubella, syphilis, blood group and a full blood count. Please note the following regarding blood borne viruses: • Women who are currently injecting drugs or who have a history of injecting drug use may be at risk of HIV, hepatitis B and hepatitis C. • The hepatitis B vaccine can be given safely in pregnancy and should be offered to all women who are likely to inject drugs in pregnancy or whose partner is an injecting drug user. • The Hepatitis C antibody test is not offered routinely as part of antenatal care in Lothian, however it should be offered to all pregnant women at risk. • Many women who use drugs may not have a history of injecting themselves, but may have a partner who does. • Non-drug using women may be at risk of blood borne virus infection if they have unprotected sex with an infected man. For more detailed information on antenatal testing for HIV, hepatitis B and C and the management of positive women and their babies see appendix 1. Other screening and diagnostic tests Numerous screening and diagnostic procedures are offered during pregnancy. These are especially important for drug and alcohol using women who may be at increased risk of pregnancy complications. Drug use is associated with an increased risk of intrauterine growth restriction (IUGR) so care should be taken to assess fetal growth by clinical examination, ultrasound and antenatal fetal monitoring. Staff should be careful to explain the reasons for any additional tests sensitively to the woman. Ultrasound scan is normally arranged for 10 – 14 weeks. It is important partly to confirm gestational age, but also to provide the mother with a positive experience of the hospital. Substance-misusing women often worry about fetal abnormality more than any other problem and feel guilty about the damage they may have caused their baby. In general, it is Substance Misuse in Pregnancy 72
usually possible to be quite reassuring (Johnstone 1998). Detailed fetal anomaly scanning is not normally required as substance misuse is not associated with an increased risk of structural fetal abnormality. The only exceptions would be with heavy alcohol consumption (>8 units/day), cocaine or amphetamine use. Attendance for fetal monitoring (cardiotocography or CTG) may sometimes be necessary for substance-misusing women, particularly if growth restriction (IUGR) is established. Please note however that there may be reduced activity (loss of variability and accelerations) following ingestion of opiates, benzodiazepines and alcohol. Repeat or extended monitoring is sometimes required. The biophysical profile is less affected and will usually be normal even after ingestion of drugs. Another fetal monitoring test, the umbilical artery doppler assessment, can identify vascular problems in the placenta, which can lead to distress or death. This test might be necessary for women who are heavy users of stimulant drugs (such as cocaine or amphetamines) or women in whom IUGR is demonstrated by ultrasound. Some women drug users (for instance those working in the sex industry) are at higher risk of sexually transmitted and other vaginal infections. Because infections are a risk factor in pre-term labour and delivery it is important to detect and treat all infections in pregnancy. Screening for chlamydia, gonorrhoea, bacterial vaginosis and Group B streptococcus should be considered. Some women (in particular HIV positive and immuno-compromised women) may also be at greater risk of cervical intraepithelial neoplasia (CIN) and may not have attended for routine cytological screening (cervical smears). Pregnancy can be a good opportunity to attract women into cytological surveillance, certainly in the 1 st and early 2 nd trimester. Pregnancy complications Other complications can occur in substance-using women but not much more frequently than other women, with the exception of women using large amounts of stimulants, such as cocaine (Johnstone 1998). Substance Misuse in Pregnancy 73
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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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Page 37 and 38: Introduction Information and guidel
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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 and 52: Introduction Key points Setting Neo
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Page 55 and 56: monitored. Any drug treatment admin
Page 57 and 58: � Swaddling of the baby will help
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Page 63 and 64: Scottish Executive advice recommend
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Page 67 and 68: Assessing drug related problems It
Page 69 and 70: Substitute prescribing Lothian has
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Page 73 and 74: A final word: Over the years, much
Page 75 and 76: Introduction Key points Setting the
Page 77 and 78: Amenorrhoea does not necessarily me
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Page 81 and 82: Antenatal care Receiving good quali
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Page 89 and 90: Introduction Key Risk points assess
Page 91 and 92: for the women and can make attendan
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Page 95 and 96: Intrapartum care (labour and childb
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Page 101 and 102: Introduction Key points Setting the
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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
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Page 125 and 126: Local drug services � Locality Cl
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
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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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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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