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Chapter 40. Perinatal Substance AbuseDrug Dependence, Motherhood, and the Newborn

Loretta P. Finnegan, M.D.; Stephen R. Kandall, M.D.
DOI: 10.1176/appi.books.9781585623440.356218

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Excerpt

The perinatal period should be regarded as a continuum that extends from the beginning of a woman's pregnancy through delivery and the first month of a child's life. Although in this chapter we discuss discrete drugs, clinicians must be aware that the use of any psychoactive drug during pregnancy may mean that other psychoactive agents are being used concomitantly. Perinatal effects may therefore reflect pharmacological effects of individual agents or the combined effects of multiple drugs. In all cases, substance use during pregnancy must be considered to be high risk from general medical, obstetric, neonatal, pediatric, and psychosocial standpoints. It is extremely important, however, to recognize that providing comprehensive, supportive, nonjudgmental care for the pregnant woman and her family in a well-integrated, multidisciplinary setting offers a unique opportunity to restructure the woman's life in a positive direction.

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FIGURE 40–1. Family center schema for treatment of drug dependency in the perinatal period and aftercare.Note. DHHS = Department of Health and Human Services; DPW = Department of Public Welfare; WIC = Special Supplemental Nutrition Program for Women, Infants, and Children.Source. Adapted from Finnegan et al. 1991.

FIGURE 40–2. Neonatal abstinence scoring sheet used for the assessment of infants undergoing neonatal abstinence.Note. Evaluator should check sign or symptom observed at various time intervals. Scores should be added to determine total at each evaluation.Source. From Finnegan et al. 1975.
Table Reference Number

Because polysubstance use is common, proper evaluation and treatment of the substance-exposed infants rest with accurate assessment of maternal drug-taking patterns.

Neonatal opiate abstinence, consisting of central nervous system, respiratory, gastrointestinal, and autonomic signs, is best treated with an opiate such as tincture of opium, with a severity scoring scale used as a guide to management.

Neurotoxicity secondary to stimulant (cocaine, amphetamines) exposure consists of mainly neurological and neurobehavioral findings; the use of a supportive and comforting individual environment usually makes specific pharmacotherapy unnecessary.

Recent reports linking selective serotonin reuptake inhibitors to fetal and neonatal problems underscore the need for vigilance whenever new drugs are prescribed during pregnancy.

Because more women consume alcohol during pregnancy than they do all illicit drugs combined, it is important to remember that fetal alcohol spectrum disorders range from subtle to severe and are permanently disabling.

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In its 1992–1993 National Pregnancy and Health Survey, the National Institute on Drug Abuse (1996) used cross-sectional analysis to estimate the incidence of maternal drug use during pregnancy. Which illicit drug was most commonly used?
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There are approximately 15,000 children in the United States who have contracted HIV. What percentage contracted the virus from their mothers during pregnancy or birth?
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Signs of neonatal abstinence syndrome from opiates include central nervous signs, gastrointestinal signs, respiratory signs, and autonomic nervous signs. Which of the following is not a common central nervous sign?
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