Drug Use During Pregnancy: The devastating effects to the infant FSU COHP 450 By: Elaine Spencer

PICO: In pregnant women, what are the effects of using drugs, compared to not using, on the developing fetus following delivery. Throughout the duration of this presentation, I have identified an area of interest, complete with credible research and design to support the focus of this power point. I have included evidence that will support the findings of my PICO question.

Searching... Search words: drugs, affect, pregnancy, infant Search engines: FLITE, Smart Search Results: 138 total, 77: Peer-reviewed journals, 120: full-text online, 14 at the FSU library

Research Articles Article 1: Bada, H.S., Bauer, C. R., (2002). Central and autonomic systems signs with in utero drug exposure. British Medical Journal. Retrieved from: http://fn.bmjjournals.com/content/87/2/F106.full.pdf+html Article 2: Ackerman, J., Riggins, T., Black, M., (2010). A review of the effects of prenatal cocaine exposure among school-aged children. The American Academy of Pediatrics. Retrieved from: http://pediatrics.aappublications.org/content/125/3/554.full.pdf

Rationale Findings focus at two different stages in infant and childhood development. Gestational age is not applicable Article 1: comparative study Article 2: dire long term effects Measured against the control group (meconium was negative for drugs) Dire effects show that once the withdrawal process is over, the infant and developing child continue to struggle through the course of normal developmental patterns.

Article 1 Theory used: Drug use during pregnancy affects the unborn baby’s central and autonomic nervous system. Type of study: Quantitative, Randomized, Analytic Design: Experimental design Methods: Quantitative- 89% met criteria for research, 70% consented, history of cocaine and opiate (heroin and methadone) usage during any stage of pregnancy. Meconium was collected and analyzed. Findings: The use of cocaine and/or opiates during pregnancy increases risk of CNS/ANS complications. Up to 62% increase of withdrawal symptoms in babies exposed to both cocaine and opiates. Type of study-analytic study: tests the difference between groups (drug use during pregnancy vs no drug use during pregnancy). Design-Experimental: randomization of the subjects and a control group. Reseachers identified and planned out the study using a pool of 11,811 couplets. Methods-

Article 2 Theory used: Prenatal cocaine use and effects it has on motor development on the two year old child Type of study: Analytic study Design: Quasi-experiment Methods: Cocaine exposed infants vs unexposed infants, Findings: Children prenatally exposed to cocaine suffer from impairments related to attention and behavioral self-regulation Quasi-non-randomized study

Findings Article 1: The use of cocaine and/or opiates during pregnancy increases risk of CNS/ANS complications. Up to 62% increase of withdrawal symptoms in babies exposed to both cocaine and opiates. Article 2: Comparative to an unstable environment. We see poor behavior choices and limited coping skills.

Ethics Choosing to safely treat drug addicted mothers through the pregnancy with drugs Caring for the withdrawing baby Caring for the mother following the delivery Treating infants with morphine or other controlled substances through the withdrawal period Sterilization for expectant mothers that continue to use and become pregnant time after time Anytime research and unborn babies come up, there are ethical points to address.

Article 1: Strength: High Quality and credibility: International, peer-reviewed journal written for health professionals and researchers Criteria used: Large random population was used Evidence based practice Criteria: based on proper/adequate meconium collection, participants were included or eliminated.

Article 2 Strength: High Quality and credibility: Highly respected publication viewed by respected pediatricians and medical personnel Generalizability: Focusing on children that were exposed to drugs in utero. Study can be replicated. Contributes to EBP: understanding the result of the drug exposure can lead to the development of procedures/programs to assist in the development of these kids.

Findings Developmentally Crossing the placenta

Relevancy to practice Both articles set out to prove the connection between perinatal drug use (cocaine and opiates) and the devastating effects on the infant through the withdrawal process and up to two years of age. The results of this study can be used to better treat pregnant drug addicts with other forms of controlled medicine, such as methadone or suboxone. These drugs, when controlled and titrated under a physician, can result in less adverse effects in the infant.

Communication/Implications Communication/Policy UDS-->perinatal addiction specialist doctor-->treatment Policy-treatment beginning at the prenatal visits and continuing through duration of pregnancy and delivery Communication would begin with the Obstetrician making a referral to the specialist to begin treatment. Plan of care would include the patient and caregiver(s). Policy change Quality and patient safety would both increase. Implications may surface if a UDS is negative, due to strategic timing by the patient, but continues to use throughout the pregnancy, thus having negative UDS’.

Barriers/PICO questions Dealing with an extremely selfish group of individuals Focus and priority is skewed due to their addiction Transportation to the specialist Push back/non-compliance with birth plan at the obstetrician level In pregnant women, what is the result or withdrawal severity on the infant, of treating drug addiction with methadone or suboxone compared with them using street drugs like cocaine or opiates?

Conclusions Harmful effects from drug use on the prenatal infant and developing child Depending on severity of usage, withdrawal process has varying degrees CPS and other governmental services involved See the effects in the classroom