1. Pregnancy and Drug Abuse Eva Janecek-Rucker

2. Learning Objectives 1.To develop a knowledge base of the effects of substances of abuse (e.g., alcohol, cocaine, nicotine et al.) during pregnancy. 2.To examine the pharmacist’s role and develop a comfort level with respect to prevention, counselling and referral of women planning pregnancy as well as those who are pregnant and using psychoactive substances.

3. Drugs in Pregnancy CNS depressants –alcohol –benzodiazepines –barbiturates –inhalants (toluene; often combined with alcohol) CNS stimulants –cocaine –caffeine –nicotine

4. Drugs in Pregnancy Hallucinogens –cannabis –LSD Opioids –codeine, morphine –heroin

5. Interpretation of Results Animal studies Prenatal drug exposure (dose, timing, duration) Withdrawal Breastfeeding

6. Issues with Illicit Drug Use During Pregnancy Drug –authenticity –dose –additives Pharmacological effects Multiple drug use Injection drug use Effect of father’s drug use

7. Issues (cont’d) Lack of prenatal care Poor diet Smoking Drinking Violence

8. Alcohol Fetal Alcohol Spectrum Disorder (FASD) High risk: woman drinking 6 standard drinks/day during the first trimester Signs of FAS: –prenatal and postnatal growth retardation –CNS dysfunction (often including mental retardation) Facial dysmorphology Other congenital abnormalities Fetal alcohol effects (FAE)

12. Alcohol (cont’d) No safe level established –a Canadian committee recommended abstinence ‘ or at least to limit consumption to less than 4 drinks per week ’

13. Alcohol (cont’d) Treatment of a pregnant alcoholic –diazepam loading for alcohol withdrawal Disulfiram -contraindicated in pregnancy Naltrexone ?

14. Solvents Effects similar to FAS: –CNS dysfunction –Attentional deficits –Growth deficiency –Development delay –Facial dysmorphology

15. Benzodiazepines Likely not teratogenic; cleft lip/palate??? Neonatal withdrawal symptoms

16. Barbiturates and other hypno-sedatives No evidence of teratogenicity Neonatal withdrawal syndrome Treatment: phenobarbital

17. Cocaine Spontaneous abortion Prematurity Intrauterine growth retardation Abruptio placentae Perinatal cerebral infarction Structural CNS abnormalities Urogenital abnormalities Concomitant use of other drugs (alcohol and benzodiazepines)

18. Nicotine Spontaneous abortion Low birth weight Perinatal mortality Prematurity Abruptio placentae Congenital malformations (most studies show lack of) Sudden infant death syndrome (SIDS)

19. Caffeine Low dose - no effect High dose: –in animals - adverse effects –in humans - ?

20. Heroin Fetal distress or death during withdrawal in utero Decreased birth weight Higher incidence of  Infections  medical complications  obstetrical complications Neonatal withdrawal SIDS

21. Heroin (cont’d) Treatment of pregnant woman methadone

22. Cannabis Decreased birth weight Prematurity Effect of tar No congenital abnormalities

23. LSD Limb defects CNS abnormalities Ocular abnormalities

24. Pharmacist’s Role Identification Information Referral

25. Resources Alcohol and Drug Assessment and Treatment Services Motherisk: www.motherisk.org (416) 813-6780 www.pregnets.org Information sources –Textbooks  Drugs in Pregnancy and Lactation 6 th Edition, GG Briggs, RK Freeman, SJ Yaffe (eds), 2001  Maternal-Fetal Toxicology: A Clinician’s Guide 2 nd Edition, G Koren (ed), 1994 –Journals