• Effects on the developing fetus
• Effects on the pregnancy
• Labor and delivery
• Postpartum
  * mother
  * neonate
• Withdrawal
• Treatment for exposed neonate

1

• Effects on reproduction/fertility
  * males
  * females
• Effects on the developing fetus
• Effects on the pregnancy
• Effects on the mother
• Labor and delivery
• Postpartum
  * mother
  * neonate

4

• LAAM
• Buprenorphine

6

• Inpatient medical withdrawal with continual monitoring of mother and fetus recommended for:
  * Barbiturates
  * Benzodiazepines
  * Other sedative-hypnotic drugs
• Consideration for withdrawal from sedative-hypnotics during pregnancy
  * severe withdrawal can produce epilepticus and maternal/fetal respiratory arrest
  * use of anticonvulsants have been associated with congenital anomalies

7

• Higher incidence of preterm birth
• Low birth weight
• Reduced length
• Reduced head circumference
• Possible genitourinary malformations
• Increased minor congenital anomalies
• Possible intrauterine CVA

10

• Embryopathy
• Fetal intracerebral hemorrhages
• Maternal CVA
• Risk of HIV
• Abruptio placentae
• Spontaneous abortion
• Fetal hypoxia
• Premature ruptured membranes
• Premature labor
• Fetal demise

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• Intrauterine growth retardation
• Reduced head circumference
• Neurobehavioral abnormalities
• CNS irritability
• Increased risk of SIDS
• Increased congenital anomalies
• Increased possibility of HIV
• CNS hemorrhagic-ischemic lesions
• Feeding difficulties
• Cerebral infarction and seizures
• Congenital infections
• Cardiovascular dysfunction
• Vascular disruption syndrome
• Post-excitatory depression
• Delayed effects

13

• Sound primary nursing care
• Gentle handling
• As few caretakers as possible
• Avoidance of stimuli

16

• Monitor feeds
• Facilitate intake for infants experiencing feeding difficulties
• Observe for inflammation of the mucous membrane of the small intestine or colon
• Teach parent-infant interaction

17

• Preterm infants
• Head circumference below the 10th percentile
• Abnormal neurologic signs
• Neurobehavioral dysfunction
• Seizure activity

19

• CNS stimulation
• Increased cardio-respiratory activity
• Decreased blood flow to placenta
• CVA
• Risk of HIV infection

21

• Males
  * Lowered testosterone levels
  * Diminished sexual drive
• Females
  * Cessation of menstrual cycle
  * Menstrual irregularity
  * Decrease in sexual desire

23

• Low birth weight
• Small head circumference
• Average birth weight 2500 grams
• Meconium aspiration
• Prematurity
• Neonatal Abstinence Syndrome
• Stillbirth
• Sudden Infant Death Syndrome
• Sexually transmitted diseases
• Delayed effects

24

• Poor nourishment
• Sexually transmitted diseases
• Hypertensive disorder
• Deficiencies of:
  * Vitamins
  * Iron
  * Folic acid
• Medical complications from use

26

• Breast feeding contraindicated
• Symptoms of opioid withdrawal
  * rarely life-threatening
  * rarely permanently disabling
  * methadone substitution
     - 50 to 100 mg/day; high dose
     - 60 mg/day; low dose
     - medical withdrawal not
     recommended
• * additional psychosocial counseling and other services

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• Initial oral dose to reverse opioid abstinence syndrome
  * additional doses repeated until signs of withdrawal not present
• Adjust dose by 5 to 10 mg daily based on signs/symptoms of withdrawal
• Keep at stabilization level for several days

30

• May have lower pain threshold
• May not respond to narcotics in usual doses
• Narcan is contraindicated

31

• Breast feeding is not contraindicated if NOT polydrug user or HIV positive
• The advantages of breast feeding outweigh the disadvantages of methadone passing through the breast milk

33

• Narcan is contraindicated
• Birth weight may be reduced
• Head circumference may be reduced
• Reduced perinatal mortality
• Seizures
• Thrombocytosis
• Hyperthyroid state
• Delayed effects
• SIDS occurrence 3 to 4 times higher than normal population

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• Systematic examinations
• Pharmacological interventions
  * Paragoric
  * Phenobarbitol
• Environmental modifications
  * Reduce stimuli
  * Swaddling
  * Use non-oscillating waterbed
  * Comfort in a prone or lateral position

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• Possible maternal effects
• Fetal effects
• Neonatal/infant effects
• More studies needed

2

• Effects on reproduction and fertility
  * males
  * females
• Effects on the pregnancy
• Postpartum
  * mother
  * neonate

3

• Effects on reproduction/fertility
• Benefits of methadone maintenance for pregnant, opioid dependent women
• Effects on the developing fetus
• Effects on the pregnancy
• Methadone dosing strategy
• Labor and delivery
• Postpartum
  * lactation
  * neonate
• Treatment for neonate

5

• Never positively linked to birth defects
• Never positively linked to chromosomal damage
• Increased rate of spontaneous abortion

8

• Effects on the neonate
  * increased state lability
  * decreased consolability
  * PCP withdrawal syndrome
  * jitteriness
  * poor visual coordination
  * abnormal muscle tension

9

• Cocaine found in breast milk
• Breast feeding contraindicated
• HIV testing and counseling recommended
• Consider infectious comorbidities when counseling for breast feeding

12

• Characterized by:
  * depression
  * anxiety
  * lethargy
  * paranoid psychosis
• Medication administered only:
  * in cases of extreme agitation
  * by order of health care provider

14

• Optimal nursery environment
• Facilitate and promote optimal infant growth and development
• Neonatal neurotoxicity assessment
• Pharmacotherapy
• Cranial sonograms
• Assessment for congenital malformation/vascular disruptions

15

• Behaviors
• State
• Characteristics in changes of state
• Neurological development
• Motor development

18

• Systems that may be affected
  * genitourinary tract
  * cardiovascular
  * gastrointestinal tract
  * skeletal

20

• Reproduction and fertility
  * males
     - lowered sperm counts
     - altered sperm morphology
  * females
     - irregular menstrual cycles
     - ovulation abnormalities
  * temporary infertility
  * effects appear reversible when use stops
• The course of pregnancy
  * marijuana readily crosses the placenta
     - Transfer appears higher
     early in pregnancy than in
     third trimester
     - THC may cause higher male
     to female sex ratio in offspring
• Postpartum
  * mother
     - THC in breast milk
     - breast feeding not
     recommended
  * neonate
     - tremulousness
     - altered visual response
     patterns to light
     - shrill crying
     - sleep and arousal patterns

22

• Pre-eclampsia
• Anemia
• Premature rupture of membranes
• Abruptio-placentae
• Meconium-stained amniotic fluid
• Hypoxia (oxygen deficiency)
• Maternal appetite suppressed
• Intrauterine growth retardation
• Toxemia
• Miscarriage
• Infections
• Breech presentation
• Preterm labor
• Maternal withdrawal during pregnancy may result in fetal death

25

• Perinatal mortality 3 times higher
• Metabolic disturbances
• Hypoglycemia (7%)
• Narcan contraindicated

28

• CNS
  * High-pitched crying
  * Frantic fist sucking
  * Frantic searching for food
  * Early seizures (about 1%)
  * High level of arousal with muscle hypertonia
• Gastrointestinal
  * Vomiting
  * Diarrhea
• Respiratory
  * Rapid, heavy breathing
  * Insufficient oxygen in blood
• Autonomic nervous system
  * Sweating
  * Tearing
  * Fever

29

• Reduction of illegal drug use
• Removal from drug-seeking environment
• Eliminates illegal behavior
• Prevents fluctuation of drug levels
• Improves maternal nutrition
• Leads to consistent prenatal care
• Reduces obstetrical complications
• Reduces risk of HIV
• Enhances homemaking

32

• Typically more severe than heroin
• Occurs within 2-3 days of birth
• Can occur at 2-3 weeks of age
• Can persist up to 6 months of age
• Typical CNS withdrawal symptoms (5%; peaks 7-14 days)
  * high pitched crying
  * searching for food
  * frantic fist sucking
  * seizures
  * high level of arousal
  * hypertonia

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