| A. |
Possible effects on reproduction and fertility |
|
| 1. |
Males: |
|
| a. |
Lowered testosterone levels |
| b. |
Diminished sexual drive |
|
| 2. |
Females: |
|
| a. |
Amenorrhea (cessation of menstrual cycle) |
| b. |
Menstrual irregularity |
| c. |
Decrease in sexual desire |
|
|
| B. |
Possible effects on the developing fetus |
|
| 1. |
Low birth weight (may be secondary to
prematurity or IUGR) |
| 2. |
Small head circumference |
| 3. |
Average birthweight: 2500 grams |
| 4. |
Meconium aspiration |
| 5. |
Prematurity |
| 6. |
Neonatal abstinence syndrome (approximately
60-80 percent of heroin-exposed infants) potentially involving several body systems |
|
| a. |
Central Nervous System |
| b. |
Gastrointestinal System |
| c. |
Respiratory System |
| d. |
Autonomic Nervous System |
|
| 7. |
Stillbirth |
| 8. |
Sudden Infant Death Syndrome |
| 9. |
Sexually transmitted diseases |
| 10. |
Delayed effects |
| 11. |
No effect |
|
| C. |
Possible effects on the course of pregnancy |
|
| 1. |
Pre-eclampsia (pregnancy-induced hypertension) |
| 2. |
Anemia |
| 3. |
Premature rupture of membranes |
| 4. |
Abruptio-placentae |
| 5. |
Meconium-stained amniotic fluid (with fetal
withdrawal) |
| 6. |
Maternal withdrawal during pregnancy may result
in fetal death |
| 7. |
Hypoxia (oxygen deficiency) |
| 8. |
Maternal appetite suppressed |
| 9. |
Intrauterine growth retardation (IUGR) |
| 10. |
Toxemia |
| 11. |
Miscarriage |
| 12. |
Infections |
| 13. |
Breech presentation (abnormal presentation due
to premature delivery) |
| 14. |
Preterm labor |
| 15. |
No effect |
|
| D. |
Possible effects on the mother |
|
| 1. |
Poor nourishment |
| 2. |
Vitamin, iron and folic acid deficiency |
| 3. |
Medical complications from frequent use of dirty
needles |
| 4. |
Sexually transmitted diseases |
| 5. |
Hypertensive disorder |
| 6. |
No effect |
|
| E. |
Labor and delivery |
|
| 1. |
Patients may require higher amounts of
anesthesia |
| 2. |
Narcan is contraindicated for use in
labor and delivery; it may produce severe withdrawal |
|
| F. |
Postpartum |
|
| 1. |
Mother |
|
| a. |
Breast feeding is contraindicated for heroin
using women and for all women who are HIV positive and/or who inject with needles |
| b. |
Symptoms of opioid withdrawal syndrome |
|
| • |
Rarely life-threatening or permanently disabling |
| • |
Methadone substitution is standard treatment;
consists of |
|
| * |
High-dose blockage (50 to 150 mg per day) |
| * |
Low-dose maintenance (less than 60 mg per day) |
| * |
Medical withdrawal |
|
| - |
not recommended in pregnancy because of the increased
risk of intrauterine death |
|
|
| • |
In addition to methadone maintenance a
comprehensive approach provides psychosocial counseling and other services |
|
|
| 2. |
Child |
|
| a. |
Neonate |
|
| • |
3 times higher rate of perinatal mortality |
| • |
Metabolic disturbances |
| • |
Hypoglycemia (7 percent) |
| • |
Narcan is contraindicated |
|
| b. |
Heroin withdrawal in the neonate; neonatal
abstinence syndrome (NAS) |
|
| • |
Heroin withdrawal occurs within the first 24-48
hours after birth |
| • |
May be related to gestational age and weight |
| • |
Typical withdrawal symptoms |
|
| * |
CNS |
|
| - |
High-pitched crying |
| - |
Frantic fist sucking or searching for food |
| - |
Early seizures (in only about 1 percent of babies) |
| - |
High level of arousal with muscle hypertonia |
|
| * |
Gastrointestinal |
|
|
| * |
Respiratory |
|
| - |
Rapid, heavy breathing |
| - |
Cyanosis (insufficient oxygen in the blood resulting
in bluish discoloration) |
|
| * |
Autonomic Nervous System |
|
| - |
Sweating |
| - |
Tearing |
| - |
Fever |
|
|
|
|
|
University of Nevada, Reno
