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Maternal Drug Use

Maternal Drug Use. How to Create the Best Offspring or Not … Alison Freeman, Geleen Antonio, Jae Eun Kim, Matthew White, and Sydney Shera. Overview. Development Babies and mommies Cocaine Moms Babies Heroin Moms Babies Other bad decisions. Review. You take a drug

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Maternal Drug Use

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  1. Maternal Drug Use How to Create the Best Offspring or Not … Alison Freeman, Geleen Antonio, Jae Eun Kim, Matthew White, and Sydney Shera

  2. Overview • Development • Babies and mommies • Cocaine • Moms • Babies • Heroin • Moms • Babies • Other bad decisions

  3. Review • You take a drug • Hopefully feel good • Brain notices NT difference • Brain adapts to this • Up-regulation • Down-regulation • Life decision • Rehab / withdrawal

  4. Pregnancy http://www.google.com/imgres?imgurl=http://katemoller.com/wp-content/uploads/2010/10/iStock_000008922315XSmall.jpg&imgrefurl=http://katemoller.com/a-healthy-dose-of-ecstacy/&usg=__QHNfRMMCwiyeLhkGP4vL7x2_toQ=&h=282&w=425&sz=60&hl=en&start=31&sig2=I_1y8wDSHPTtjCrN8KrPTA&zoom=1&tbnid=gethF2oCyfBCDM:&tbnh=117&tbnw=183&ei=0ghoTYPDL42ssAPOp92mBA&prev=/images%3Fq%3Dbabies%2Band%2Becstasy%26hl%3Den%26gbv%3D2%26biw%3D1003%26bih%3D564%26tbs%3Disch:10%2C869&itbs=1&iact=hc&vpx=701&vpy=117&dur=4328&hovh=183&hovw=276&tx=215&ty=101&oei=ywhoTbzGH4GssAPh7eCoBA&page=3&ndsp=16&ved=1t:429,r:4,s:31&biw=1003&bih=564

  5. Pregnancy Basics • Consists of a Mom and a growing ‘baby’ • ‘baby’ development • Genes, embryos, development • Average duration 42 weeks • One cell  a mini-person • 10 – 25 % of recognized pregnancies  miscarriages • Birth defects occur in 150,000 America babies per year

  6. http://www.google.com/imgres?imgurl=http://www.cerebralpalsychildren.com/CP1.jpg&imgrefurl=http://www.cerebralpalsychildren.com/CPFetal.html&usg=__0-oqJOJ9ROBuxUo59HhmaH1W3_o=&h=606&w=894&sz=91&hl=en&start=0&sig2=o1wSmbVQveFriw9-8kseFQ&zoom=1&tbnid=M6kLfgXXVJNokM:&tbnh=111&tbnw=164&ei=hSdoTbbOFIHAsAP5tuioBA&prev=/images%3Fq%3Dfetal%2Bdevelopment%26hl%3Den%26gbv%3D2%26biw%3D1003%26bih%3D564%26tbs%3Disch:1&itbs=1&iact=hc&vpx=603&vpy=124&dur=266&hovh=185&hovw=273&tx=120&ty=73&oei=hSdoTbbOFIHAsAP5tuioBA&page=1&ndsp=15&ved=1t:429,r:3,s:0http://www.google.com/imgres?imgurl=http://www.cerebralpalsychildren.com/CP1.jpg&imgrefurl=http://www.cerebralpalsychildren.com/CPFetal.html&usg=__0-oqJOJ9ROBuxUo59HhmaH1W3_o=&h=606&w=894&sz=91&hl=en&start=0&sig2=o1wSmbVQveFriw9-8kseFQ&zoom=1&tbnid=M6kLfgXXVJNokM:&tbnh=111&tbnw=164&ei=hSdoTbbOFIHAsAP5tuioBA&prev=/images%3Fq%3Dfetal%2Bdevelopment%26hl%3Den%26gbv%3D2%26biw%3D1003%26bih%3D564%26tbs%3Disch:1&itbs=1&iact=hc&vpx=603&vpy=124&dur=266&hovh=185&hovw=273&tx=120&ty=73&oei=hSdoTbbOFIHAsAP5tuioBA&page=1&ndsp=15&ved=1t:429,r:3,s:0

  7. Effects of Cocaine and Heroin on the Pregnant Woman and Co. http://www.google.com/imgres?imgurl=http://www.onlinenewsreporters.com

  8. The Effects of Heroin & Cocaine on the Normal Physiology of Pregnancy • Placental abruption: -Placental lining has separated from the mother’s uterus , causing late pregnancy bleeding within uterus, which can ultimately result in maternal mortality. -Fetal membranes prematurely rupture, triggering pre-term labor.

  9. How Drugs Cross the Placenta http://www.merckmanuals.com/home/sec22/ch259/ch259a.html

  10. Cocaine http://www.google.com/imgres?imgurl=http://www.topnews.in/usa/files/pregnant-ladyhttp://www.google.com/imgres?imgurl=http://www.drugnet.net

  11. The Effects of Cocaine on the Normal Physiology of Pregnancy • Pre-term labor, Pre-term delivery: -Cocaine use during pregnancy may cause the down-regulation of myometrial (middle layer of uterine wall) beta-adrenergic receptors HOW? http://www.google.com/imgres?imgurl=http://www.epigee.org

  12. Mechanism (Cocaine inhibits the reuptake of 5-HT, NE, and E) Normally NE and E bind to Beta-2 adrenergic receptors in the smooth muscles of the uterine walluterine relaxation Cocaine Use An increase in NE and E in the synapse over-activates the myometrial Beta-2 adrenergic receptors -Over time, down-regulation of these receptorsprevent over-activation -Down-regulation of myometrial Beta-2 adrenergic receptors prevents normal uterine relaxation, prolonging the contraction state and inducing pre-term labor and pre-term delivery Norepinephrine Epinephrine Cocaine http://www.google.com/imgres?imgurl=http://images.wikia.com/psychology/images http://www.google.com/imgres?imgurl=http://www.edinformatics.com http://www.google.com/imgres?imgurl=http://3.bp.blogspot.com

  13. The Effects of Cocaine on the Normal Physiology of Pregnancy • Normal pregnancy: Vasodilation occurs due to increased levels of progesterone. This vasodilation may be counteracted by cocaine-induced vasoconstriction • Hyperthermia caused by vasoconstriction • An increase in [E]synaptic from cocaine usevasoconstriction, resulting in the retention of heathyperthermia • Cocaine-induced maternal hyperthermiafetal prematurity, low birth weight, and fetal death. --May also alter the mother’s mental status

  14. Epinephrine Causes Vasoconstriction and Progesterone Causes Vasodilation http://www.google.com/imgres?imgurl=http://www.pgbeautygroomingscience.com/assets/images

  15. The Socio-political Effects of Cocaine on the Pregnant Woman • The Anti-Drug Abuse Act of 1986 –mandatory minimum sentencing time for cocaine use/possession • A negative unforeseen affect: pregnant woman who abuse cocaine are less likely to seek prenatal care, drug treatment, and other social services; may lead to unnecessary abortions • Very few US drug treatment programs will admit pregnant women • Minority women constitute 80% of those prosecuted for delivering drug-abused babies, regardless of equal levels of drug use in pregnant Caucasian women.

  16. How a drug affects a fetus depends on… • The fetus’s stage of development • Early in pregnancy (within 20 days after fertilization) • Between 3rd and 8th week after fertilization • After organ development • The strength & dose of the drug http://adoption.families.com/blog/considerations-in-adoption-prenatal-drug-and-alcohol-exposure

  17. What are the risks with use of cocaine during pregnancy? • Increased risk of miscarriage • Preterm labor • Premature & low-birth weight • 3 to 6 times more likely to be born at a low birth weight (less than 5.5 pounds) • Smaller heads

  18. More problems… • Placental & urinal tracts problems • Physical condition & overall responsiveness • Sudden Infant Death Syndrome (SIDS) • Dependence & withdrawal symptoms http://www.thepanamadigest.com/2010/04/daddys-baby-grabs-1400-kilos-of-cocaine/ http://www.drugcouncil.tc/cocaine.html

  19. What is the long-term outlook for babies who were exposed to cocaine before birth? • Negative effects of cocaine exposure is permanent • Normal intelligence but subtle learning & behavioral problems • Lower IQ • Language delays & attention problems • Deficits in cognitive & emotional development

  20. http://www.google.com/imgres?imgurl=http://tothewire.files.wordpress.com/2008/12/heroin.gif&imgrefurl=http://tothewire.wordpress.com/2008/12/01/swiss-approve-pioneering-legal-heroin-program/&usg=__ZPbm9ae-kHUSTu0LygOHtm7uy2E=&h=400&w=400&sz=49&hl=en&start=0&sig2=R7FaNkAz2UskHWdzraYiqg&zoom=1&tbnid=cL3i26vnbAlUiM:&tbnh=122&tbnw=121&ei=FC5oTbLvBZOssAP0w9SoBA&prev=/images%3Fq%3Dheroin%26hl%3Den%26biw%3D1020%26bih%3D564%26gbv%3D2%26tbs%3Disch:1&itbs=1&iact=hc&vpx=752&vpy=105&dur=94&hovh=225&hovw=225&tx=172&ty=88&oei=FC5oTbLvBZOssAP0w9SoBA&page=1&ndsp=17&ved=1t:429,r:5,s:0http://www.google.com/imgres?imgurl=http://tothewire.files.wordpress.com/2008/12/heroin.gif&imgrefurl=http://tothewire.wordpress.com/2008/12/01/swiss-approve-pioneering-legal-heroin-program/&usg=__ZPbm9ae-kHUSTu0LygOHtm7uy2E=&h=400&w=400&sz=49&hl=en&start=0&sig2=R7FaNkAz2UskHWdzraYiqg&zoom=1&tbnid=cL3i26vnbAlUiM:&tbnh=122&tbnw=121&ei=FC5oTbLvBZOssAP0w9SoBA&prev=/images%3Fq%3Dheroin%26hl%3Den%26biw%3D1020%26bih%3D564%26gbv%3D2%26tbs%3Disch:1&itbs=1&iact=hc&vpx=752&vpy=105&dur=94&hovh=225&hovw=225&tx=172&ty=88&oei=FC5oTbLvBZOssAP0w9SoBA&page=1&ndsp=17&ved=1t:429,r:5,s:0

  21. Heroin Addicts and Pregnancy Pregnant heroin addicts tend to be: • younger than non-addicted pregnant patients • unmarried or separated from spouses • disproportionately large number are members of minority ethnic groups http://www.ncbi.nlm.nih.gov/pubmed/2304039 Injection drug use during pregnancy -Increases risk of contracting HIV and the Hepatitis C virus -These infections can be passed on to the infant during pregnancy or at birth Photo: http://www.topnews.in/law/australian-woman-who-hid-heroin-stomach-held-235974

  22. Complications Significant medical and obstetrical complications resulting in acute and chronic abnormalities in neonates: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1272838/ http://www.ireta.org/sbirt/pdf/Heroin_in_Pregnancy.pdf

  23. Treatment Options Prenatal care and comprehensive drug treatment program • -Detoxification • -Methadone • -Buprenorphine (2002) Photo: http://www.whatwinnersdo.com/recommended-addiction-recovery-books/

  24. Heroin Withdrawal Symptoms Shame and embarrassment deters pregnant women from seeking help with addiction Women who become pregnant while addicted to heroin should not stop using heroin without the advice of a doctor. Severe effects and death may occur in both mothers and unborn babies. Health effects resulting from Heroin withdrawals: Diarrhea Restlessness Vomiting Muscle or bone pain Insomnia Cold flashes

  25. Detoxification -For women who do not want or are not able to receive pharmacotherapy for heroin addiction -Medical supervision necessary -Potential risk to fetus and likelihood of relapse -Pregnant women advised not to detoxify from opiates because of increased risk of spontaneous abortion or premature delivery

  26. Methadone Treatment for a Healthy Pregnancy • Methadone: long-acting opioid drug used with counseling and other services to help people to stop using heroin • Methadone Maintenance Treatment(MMT): • Helps with a healthy pregnancy and birth(increased birth weight, gestational age of infant, and increased prenatal and antenatal visits) • Safe for babies but has resulting side effects: • Fussiness • Not eating or sleeping well • Fever • Vomiting • Trembling • Symptoms go away after a few weeks http://www.recoveryconnection.org/blog/2010/08/addiction-treatment-over-suboxone-or-methadone-clinic/

  27. Buprenorphine In the United States, several studies have found buprenorphine to be equally effective and as safe as methadone in the adult outpatient treatment of opioid dependence. Given this efficacy among adults, current studies are attempting to establish the safety and effectiveness of buprenorphine in opioid-dependent pregnant women. http://arch1design.com/blog/2010/06/03/cold-turkey-obesity-and-sterilization/

  28. Buprenorphine -An opioid partial agonist -Although an opioid that can produce the typical side effects of euphoria and respiratory depression, it is less effective than full agonists like heroin and methadone. -At low doses, can produce an agonist effect that enables opioid-addicted individuals to discontinue opioid misuse without withdrawals. -”Ceiling effect”: at moderate doses, plateau is reached and effects do not increase with dosage(safer in overdose) -Max effects occur around the 16-32 mg range for sublingual tablets. -Lower risk of abuse, addiction, and side effects compared to full opioid agonists. -No evidence of organ damage with chronic use -No evidence of significant disruption of cognitive or psychomotor performance with buprenorphine maintenance dosing

  29. Effect of Heroin Use on Newborns • Increased chance of: • Low birth weight • Small Head Circumference • Breathing difficulties • Hypoglycemia • Intracranial Hemorrhage • Sudden Infant Death Syndrome

  30. Effect of Heroin Use on Fetal Development Unborn baby can develop drug dependence Withdrawal Symptoms in Babies of Heroin Users: Fever Sneezing Trembling Irritability Diarrhea Vomiting Continual crying Seizures Sleep abnormalities Joint stiffness

  31. Thrombocytosis -High platelet counts in the blood Study by Calderon et al.: • Thrombocytosis observed in infants exposed to in-utero to illicit drugs, has been assoc. with methadone exposure • Took a retrospective look at medical records of newborns with intrauterine drug exposure admitted to San Juan City Hospital (1999-2001) • Found 96% of these infants had thrombocytosis. • Of these 75% were exposed to methadone, heroin and cocaine • Began at ten days of life and resolution seen in 3-4 weeks without complications

  32. Breastfeeding -Social drug use in pregnant and breastfeeding mothers -Breastfeeding  nourishment for baby -Transfer of heroin -Not absorbed well by infant because of poor oral bioavailability from the milk - Risk of HIV and Hepititis C. -Acute Stages of Illness http://www.wellsphere.com/wellpage/neonatal-withdrawal-syndrome-from-methadone-while-pregnant http://www.health-e-learning.com/articles/Social_Drugs_and_Breastfeeding.pdf

  33. Breastfeeding and Methadone • The American Academy of Pediatricians states that methadone use of 20 mg or less per day is compatible with breast-feeding. • However, no dose information or other guidelines are included.

  34. Heroin and Its Effect on Children After Birth • Low Birth weight linked to: • Language, visual-motor and other learning disabilities • Behavior problems • Suffered performance in school • Inconclusive data relating to long-term effects to prenatal exposure to heroin/methadone

  35. Other Drugs http://www.google.com/imgres?imgurl=http://images.paraorkut.com/img/funnypics/images/l/like_father_like_son-11995.jpg&imgrefurl=http://www.graphicshunt.com/funny/search/1/babies.htm&usg=__2kYUuD04iTirE1tbn8zLvY7OYGE=&h=300&w=440&sz=25&hl=en&start=0&sig2=VAkSm3iypeUh7akVFyB1Qg&zoom=1&tbnid=yWnAplc_KK13XM:&tbnh=135&tbnw=180&ei=mShoTairIYW2sAOkkOmoBA&prev=/images%3Fq%3Dfather%2Bdrinking%2Bwith%2Bbaby%26hl%3Den%26gbv%3D2%26biw%3D1003%26bih%3D564%26tbs%3Disch:1&itbs=1&iact=rc&dur=344&oei=mShoTairIYW2sAOkkOmoBA&page=1&ndsp=20&ved=1t:429,r:0,s:0&tx=91&ty=58

  36. Marijuana and your ‘Baby’ • Gestation Age • Birth Weight • Head Circumference • Birth Length • However, the # of joints in the third trimester does not correlate • http://www.google.com/imgres?imgurl=http://gal.darkervision.com/wp-content/uploads/2008/07/baby.jpg&imgrefurl=http://gal.darkervision.com/2008/07/25/teen-jailed-for-8-years-for-giving-a-toke-to-2-and-4-year-old-nephews-who-are-then-placed-into-care-just-another-fine-day-in-the-war-on-drugs-madhouse/&usg=__zBgv4Xcn3kwwpcPgbEThg8GlT44=&h=377&w=398&sz=18&hl=en&start=0&sig2=p0l8_v8OIZV_ZmPZ32jwHw&zoom=1&tbnid=s2WKF-2oEM3FFM:&tbnh=120&tbnw=135&ei=cAhoTZq5KIu4sQOR1fyoBA&prev=/images%3Fq%3Dmarijuana%2Bbabies%26hl%3Den%26biw%3D1020%26bih%3D564%26gbv%3D2%26tbs%3Disch:1&itbs=1&iact=hc&vpx=658&vpy=104&dur=15&hovh=218&hovw=231&tx=118&ty=121&oei=cAhoTZq5KIu4sQOR1fyoBA&page=1&ndsp=18&ved=1t:429,r:4,s:0

  37. Your Bab E • Impaired brain development • MDMA interferes with neuronal differentiation • Atg5 gene on overdrive • Severe teratogenesis • Fetal brain damage • Persistent alteration in brain • Changes in DA and 5-HT metabolism http://www.google.com/imgres?imgurl=http://www.motifake.com/image/demotivational-poster/1003/crack-meth-ecstasy-crack-meth-ecstasy-demotivational-poster-1267977486.jpg&imgrefurl=http://www.motifake.com/crack-meth-ecstasy-crack-meth-ecstasy-demotivational-posters-93079.html&usg=__Y3lmUHtYC0KZn6n_dafcszDHfN4=&h=844&w=640&sz=100&hl=en&start=0&sig2=JdgWUoD_nGoCukjdwYukfg&zoom=0&tbnid=VanbHMJzDalAbM:&tbnh=128&tbnw=97&ei=UiJoTdqZOoT2swPV6N2oBA&prev=/images%3Fq%3Decstasy%2Bmeth%2Bcrack%26hl%3Den%26gbv%3D2%26biw%3D1003%26bih%3D564%26tbs%3Disch:1&itbs=1&iact=hc&vpx=135&vpy=112&dur=31&hovh=145&hovw=110&tx=67&ty=55&oei=UiJoTdqZOoT2swPV6N2oBA&page=1&ndsp=15&ved=1t:429,r:0,s:0

  38. Other Things to be Scared of … • Terbutaline treatment (medication) • Increased incidence of autism spectrum disorder • Organophosphates (pesticides) • Inhibit cholinesterase; produce cholinergic overstimulation • Manganese (naturally occurring heavy metal) • Manganism – similar to Parkinson’s • Childhood behavioral disinhibition

  39. http://www.google.com/imgres?imgurl=http://inigobautista.files.wordpress.com/2010/01/vaccination-comic-2.jpg&imgrefurl=http://inigobautista.wordpress.com/2010/01/28/&usg=__g5SqawA_Cjv2rrifApH6fcL6Drg=&h=370&w=530&sz=52&hl=en&start=17&sig2=Fqrtr6L7ZwVIKY1zxP-V2Q&zoom=1&tbnid=eCs4-gVGEMZUUM:&tbnh=110&tbnw=158&ei=pending&prev=/images%3Fq%3Ddoctor%2Band%2Bbaby%2Bcomic%26hl%3Den%26gbv%3D2%26biw%3D1003%26bih%3D564%26tbs%3Disch:10%2C4350%2C435&itbs=1&iact=rc&dur=156&oei=YB9oTYj_BtS2twfYsoXoAw&page=2&ndsp=18&ved=1t:429,r:14,s:17&tx=79&ty=54&biw=1003&bih=564http://www.google.com/imgres?imgurl=http://inigobautista.files.wordpress.com/2010/01/vaccination-comic-2.jpg&imgrefurl=http://inigobautista.wordpress.com/2010/01/28/&usg=__g5SqawA_Cjv2rrifApH6fcL6Drg=&h=370&w=530&sz=52&hl=en&start=17&sig2=Fqrtr6L7ZwVIKY1zxP-V2Q&zoom=1&tbnid=eCs4-gVGEMZUUM:&tbnh=110&tbnw=158&ei=pending&prev=/images%3Fq%3Ddoctor%2Band%2Bbaby%2Bcomic%26hl%3Den%26gbv%3D2%26biw%3D1003%26bih%3D564%26tbs%3Disch:10%2C4350%2C435&itbs=1&iact=rc&dur=156&oei=YB9oTYj_BtS2twfYsoXoAw&page=2&ndsp=18&ved=1t:429,r:14,s:17&tx=79&ty=54&biw=1003&bih=564

  40. Works Cited Chae, Myounghee, and Gyu-Seek Rhee. "ATG5 Expression Induced by MDMA (Ecstasy), Interferes with Neuronal Differentiation of Nueroblastoma Cells." Molecules and Cells 27 (2009): 571-75. Springer. Web. 15 Feb. 2011. <http://moleculesandcells.org>. Frederick, Aliya L., and Gregg D. Stanwood. "Drugs, Biogenic Amine Targets and the Developing Brain." Developmental Neuroscience 31 (2009): 7-22. Karger. Web. 13 Feb. 2011. <http://www.karger.com/dne>. Frost, Elizabeth A., Richard S. Gist, and Elizabeth Adriano. "Drugs, Alcohol, Pregnancy, and the Fetal Alcohol Syndrome." Wolters Kluwer Health 49.1 (2011): 119-33. Ovid. Web. 15 Feb. 2011. <http://ovidsp.tx.ovid.com>. Gray, Teresa R., Rina D. Eiden, Kenneth E. Leonard, Gerard J. Connors, Shannon Shisler, and Marilyn A. Huestis. "Identifying Prenatal Cannabis Exposure and Effects of Concurrent Tobacco Exposure on Neonatal Growth." Clinical Chemistry 56 (2010): 1442-450. PubMed. Web. 15 Feb. 2011. <http://www.clinichem.org/cgi/content/full/56/9/1442>. Websites:http://www.americanpregnancy.org/pregnancyhealth/illegaldrugs.htmlhttp://www.marchofdimes.com/pregnancy/alcohol_illicitdrug.htmlhttp://www.teach-nology.com/tutorials/teaching/abuse/print.htmhttp://www.drugpolicy.org/library/research/cocaine.cfm?printpage=1&printpage=1http://www.mayoclinic.com/health/medical/IM03117http://www.ncbi.nlm.nih.gov/pubmed/7862372http://www.tgorski.com/Prevention/cocaine_use_during_pregnancy.htmlhttp://www.americanpregnancy.org/pregnancyhealth/illegaldrugs.htmlhttp://www.marchofdimes.com/pregnancy/alcohol_illicitdrug.htmlhttp://www.merckmanuals.com/home/sec22/ch259/ch259a.htmwww.drugpolicy.org/library/research/cocaine.cfm?printpage=1&printpage=1http://www.mayoclinic.com/health/medical/IM03117http://www.ncbi.nlm.nih.gov/pubmed/7862372

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