RETIRED: Substance Use in Pregnancy

doi:10.1016/S1701-2163(16)34855-1

Journal of Obstetrics and Gynaecology Canada

Volume 33, Issue 4, April 2011, Pages 367-384

https://doi.org/10.1016/S1701-2163(16)34855-1 Get rights and content

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Psychiatric Disorders in Pregnant Women Admitted to the High-Risk Obstetric Service in a Colombian University Clinic Between 2013 and 2017
2024, Revista Colombiana de Psiquiatria
Determinar los diagnósticos psiquiátricos y describir características clínicas, el riesgo biopsicosocial y los tratamientos de las pacientes hospitalizadas en el servicio de alto riesgo obstétrico para las que se realizó una interconsulta con psiquiatría.
Estudio observacional descriptivo en el que se incluyó a las pacientes del servicio de alto riesgo obstétrico de una institución de alta complejidad de Medellín para las que se interconsultó por psiquiatría de enlace entre 2013 y 2017. Las principales variables de interés fueron los diagnósticos y tratamientos tanto psiquiátricos como ginecoobstétricos, además de los factores de riesgo obstétricos y psicosociales.
Se cribaron en total 361 historias clínicas, y 248 pacientes cumplían los criterios de inclusión. El diagnóstico psiquiátrico principal más prevalente fue trastorno depresivo mayor (29%), seguido por el trastorno de adaptación (21,8%) y los trastornos de ansiedad (12,5%); los fármacos más prescritos por psiquiatría fueron antidepresivos ISRS (24,2%), trazodona (6,8%) y benzodiacepinas (5,2%). El diagnóstico obstétrico principal más común fue el parto espontáneo (46,4%) y los diagnósticos obstétricos secundarios que predominaron fueron trastorno hipertensivo asociado con el embarazo (10,4%), diabetes gestacional (9,2%) y abortos recurrentes (6,4%). El 71,8% de las pacientes tenían un riesgo biopsicosocial alto.
Los principales diagnósticos psiquiátricos fueron trastorno depresivo mayor, trastorno de adaptación y trastornos de ansiedad, lo que implica la importancia del oportuno reconocimiento en la evaluación prenatal de los síntomas de estas entidades, conjuntamente con los factores de riesgo obstétrico y social. La intervención psiquiátrica es necesaria considerando las implicaciones negativas que tiene el alto riesgo tanto para la madre como para el niño.
To determine the psychiatric diagnoses and treatments of patients admitted to the high-risk obstetric service who underwent a consultation with a liaison psychiatrist.
A descriptive observational study that included pregnant women from the high-risk obstetric service of a highly specialised clinic in Medellín, who had a liaison psychiatry consultation between 2013 and 2017. The main variables of interest were psychiatric and obstetric diagnoses and treatments, in addition to biopsychosocial risk factors.
A total of 361 medical records were screened, with 248 patients meeting the inclusion criteria. The main prevailing psychiatric diagnosis was major depressive disorder (29%), followed by adaptive disorder (21.8%) and anxiety disorders (12.5%). The pharmacologic treatments most used by the psychiatry service were SSRI antidepressants (24.2%), trazodone (6.8%) and benzodiazepines (5.2%). The most common primary obstetric diagnosis was spontaneous delivery (46.4%), and the predominant secondary obstetric diagnoses were hypertensive disorder associated with pregnancy (10.4%), gestational diabetes (9.2%) and recurrent abortions (6.4%). Overall, 71.8% of the patients had a high biopsychosocial risk.
The studied population's primary psychiatric disorders were major depressive disorder, adjustment disorder and anxiety disorders, which implies the importance of timely recognition of the symptoms of these perinatal mental pathologies, together with obstetric and social risks, in the prenatal consultation. Psychiatric intervention should be encouraged considering the negative implications of high biopsychosocial risk in both mothers and children.
Drug testing in support of the diagnosis of neonatal abstinence syndrome: The current situation
2023, Clinical Biochemistry
Citation Excerpt :
From their report, selected recommendations include that all pregnant women and women of childbearing age should be screened periodically for alcohol, tobacco, prescription and illicit drug use, and that urine testing is the preferred sample type. Informed consent should be obtained from the woman before maternal drug toxicology testing is ordered [23,27]. Testing compliance may be better in Canada than in other jurisdictions since a pregnant woman cannot be mandated by a court order to attend addiction treatment when her fetus may be in danger of harm resulting from substance use.
Illicit drug use during pregnancy is a concern worldwide, with many international studies describing attempted strategies to mitigate this problem. Drug misuse during pregnancy is associated with significant maternal as well as perinatal complications, which include a high incidence of stillbirths, fetal distress, neonatal abstinence syndrome (NAS) and increased neonatal mortality.
Unfortunately, the identification of a drug-exposed mother or neonate is challenging. Maternal disclosure of drug use is often inaccurate, principally due to psychosocial factors including behavioral denial or the fear of the consequences resulting from such admissions. Likewise, many infants who have been exposed to drugs in utero may appear normal at birth and initially show no overt manifestations of drug effects. Thus, the identification of the drug-exposed infant requires a high index of clinical suspicion. Conversely, analytical testing is an objective means of determining drug exposure when it may be necessary to document proof of the infant's exposure to illicit drugs.
The review will discuss the different matrices that are most commonly used for testing (e.g., maternal urine, neonatal urine, meconium, and umbilical cord), the strengths and limitations for each matrix, which drugs and metabolites are appropriate for testing, the various testing methods, and the advantages and disadvantages of each method.
Cocaine and the Long-Term Risk of Cardiovascular Disease in Women
2022, American Journal of Medicine
Cocaine is associated with acute cardiovascular complications, but the long-term cardiovascular risks of cocaine use are poorly understood. We examined the association between cocaine use disorders and long-term cardiovascular morbidity in women.
We analyzed a longitudinal cohort of 1,296,463 women in Quebec, Canada between 1989 and 2020. The exposure included cocaine use disorders prior to or during pregnancy. The outcome was cardiovascular hospitalization up to 31 years later. We used adjusted Cox regression models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association of cocaine use disorders with cardiovascular hospitalization.
The cohort included 2954 women with cocaine use disorders. Compared with women without an identified cocaine disorder, women with cocaine use disorders had 1.55 times greater risk of future cardiovascular hospitalization during 3 decades of follow-up (95% CI, 1.37-1.75). Cocaine use disorders were strongly associated with inflammatory heart disease (HR 4.82; 95% CI, 2.97-7.83), cardiac arrest (HR 2.93; 95% CI, 1.46-5.88), valve disease (HR 3.09; 95% CI, 2.11-4.51), and arterial embolism (HR 2.22; 95% CI, 1.19-4.14). The association between cocaine use disorder and cardiovascular hospitalization was most marked after 5 to 10 years of follow-up (HR 2.15; 95% CI, 1.70-2.72).
Women with cocaine use disorders have a high risk of cardiovascular hospitalization up to 3 decades later. Substance use reduction and cardiovascular risk surveillance may help reduce the burden of cardiovascular disease in women with cocaine use disorders.
ABM Clinical Protocol #21: Guidelines for Breastfeeding and Substance Use or Substance Use Disorder, Revised 2015
2022, Breastfeeding: A Guide for the Medical Profession
Pediatric surgery and future risk of cocaine, opioid, cannabis, and other substance use in women: longitudinal cohort study
2021, Drug and Alcohol Dependence
Substance use is problematic in young women, particularly in pregnancy. We sought to determine whether pediatric surgery is associated with the subsequent risk of adolescent or pregnancy-related illicit drug use, including cocaine, opioids, cannabis, and other drugs.
We analyzed a cohort of 167,119 girls aged five years or less in Canada with 4,693,444 person-years of follow-up. We tracked the girls over time between 1989 and 2018. The main exposure measure was pediatric surgery before 20 years of age. The main outcome included subsequent hospitalizations for substance use disorders and substance use in pregnancy. We estimated hazard ratios and 95% confidence intervals (CI) for the association of pediatric surgery with the later risk of substance use, using Cox proportional hazards regression models adjusted for patient characteristics.
Pediatric surgery was associated with 2.08 times the risk of future hospitalization for substance use disorders (95% CI 1.96-2.22) and 1.48 times the risk of substance use in pregnancy (95% CI 1.35-1.62), compared with no surgery. Associations were stronger for girls who had surgery under general anesthesia and were present regardless of age at first surgery or total number of surgeries. Pediatric surgery was associated with the use of cocaine, opioids, cannabis, and other illicit substances later in life.
This study suggests that pediatric surgery may be associated with future substance use disorders in women, including substance use at pregnancy. Further study is needed to determine whether surgery may have a causal role in later drug abuse by women.
A Brief, Hospital-Initiated Motivational Interviewing and Acceptance and Commitment Therapy Intervention to Link Postpartum Mothers Who Use Illicit Drugs With Treatment and Reproductive Care: A Case Report
2021, Cognitive and Behavioral Practice
Maternal substance use during the prenatal period often results in infants with compromised health outcomes. The American College of Obstetrics and Gynecology recommends screening, brief motivational interviewing, and referral to existing treatment for women who use illicit substances prenatally. However, many of these women do not present for prenatal care and are not identified as using substances until delivery of their infants, many of whom are admitted to the neonatal intensive care unit (ICU). We describe a case from a novel, hospital-initiated intervention study, Moms in ACTion (MIACT) that combines motivational interviewing (MI) and acceptance and commitment therapy (ACT) to target new mothers with an infant in the neonatal ICU who screen positive for illicit substance use prenatally or at delivery. The MIACT program consists of an adaptive intervention that includes up to three sessions. Initiation of substance use treatment and reproductive care via a gynecological visit are the primary targets of the intervention. Urine samples were collected at 2- and 6-month follow-up visits. The participant successfully completed the program, achieved both treatment outcomes, and had negative urine drug screens at follow-up visits. Improvements in readiness to change and psychological flexibility were also observed. The present case report of a new mother who used substances demonstrated feasibility for combining MI and ACT treatments and the potential for MIACT to increase treatment and contraception initiation, ultimately preventing future substance-exposed pregnancies.

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This clinical practice guideline has been prepared by the Working Group on Problematic Substance Use in Pregnancy, reviewed by the Maternal Fetal Medicine Committee, the Family Physicians Advisory Committee and the Medico-Legal Committee, and approved by the Executive and Council of the Society of Obstetricians and Gynaecologists of Canada.

The literature searches and bibliographic support for this guideline were undertaken by Becky Skidmore, Medical Research Analyst, Society of Obstetricians and Gynaecologists of Canada.

Disclosure statements have been received from all members of the committees.

Dr Alice Ordean received funding from National Institute on Drug Abuse grant R01 DA015741.

This document reflects emerging clinical and scientific advances on the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Local institutions can dictate amendments to these opinions. They should be well documented if modified at the local level. None of these contents may be reproduced in any form without prior written permission of the SOGC.

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SOGC CLINICAL PRACTICE GUIDELINERETIRED: Substance Use in Pregnancy

SOGC CLINICAL PRACTICE GUIDELINE
RETIRED: Substance Use in Pregnancy