[15] Maternal Substance

• Maternal Substance Abuse: use of harmful substances by pregnant woman that can put both the mother and the fetus at risk
• Maternal Substance Abuse is one of the most significant risk factors associated for adverse birth outcomes
• Common Substances

  • Licit
  • Illicit
  • Prescription Drug use or misuse
• Licit Substances

  • Legal
  • Regulated or unregulated by the government
  • alcohol, cigarettes, caffeine
• Illicit Substances

  • Illegal
  • Tightly controlled by the government
  • cocaine, heroin, methamphetamine (shabu)
• Prescription Drug Use or Misuse

  • can be attained with the prescription of medical professional
  • opioids, morphine, tramadol, oxycodone
• opioids: use for pain killer
• Drug Misuse

  • using of drugs outside if its intended use
  • example: opioids not used for pain killers but rather for the effects of being high
• Most common use substance

  • Nicotine, alcohol, marijuana (cannabis), opioids
• Nicotine

  • highly addictive chemical compound found in tobacco plants
  • acts as depressant and stimulant
  • tobacco & cigarettes
• Alcohol

  • chemical compound found in wine, beer, liquor
  • acts as depressant which affect CNS leading to changes in mood, behavior and cognitive function
• Marijuana (Cannabis)

  • Psychoactive drug found in cannabis sativa plant
  • acts as stimulant and depressant
• Opiates

  • class of drugs that are derived from opium poppy plant
  • can be synthesized to mimic the effects of natural opioids
  • commonly used for pain reliver properties
• Timing of the teratogenic exposure

  • Preimplantation (first 2 weeks)
  • Embryonic (3rd - 8th weeks)
  • Fetal (8th week onwards)
• Preimplantation (first 2 weeks)

  • between fertilization and implantation
  • not yet susceptible to teratogens
  • all or nothing period
• Embryonic (3rd to 8th week)

  • eventful: formation of 3 germ layers & major structures
  • greatest effect & most vulnerable for abnormalities
  • CNS, Heart, Upper & Lower Limbs, Eyes, Teeth
• Fetal (8th week onwards)

  • period for continued functional development and maturation
  • only some organs are vulnerable
• Specific condition for maternal substance abuse

  • Fetal Alcohol Spectrum Disorders
  • Neonatal Opioid Withdrawal Syndrome
• Fetal Alcohol Spectrum Disorder (FASD)

  • also known as Fetal Alcohol Syndrome (FAS)
  • broad range of emotional, cognitive, behavioral, and congenital abnormalities
  • entirely preventable with the total absence of alcohol
  • commonly seen in Leyte because of Tuba (palm wine)
• Fetal Alcohol Spectrum Disorder (FASD) diagnosis is often complex due to multiple factors and negative exposures
• Fetal Alcohol Spectrum Disorder (FASD) TRIAD Symptoms

  • Short palpebral fissure
  • Flat philtrum
  • Thin upper vermillion
• Fetal Alcohol Spectrum Disorder (FASD) Other Symptoms

  • Microcephaly (Small Head)
  • CNS Impairment
  • Attention
  • Reaction Time
  • Executive Function
  • Memory
  • Language
  • Social Adaptive Functions
• Fetal Alcohol Spectrum Disorder (FASD)

  • no pathognomonic specifics in terms of neurodevelopmental deficits
• Neonatal Opioids Withdrawal Syndrome (NOWS)

  • Subset of Neonatal Abstinence Syndrome (NAS)
  • happens in Neonates
  • due to sudden withdrawal of intrauterine (in the uterus) drug exposure
  • baby in the tummy is exposed to opioids
• Neonatal Opioids Withdrawal Syndrome (NOWS) Prevalence

  • notable increased globally
  • little information in PH
• Neonatal Opioids Withdrawal Syndrome (NOWS) TRIAD Symptoms

  • Increased Muscle tone
  • Tremors when undisturbed
  • Exaggerated Moro reflex (Startle Reflex)
• Neonatal Opioids Withdrawal Syndrome (NOWS) System Symptoms

  • CNS
  • Autonomic
  • Respiratory Disturbances
  • GI Disturbances
• Neonatal Opioids Withdrawal Syndrome (NOWS) CNS Symptoms

  • Hyperirritability
  • High Pitch Crying
  • Jitteriness
  • Tremors
• Neonatal Opioids Withdrawal Syndrome (NOWS) GI Symptoms

  • poor feeding
  • regurgitation
  • vomiting
  • diarrhea
• Comprehensive Prenatal Care

  • Initial Evaluation
  • Emotional & Social Support
  • Regular Check-ups
  • Management on pregnancy complications
  • Patient Education
  • Newborn Assessment
• Treatment on FASD and NOWS

  • Interdisciplinary Team
  • Early Intervention
  • Pharmacologic
  • Parent Training