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SP 128
SP 128: 3rd LE
[15] Maternal Substance
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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