OB

Substance Abuse in Pregnancy

search

Substance Abuse in Pregnancy, Chemical Dependency in Pregnancy, Substance Use Disorder in Pregnancy, Antepartum Drug Abuse

  • See Also
  1. Chemical Dependency
  2. Substance Abuse Evaluation
  3. Cocaine Abuse in Pregnancy
  4. Opioid Use Disorder in Pregnancy
  1. Substantial increase in risk of maltreatment
  2. Risk of change in primary Caregiver before age 2 years
  3. Breast Feeding exposure to illicit substance
  4. Deliberate Poisoning with illicit substance
  5. Passive inhalation of illicit substance
  6. Accidental Ingestion of illicit substance
  7. Physical or Sexual abuse
  8. Household or neighborhood Violence
  • Screening
  1. CRAFFT Adolescent Chemical Dependency Screening
  2. P5 Integrated Screening
    1. https://fhop.ucsf.edu/sites/fhop.ucsf.edu/files/custom_download/5%20Ps%20Screening%20Tool.pdf
  3. Drug Abuse Screening Test (DAS-10)
  4. Single-Question Drug Abuse Screening Test (DAS-1)
  5. Modified Alcohol, Smoking and Substance Involvement Screening Test
    1. https://www.drugabuse.gov/sites/default/files/pdf/nmassist.pdf
  • Complications
  • General
  1. Lack of Prenatal Care and other health care
  2. Fetal Growth Restriction
  3. Placental Abruption
  4. Preterm Labor
  5. Preterm Death
  6. High Risk Behavior (e.g. prostitution)
  • Management
  • Preterm Recommendations for Obstetric Visits
  1. Every 2 weeks until 30 weeks
  2. Every week until delivery after 30 weeks
  1. First Prenatal Visit
  2. Gestational age 36 weeks
  3. Testing
    1. Syphilis Serology
    2. Condyloma
    3. Gonorrhea Culture
    4. Chlamydia screen
    5. Herpes Genitalis
    6. Hepatitis B Serology
    7. HIV Testing
  1. Baseline: late first or early second trimester
  2. Serial Ultrasound for Intrauterine Growth Retardation
  • Monitoring
  1. Random Urine Drug Screening (obtain permit)
  2. Obstetric Ultrasound as above
  3. Nonstress Test
    1. Every two weeks from 30 to 35 weeks
    2. Weekly after 35 weeks
  4. Meconium Drug Screen from fetus after delivery
  • Management
  1. Child Protective Services reporting is required by most states in U.S.
  2. See Cocaine Abuse in Pregnancy
  3. See Opioid Use Disorder in Pregnancy
  4. See Alcohol Abuse
  5. See Cannabinoid Use Disorder
  • Resources
  1. Perinatal Harm Reduction Toolkit
    1. https://www.perinatalharmreduction.org/toolkit-pregnancy-substance-use
  2. Children and Family Futures
    1. https://www.cffutures.org/infants-with-prenatal-substance-exposure/
  • References
  1. Fitzgerald (2023) Am Fam Physician 107(5): 547-9 [PubMed]