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Drug Abuse and Pregnancy

1 Contact Hour
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This peer reviewed course is applicable for the following professions:
Advanced Practice Registered Nurse (APRN), Certified Nurse Midwife, Certified Nurse Practitioner, Certified Registered Nurse Anesthetist (CRNA), Clinical Nurse Specialist (CNS), Licensed Practical Nurse (LPN), Licensed Vocational Nurses (LVN), Midwife (MW), Nursing Student, Registered Nurse (RN), Registered Nurse Practitioner
This course will be updated or discontinued on or before Sunday, September 22, 2024

Nationally Accredited

CEUFast, Inc. is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. ANCC Provider number #P0274.

Outcomes

This course will look at the risk factors and screening tools used to identify women who are at greater risk of abusing drugs. Participants will become familiar with complications that can occur to the woman and infant who abuse drugs and how to care for each of these patients.

Objectives

After completing this continuing education course, the participant will be able to:

  1. Identify the definitions of substance use and abuse.
  2. List screening methods used to identity drug use in pregnant women.
  3. Identify complications caused to the mother and fetus by drug use.
  4. List treatments for pregnant women with drug use.
  5. Plan nursing care for the woman with drug abuse during pregnancy.
CEUFast Inc. and the course planners for this educational activity do not have any relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.
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Drug Abuse and Pregnancy
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To earn of certificate of completion you have one of two options:
  1. Take test and pass with a score of at least 80%
  2. Reflect on practice impact by completing self-reflection, self-assessment and course evaluation.
    (NOTE: Some approval agencies and organizations require you to take a test and self reflection is NOT an option.)
Author:    Kelly LaMonica (DNP(c), MSN, RNC-OB, EFM)

Background

In 2016, over 6% of women interviewed stated that they had used illicit substances in the past month. Substance use and abuse can cause significant harm to the mother and the fetus. Every year, nearly 2 million babies in America are exposed to tobacco, alcohol, and illicit drugs in utero ( Addiction resource, 2019). Nurses must know how to care for these women and babies.

Definitions

It is important to define some terms. Substance use is the sporadic consumption of alcohol or drugs with no adverse consequences from that use. Abuse does not define frequency, but the user has experienced adverse consequences because of that use. Physical dependence means that the woman's body has adapted to the substance and will have withdrawal symptoms if she continues using it. Psychological dependence is a perceived sense of need for the substance by the user. Addiction is a primary, chronic disease of brain reward, motivation, and memory (Miller et al., 2019).

Drug Screening in Pregnancy

Screening for substance abuse is recommended during the initial prenatal visit and each trimester. The Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) opposes laws that result in incarceration or punitive legal actions against women because of a substance use disorder (SUD) in pregnancy and the postpartum period. (Optimizing Outcomes, 2019). Universal urine drug screening would find all women who have used illicit substances, but it is expensive to perform. Various validated screening tools can be used to determine if the woman abuses substances. The 4P's Plus Screen is a screening tool that asks questions about substance use, and any positive finding should trigger further assessment. This is a copyrighted screening tool. The CRAFFT substance abuse screen for adolescents and young adults is available for anyone to use. The National Institute on Drug Abuse (NIDA) quick screen may also screen women. There are other tools also available (Substance Use, 2019).

Risk Factors for Substance Use

Nurses and providers must know risk factors that may indicate that the woman has a history of drug use. Young, unmarried women with a low education level are more likely to use. Women who have started prenatal care late or have missed appointments may be using. Women with sudden behavior changes, relationship problems, poor work or job performance, and poor weight gain may be at risk. Women with high-risk sexual behaviors, a history of a mental health disorder, or a family history of or partner with substance abuse are at risk. Women who have an unexplained obstetric history, such as demise, miscarriages, etc., and women who do not have custody of their other children may also have a history of using (Substance Use, 2019).

Urine drug testing may be considered for women with a history of drug use, a positive screen, and poor prenatal care. Women with abruption of the placenta, preterm labor, and unexplained fetal demise may also need drug testing (COP, 2017).

Complications

Maternal

Women using drugs can have various complications. Some of the complications can have come from the drug itself, such as an overdose or cardiac arrest. These women can also experience an abruption of the placenta, which can be deadly to the woman and fetus. Miscarriage, intra-amniotic infection, preeclampsia, septic thrombophlebitis, and postpartum hemorrhage can also affect the woman (Substance Use, 2019).

Fetal

Miscarriage and fetal death can occur. Fetal growth restriction, low birth weight, and preterm delivery are both complications that can affect the fetus. Infants born to women who drink during pregnancy can have fetal alcohol syndrome. Infants born with abusive substances can have neonatal abstinence syndrome (NAS). This group of withdrawal symptoms can affect the newborn and usually require treatment to wean the baby off of the drugs (Substance Use, 2019). NAS symptoms are affected by various factors, including the type of opioid the infant was exposed to, the point in gestation when the mother used the opioid, genetic factors, and exposure to multiple substances (HH/sm 2016).

Treatment

Women who use substances during pregnancy usually want help to provide the best care for their babies. It is important to help these women to get assistance. For opiate dependence, methadone or buprenorphine are safe during pregnancy and are treatment options for these women. These medications can also cause withdrawal in the newborn but are generally considered safer for pregnancy than illicit drugs. Women on high doses of benzodiazepines and alcohol may need a detoxification program to help them stop using. Any psychiatric diagnoses should be addressed to help these women with substance abuse problems (Substance Use, 2019). A comprehensive drug rehab program reduces the risk of miscarriage, preterm delivery, congenital disabilities, and neonatal abstinence syndrome (Addiction Resource, 2019).

Nursing Care

Women with substance abuse need to feel safe with their providers, or they will not return. Nurses are trusted healthcare professionals who can positively impact as long as they are not judgmental when caring for these women. Treatment for drug abuse should be family-focused and non-stigmatizing (Optimizing Outcomes, 2019). Nurses need to be aware of screening tools and their institution and state's policy for drug testing and reporting. Each state may have different laws regarding testing and reporting, which the nurse must follow.

Case Study

LS is a 22-year-old woman who presents to the OB clinic for her first prenatal visit. She thinks she is around 26 weeks pregnant. She is thin and looks malnourished. She says she did not have a car to get to prenatal visits sooner. Her obstetric history is questionable. She says she had two spontaneous miscarriages at approximately 7-8 weeks and one elective abortion when she was 16. She also states that she has had multiple partners and does not know who the baby's father is.

What do you think about this patient? Do you think she is using any illicit substances? How will you find out?

  • This patient is young and appears to not be in ideal physical condition. Any type of substance abuse is possible. It is important to ask questions and use a screening tool. It is also important to question her gently and non-judgmental. The goal is to get her help and have her return for care. You do not want to scare her away from getting treatment or prenatal care. It is important to provide her with realistic resources that she can utilize.

Select one of the following methods to complete this course.

Take TestPass an exam testing your knowledge of the course material.
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No TestDescribe how this course will impact your practice.

Implicit Bias Statement

CEUFast, Inc. is committed to furthering diversity, equity, and inclusion (DEI). While reflecting on this course content, CEUFast, Inc. would like you to consider your individual perspective and question your own biases. Remember, implicit bias is a form of bias that impacts our practice as healthcare professionals. Implicit bias occurs when we have automatic prejudices, judgments, and/or a general attitude towards a person or a group of people based on associated stereotypes we have formed over time. These automatic thoughts occur without our conscious knowledge and without our intentional desire to discriminate. The concern with implicit bias is that this can impact our actions and decisions with our workplace leadership, colleagues, and even our patients. While it is our universal goal to treat everyone equally, our implicit biases can influence our interactions, assessments, communication, prioritization, and decision-making concerning patients, which can ultimately adversely impact health outcomes. It is important to keep this in mind in order to intentionally work to self-identify our own risk areas where our implicit biases might influence our behaviors. Together, we can cease perpetuating stereotypes and remind each other to remain mindful to help avoid reacting according to biases that are contrary to our conscious beliefs and values.

References

  • Addiction Resource, Pregnancy, and Drug Abuse: Understanding Addiction in Future Mothers. Addiction Resource. Accessed December 31, 2019. Visit Source.
  • Committee on Obstetric Practice. Committee Opinion No. 711: Opioid Use and Opioid Use Disorder in Pregnancy. Obstet Gynecol 2017; 130:e81. Reaffirmed 2019.
  • HHS A Collaborative Approach to the Treatment of Pregnant Women with Opioid Use Disorders. HHS Publication No. (SMA) 16-4978. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2016. Accessed December 31, 2019. Visit Source.
  • Miller SC, Fiellin DA, Rosenthal RN, Saitz R. The ASAM Principles of Addiction Medicine. Philadelphia: Wolters Kluwer; 2019.
  • Optimizing Outcomes for Women With Substance Use Disorders in Pregnancy and the Postpartum Period. Journal of Obstetric, Gynecologic & Neonatal Nursing. 2019;48(5):583-585. doi:10.1016/j.jogn.2019.06.001. Visit Source.
  • Substance use by pregnant women - UpToDate. Updated Oct 9, 2019. Accessed December 31, 2019. Visit Source.
  • Substance Use While Pregnant and Breastfeeding | National. Accessed December 31, 2019. Visit Source.