Course BASIC_Graduate level learning material about the challenges of human reproductive medicine in a changing Europe

2021-1-HU01-KA220-HED-000027613 - COHRICE

TEACHERS GUIDE

Pregnancy with substance abuse, women on the margins of the society

(Basic level)

Slide 3.: Talk about the aim of this presentation

Slide 4.: Define the substance abuse and talk about its consequences (medical, social, physical, emotional and job-related problems) and highlight that the substance usage in pregnancy carries both maternal and fetal disorders on short and long term. 

Slide 5.: List the risk factors that can lead to the development of this disease. 

Slide 6.: Talk about the role of an obstetrician. Highlight that screening (discussed later) and early diagnosis is essential for the best treatment possible. Note that the treatment can be provided in the obstetrician’s office or, if needed, in an institution specialized in patients with substance use disorder. 

Slide 7.: Talk about the screening methods available and highlight the recommendation of early universal screening. The suggested screening method is the usage of validated questionnaires and the detailed history taking. Toxicology testing are not recommended routinely, only if affirmative previous screening was found. 

Slide 8.: Explain the logistic of the history taking is basic level (targeted for substance use). A practical and effective approach includes respectful and sensitive use of neutrally worded questions. Preferably begin with questions about lawful and more socially acceptable substances (such as tobacco, alcohol, or cannabis use), followed by questions about nonmedical use of over-the-counter drugs (such as pseudoephedrine products and dextromethorphan products), use of prescription drugs (opioid analgesics, sedatives, stimulants, tranquilizers), and, finally, illegal substances (methamphetamine, cocaine, heroin, fentanyl, hallucinogens, and inhalants).

If needed, give some examples of the substances presented. 

Slide 9.: Explain in detail the question you have to carry out during the history taking. Highlight the possible exposure to sexually transmitted diseases (STD).

Slide 10.: List the possible laboratory tests and talk about the legal and ethical considerations.

Slide 11.: Talk about the neonatal laboratory testing.

Slide 12.: Talk about the tobacco use in pregnancy and highlight the importance of education. Explain that the tobacco use (cigarette smoking) in declining worldwide, but studies still show a 7-11% of active smoking during pregnancy. E-cigarettes is still studies, but the medical and obstetrical colleges are not recommending the usage. 

Slide 13.: List the possible adverse pregnancy outcomes associated with smoking. Explain the obstetrical terminology if needed. Explain that the pathophysiology is unclear and note the possible mechanisms which can have an impact on the fetus. List the possible congenital anomalies that can be caused by cigarette smoking. 

Slide 14.: Talk about the correlation between the cigarette smoking and preeclampsia. Highlight the increased risk of the sudden unexpected infant death. 

Slide 15.: Discuss the alcohol intake and abuse in pregnancy and its prevalence. Note that alcohol crosses the placenta and it causes irreversible central nervous system damages to the fetus and there is no safe level of alcohol intake during pregnancy. 

Slide 16.: Discuss the factors that can influence the effect of alcohol intake and talk about the most severe consequences of the alcohol abuse. 

Slide 17.: Talk in detail about the different obstetrical complications in the trimesters. 

Slide 18.: Define the ‘Fetal Alcohol Spectrum Disorders’ (FASD). 

Slide 19.: Present the clinical features of the FASD. 

Slide 20.: Present the clinical manifestations, signs and symptoms of fetal alcohol syndrome. Note that this is the most common condition of the FASD. 

Slide 21.: Discuss about cannabis (marijuana), the route of use and it’s possible effects.

Slide 22.: Present that there is conflicting data about the possible obstetrical complications (preterm birth, low birth weight). Present the nausea and vomiting (hyperemesis gravidarum) a risk factor for cannabis use, paradoxically chronic cannabis use can also cause hyperemesis syndrome. 

Slide 23.: List the possible obstetric and neonatal outcomes. 

Slide 24.: Discuss about the pseudoephedrine and it’s increasing usage worldwide. Talk about the pseudoephendine’s indication and it’s possible fetal and maternal implications.

Slide 25.: Present the medical and legal use of opioid products. List the examples of opioids. 

Slide 26.: Discuss about the increasing opioid abuse by pregnant individuals, talk about the multiple obstetric complications and highlight the dose dependent maternal risk of myocardial infarction. Discuss about the preferred treatment options. Mention the naloxone, as an opioid antagonist.  

Slide 27.: Present the neonatal abstinence syndrome caused by the maternal opioid abuse and the possible medical treatment options. 

Slide 28.: Present the most common sedatives ant their general effects. Highlight the increased risk of major congenital malformations caused by barbiturate exposure and the importance of preconception planning. 

Slide 29.: Present the benzodiazepine use in pregnancy and the conflicting data of the possible fetal development disorder. Talk about the serious neonatal withdrawal symptoms, and highlight that the symptoms may persist for months. 

Slide 30.: Present the methamphetamine as a powerfully addictive stimulant and a known neurotoxin agent crossing the placenta, with unclear structural abnormality association in the fetus but causing increased risk of fetal growth restriction, preeclampsia, abruption, preterm birth, neonatal death and stillbirth.

Slide 31.: Present the cocaine’s mental and physical effects. 

Slide 32.: Describe the cocaine’s impact on pregnancy, highlighting vasocontriction as the majos mechanism for damage and list the risk increased by cocine use during pregnancy. 

Slide 33.: Explain why cocaine toxicity can be a differential diagnostic problem with preeclampsia and why beta-blocker should be avoided in the treatment. 

Slide 34.: Define the term of neonatal abstinence syndrome and list the most common substances. Define the possible pathophysiological mechanism that play role in the NAS. 

Slide 35.: List the major signs and symptoms of NAS. 

Slide 36.: Present the aspects that can help with the positive diagnose of NAS (clinical, laboratory testing). Talk about the management of NAS, discussing the medication related and the non-pharmacologic treatment options as well. Highlight the avoidance of naloxone. 

Slide 37.: Thank you for the attention. 

Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or the Foundation for the Development of the Education System. Neither the European Union nor entity providing the grant can be held responsible for them.