NCM 109B_MATERNAL AND CHILD NURSING 2

ACTIVITY: SUBSTANCE ABUSE IN PREGNANCY

BARBAQUINO, JULIA G.
BSN 2-E, GROUP 1

ROSELLA ASUNCION LUCERO

CLINICAL INSTRUCTOR/PRECEPTOR

FEBRUARY 26, 2024

Definition
Substance abuse during pregnancy involves the consumption of detrimental substances by expectant mothers.
Commonly utilized substances during pregnancy encompasses tobacco, alcohol, marijuana, cocaine, and opiods.
The act of using these substances while pregnant is linked to various negative consequences for both the mother
and the unborn child. According to Prince (2023), substance use and substance use disorders in pregnancy are
common and linked with multiple obstetric and neonatal adverse outcomes. Ideally, all pregnant women should
be screened, and those with positive screens should be promptly diagnosed and treated to avoid the morbidity
and mortality associated with continued substance use during pregnancy.

Incidence
Substance abuse during pregnancy is a major public health issue, as pregnant individuals commonly use various
harmful substances. Studies show that tobacco, alcohol, and marijuana are the most frequently used substances
during pregnancy, followed by cocaine and opiods. Pregnant women between the ages of 15 and 44 have
reported current illicit drug use, with the highest rates ibserved among teenage pregnant women, followed by
young adult and aduld women. According to Prince (2023), it is crucial to address substance mother and the
child. Universal screening for substance use during pregnancy is recommended to identify those at risk and
provide appropriate interventions. However, barriers to evidence-based treatment exist, and pregnant women
who uses substances often feel stigmatized.

Risk factors
Substance misuse during pregnancy can result in substantial adverse health consequences for both the expectant
mother and the developing fetus. Factors that increase the likelihood of substance abuse during pregnancy
encompasses prior use of alcohol, tobacco, or illegal drugs, unintended pregnancy, limited educational
attainment, unemployed, youthfullness, exposure to intimate partner, concurrent physical and mental health
issues, environmental pressure, and insufficient awareness to intimate partner violence, ready availability of
substances, and insufficient awareness regarding the effects of substances on fetal growth and development.
(Manag, 2021).

Causes
Substance abuse during pregnancy can have serious consequences for both the mother and the developing fetus.
The causes of substances abuse during pregnancy are complex and multifactorial. Some of the factors that may
contribute to substance abuse during pregnancy include:
1. History of Substance Abuse
Women with a history of substance abuse are at a higher risk of continuous use of drugs or alcohol during
pregnancy.
2. Mental Health Disorders
Women with mental health disorders such as depression or anxiety may be more likely to use drugs or alcohol
during pregnancy as a way to cope with their symptoms.
3. Lack of Social Support
Women who lack social support such as a partner or family members, may be more likely to use drugs or alcohol
during pregnancy as a way to cope with stress and isolation.
4. Unintended Pregnancy
Women who have unintended pregnancies may be more likely to use drugs or alcohol during pregnancy as a way
to cope with the stress and uncertainty of the situation.
5. Environmental Factors
Women who live in environments with high levels of stress, poverty, or violence may be more likely to use drugs
or alcohol during pregnancy as a way to come with their circumstances.
Signs And Symptoms
Substance abuse during pregnancy can have negative effects on both the pregnant person and the developing
fetus. Signs and symptoms of substance abuse during pregnancy can vary depending on the substance used, the
amount of frequency of use, and the stage of pregnancy. (Prince, 2023). Some common signs and symptoms of
substance abuse during pregnancy are:
• Physical symptoms such as nausea, vomiting, and weight loss
• Behavioral changes such as mood swings, irritability, and aggresion
• Poor prenatal care and missed appointments
• Premature birth, low birth weight, and developmental delays in the baby
• Neonatal abstinence syndrome (NAS) in the baby, which can cause excessive crying, high pitched cry,
irritability seizures, and gastrointestinal problems.

Diagnostic/laboratory procedures
Diagnostic and laboratory procedures for substance use during pregnancy involve a combination of medical
history, physical examinations, and screening tools. Common approaches are thorough medical history. Ask
about the current and previous substance use including alcohol, tobacco, and illicit drugs. A thorough physical
assessment during pregnancy seeks out indicators of substance usage, comprising expanded or contracted
pupils, marks suggestive of domestic violence, peculiar bodily scents, and oral hygiene concerns. Next, self-
disclosure questionnaires, such as Alcohol Use Disorders Identification Test (AUDIT-C) and the 4 P’s test, serve
to evaluate substance consumption. Urinary toxicological analyses can identify the presence of particular
substances inside the body; however, false positive and negative results might arise. Blood tests measure levels
of specific substances to a certain recent intake. Lastly, the meconiun testing analyzes newborn fecal matter to
discern extended patterns of substance utilization.

Management
a. Medical
Management of substance abuse during pregnancy involves a comprehensive approach that includes medical,
psychological, and social interventions to ensure the well-being of both the mother and the baby. Some key
strategies for managing substance abuse during pregnancy include:
1. Maintaining Adequate Nutrition:
Ensuring access to appropriate prenatal care, promoting healthy lifestyle choices, fascilitating substance abuse
treatment referrals, and advocating for the rights and best interests of the mother and baby.

2. Pregnancy Education and Counseling:

Providing education on the risks associated with substance abuse during pregnancy, offering counselling on
parenting and pregnancy-related issues, and addressing any underlying mental health disorders.

3. Medical Detox if Needed:

In cases where detoxification is necessary, providing medical detox under the supervision of healthcare
professionals specializing in addiction medicine in conjunction with obstetricians.

4. Specialized Treatment Plans:

Developing individualized treatment plans designed by professionals from various specialties to address the
specific needs of pregnant women with substance use disorders.

5. Behavioral Therapy:
Implementing therapeutic approaches such as motivational interviewing and cognitive behavioral therapy to
address substance use disorders in pregnant women.
 6. Medication-Assisted Treatment (MAT):
Considering MAT for pregnant women with opioid use disorder (OUD) under close medical supervision to
improve outcomes for both mothers and infants.

b. Nursing

Management for nursing of substance abuse during pregnancy focuses on several aspects:
1. Establishing trust and maintaining open communication with the patient.
2. Encouraging maternal and fetal safety through regular monitoring and early detection of complications.
3. Educating the patient about the risks associated with substance abuse during pregnancy.
4. Offering non-judgmental and empathetic support throughout the entire process.
5. Helping the patient engage in prenatal care and maintain adequate nutrition.
6. Referring the patient to appropriate substance abuse treatment programs, if needed.
7. Monitoring for withdrawal symptoms and providing symptomatic relief when necessary.
8. Addressing the patient's fears and concerns about seeking help.
9. Coordinating care with an interprofessional team, including specialists in obstetrics, pediatrics,
psychology, and addiction medicine.
10. Providing information about the condition, prognosis, and treatment needs.

Nursing interventions and actions may include:

o Maintaining adequate nutrition.
o Engaging in risky behaviors, such as driving under the influence.
o Experiencing legal problems related to substance use.
o Experiencing legal problems related to substance use.
o Relationship difficulties or conflicts with loved ones.
o Neglecting prenatal care or missing appointments.
o Screening for substance abuse using validated screening instruments.
o Providing education on new ways to decrease anxiety and cope with stress.
o Incorporating the patient into supportive community environments.
o Promoting family involvement in the treatment process.
o Providing information about the con dition, prognosis, and treatment needs.

References:
Louw, K. (2019). Substance use in pregnancy: The medical challenge. PubMed Central
(PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6038015/

Manag, J. (2021). Independent risk factors for chronic illicit substance use during pregnancy. PubMed
Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8375396/

Prince, M. (2023). Substance use in pregnancy - StatPearls - NCBI bookshelf. National Center for
Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK542330/