Identifying Substance Misuse in Pregnancy
The term substances encompass’ a wide range of drugs, volatile substances and alcohol that are used regardless of the effect it may impose. This list includes but is not limited to:
In 2017 it was recorded that 29.5% of antenatal booking appointments did not document and answer to questions asked regarding alcohol and substance misuse. It is vital that we ask these difficult questions for multiple reasons in which this page will explain.
The Office for National Statistics reported that in 2020 9.4% of 16-59-year olds have used drugs in the last year and 21% of 16-24 year old have taken a drug within the last year. With 1 in 5 young people misusing substances and 1 in 11 adults have misused substances it is essential that we risk assess all women and families.World Health Organization (WHO) (2014) have published principles in which we should work towards which include prioritising the acknowledgment, prevention, reduction and overall cessation of substance misuse. To to this women should be provided with comprehensive unbiased care which safeguards them against discrimination and encourages them to engage with treatment services.
WHO (2014) also recommends that midwives should ask about previous and current substance and alcohol misuse at booking and at every antenatal visit as a woman is more likely to report sensitive information to a trusted healthcare professional. It is required that midwives are prepared to receive this information and can care for a refer women whom need specialist care.
The Department of Health (2017) state that drug misuse is more prevalent in areas with social deprivation as this is synonymous with poorer health.
At Risk Women
- Women who live in socially deprived areas
- Women between the ages of 16-24
- Women who smoke
- Women who have previous or ongoing mental health issues
Risks to Mother
- Social problems
- Cardiovascular problems in mother
- Psychotic episodes
- Vasoconstriction leading to Hypertension
- Seizures if begging to withdraw
Risks to Baby
- Premature labour
- Placental abruption
- Low birth weight
- Congenital abnormalities
- Behavioral issues in childhood
Neonatal Abstinence Syndrome (NAS)
NAS is defined by WHO (2104) as "a neonate which is showing signs of withdrawal from exposure to psychotropic substances in utero". Signs of NAS include irritability, tremors, diarrhea, increased rigidity and increased respiration rate. Pharmaceutical treatment may be needed.