1
|
Perinatal Psychoactive Substances Use: A Rising Perinatal Mental Health Concern. J Clin Med 2023; 12:jcm12062175. [PMID: 36983176 PMCID: PMC10056692 DOI: 10.3390/jcm12062175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 03/16/2023] Open
Abstract
Introduction: A significant increase in psychoactive drugs use was observed in women of childbearing age and during the perinatal period worldwide. Yet, the use of illicit drugs, alcohol and tobacco during pregnancy is a serious health risk for the mother, developing fetus and newborn. Methods: This review of current trends and consequences of psychoactive substance use in the general population and in pregnant women was conducted using the English and French literature published during the years 2000 to 2022, supplemented by guidelines, meta-analyses and reviews. Results: According to current rates of prenatal substances use, it was calculated that 380,000 offspring were exposed to illicit substances, more than 500,000 to alcohol and over one million to tobacco during uterine life. Alarmingly, drug-related pregnancy-associated mortality has shown a staggering 190% rise between 2010 and 2019 in the USA. Different drugs of abuse, when used during pregnancy, increase the risk of stillbirth, neonatal abstinence syndrome and sudden infant death. Adverse effects on pregnancy include premature rupture of membranes, placental abruption, preterm birth, low birth space? weight and small-for-gestational-age infants. There is also an increased risk of morbidity and mortality for the pregnant women. Long-term negative adverse effects of perinatal exposure to substances also include a number of neurocognitive, behavioral and emotional dysfunctions in infants. Each type of substance has its own specificities, which will be briefly summarized. Conclusion: All childbearing age women must be informed about the potential harm of the prenatal use of psychoactive substances and should be encouraged to stop their use when pregnancy is planned and, at least, when pregnancy is known. Questioning women about their alcohol consumption should be systematic at the first prenatal visit and then at every prenatal visit until delivery. Multidisciplinary prevention approaches as well as intervention measures targeted to each type of psychoactive substance can save mothers’ lives and mitigate serious adversities to the offspring.
Collapse
|
2
|
Blayac L, Ponte C, Lavaud M, Micallef J, Lapeyre-Mestre M. Increase of cannabis and cocaine use by pregnant women in France from 2005 to 2018: Insights of the annual cross sectional OPPIDUM survey. Therapie 2023; 78:201-211. [PMID: 36283856 DOI: 10.1016/j.therap.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 06/21/2022] [Indexed: 11/06/2022]
Abstract
CONTEXT Substance use disorders during pregnancy are associated with antenatal, neonatal and long-term adverse drug reactions in children. The aim of this study was to describe, using data from OPPIDUM survey, the evolution of illicit substance use or diverted prescription drug use among pregnant women visiting French addiction care centres from 2005 to 2018. MATERIAL AND METHOD The current study focused on women of childbearing age (15-44years old) identified as pregnant, and included in the OPPIDUM survey from 2005 to 2018. OPPIDUM is a French nationwide survey repeated each year since 1995, which anonymously collects information on drug abuse and dependence observed in patients recruited in addiction care centres. Patterns of illicit substance use, psychoactive medications, and opioid maintenance treatment (OMT) were described over time (by period of 2 years) and changes between 2005-2006 and 2017-2018 were investigated. RESULTS From 2005 to 2018, 784 pregnant women were included in the OPPIDUM survey (median age 28, interquartile range (IQR): 25-33). The proportion of women using exclusively cannabis (1.2% vs. 17.1%, P=0.0004) and cocaine (including crack) use (4.7% vs. 14.3%, P=0.0384) significantly increased over the period. Considering the first substance reported as leading to dependence, heroin significantly decreased (78.8% vs. 50.0%, P=0.0002) whereas cannabis significantly increased (5.9% vs. 25.7%, P=0.0005). CONCLUSION This study highlighted an important change of patterns of drug use by French pregnant women over a 14-year-period. Health professionals must be aware of these changes to adapt prevention and care among women of childbearing age and pregnant women.
Collapse
Affiliation(s)
- Léna Blayac
- Service de pharmacologie médicale et clinique, centre d'addictovigilance (CEIP-A), CHU de Toulouse - UFR santé, université de Toulouse, 31000 Toulouse, France.
| | - Camille Ponte
- Service de pharmacologie médicale et clinique, centre d'addictovigilance (CEIP-A), CHU de Toulouse - UFR santé, université de Toulouse, 31000 Toulouse, France
| | - Monique Lavaud
- École de sages-femmes, université de Toulouse, 31059 Toulouse, France
| | - Joëlle Micallef
- UMR 1106, Inserm, service de pharmacologie clinique, centre d'addictovigilance, AP-HM, Aix-Marseille université, 13005 Marseille, France
| | - Maryse Lapeyre-Mestre
- Service de pharmacologie médicale et clinique, centre d'addictovigilance (CEIP-A), CHU de Toulouse - UFR santé, université de Toulouse, 31000 Toulouse, France
| |
Collapse
|
3
|
Blanchot A, Antal MC, Ameline A, Gheddar L, Arbouche N, Raul JS, Kintz P. Pregnancy denial and unplanned home delivery: Considerations about fetal death causes and maternal drug use imputability. Forensic Sci Int 2023; 342:111538. [PMID: 36543017 DOI: 10.1016/j.forsciint.2022.111538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/03/2022] [Indexed: 12/12/2022]
Abstract
Determining fetal death causes is a complex problem for the forensic pathologist. Beyond the medico-legal context, the expert must be able to evaluate the viability of the fetus at the time of death, to eliminate in-utero fetal death and to determine if the death is related to a fetal, a maternal, a placental cause, or simply related to obstetrical complications. The authors present the case of a 21-year-old woman who unexpectedly gave birth to a fetus during a party. As pregnancy was not acknowledged by the mother (regular menstrual cycles and use of hormonal contraception), no obstetrical check-up had been performed. She would have presented violent abdominal pain and expelled a mass in the toilet. The fetus body, enclosed in the amniotic pouch, and the placenta were found in the toilet. A forensic autopsy was performed jointly by a forensic pathologist and a specialist in fetal pathology. Histological, toxicological and genetic samples were collected. Body morphometry and bone maturation indicated a gestational age of 31-32 weeks of amenorrhea. A significant asphyxia syndrome and non-specific multi-visceral congestion were noted at autopsy. Histological analysis of the fetal tissues revealed a lung and skeletal muscle maturation in accordance with the estimated term. At the brain level, there were signs of anoxia and abnormal cortical development with periventricular nodular heterotopia areas. The placenta microscopic analysis revealed acute chorioamniotitis, the probable cause of the premature fetal expulsion. Toxicological analyses revealed the presence of ecstasy (48 ng/mL) and its metabolite MDA (2 ng/mL) in fetal blood. Although negative in blood, THC-COOH tested positive in urine (9 ng/mL). The fetus was repetitively exposed to cannabis, as Δ9-THC tested positive in hair (51 pg/mg). Maternal hair analysis on 4 × 3 cm evidenced a long-term use of cannabis, while results support single massive exposure to ecstasy. In this article, the authors try to explain the reflexive pathway carried out to establish death causes and the maternal toxic consumption imputability on the cerebral malformations and fetal death. This case illustrates both the interest of toxicological analyses in cases of fetal death and the importance of a collaborative work between forensic and fetal pathologists and toxicologists, which appeared critical to answer in the best conditions to the magistrates questions, as well as to the bereaved families.
Collapse
Affiliation(s)
- Adeline Blanchot
- Institut de médecine légale, 11 rue Humann, 67085 Strasbourg, France.
| | - Maria Cristina Antal
- UF6349 Fœtopathologie, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - Alice Ameline
- Institut de médecine légale, 11 rue Humann, 67085 Strasbourg, France
| | - Laurie Gheddar
- Institut de médecine légale, 11 rue Humann, 67085 Strasbourg, France
| | - Nadia Arbouche
- Institut de médecine légale, 11 rue Humann, 67085 Strasbourg, France
| | | | - Pascal Kintz
- Institut de médecine légale, 11 rue Humann, 67085 Strasbourg, France
| |
Collapse
|
4
|
Chanal C, Mazurier E, Doray B. Use of Psychoactive Substances during the Perinatal Period: Guidelines for Interventions during the Perinatal Period from the French National College of Midwives. J Midwifery Womens Health 2022; 67 Suppl 1:S17-S37. [PMID: 36480661 DOI: 10.1111/jmwh.13419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/10/2022] [Indexed: 12/13/2022]
Abstract
Based on their clinical practice and an extensive review of the literature, the authors propose a framework of procedures to be followed to provide services to all women of childbearing age who use psychoactive substances (alcohol, cannabis, cocaine, amphetamines, and opioids), especially during pregnancy or during the postpartum and breastfeeding periods, in view of their individual situations and environmental contexts.
Collapse
Affiliation(s)
- Corinne Chanal
- Hôpital Arnaud de Villeneuve, CHU Montpellier, 371 avenue du Doyen Gaston Giraud cedex 5, Montpellier, 34295, France.,Réseau de Périnatalité Occitanie Espace Henri BERTIN SANS, Bat A, 59 avenue de Fès-34080, Montpellier, France
| | - Evelyne Mazurier
- Hôpital Arnaud de Villeneuve, CHU Montpellier, 371 avenue du Doyen Gaston Giraud cedex 5, Montpellier, 34295, France
| | - Bérénice Doray
- Service de génétique, CHU de La Réunion, allée des Topazes, cedex, 97405, SAINT-DENIS.,Centre Ressource Troubles du Spectre de l'Alcoolisation Fœtale (TSAF) - Fondation Père Favron - 43 rue du Four à Chaux, Saint-Pierre, 97410, Réunion
| |
Collapse
|
5
|
Fasakin OW, Oboh G, Ademosun AO. The prevalence, mechanism of action, and toxicity of Nigerian psychoactive plants. COMPARATIVE CLINICAL PATHOLOGY 2022; 31:853-873. [PMID: 35789743 PMCID: PMC9243860 DOI: 10.1007/s00580-022-03374-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 06/19/2022] [Indexed: 06/15/2023]
Abstract
Cannabis sativa, Datura stramonium, Nicotiana tabacum, and Carica papaya are plants that naturally grow in Nigeria. They are reportedly rich in neuroactive compounds that are capable of reacting with the nervous system to elicit psychoactive and/or toxic effects that deter predators. However, despite the toxicological potential of these plants, their recreational use is on the rise due to the psychoactivity they proffer and prevalence in Nigeria. The aim of the present study is to evaluate the plants' recreational use, mechanism of actions and toxicities. Relevant published documents on psychoactive plants in Nigeria were obtained from Web of Science between 2002 and 2020. Non-English documents, documents not in Science Citation Index Expanded and Google Scholar were removed while 1186 documents were reviewed. Results showed that the plants are recreationally used in Nigeria with a higher prevalence than the global frequency. They are very addictive and lead to dependence. The plants were also observed to elicit different mechanism of action, though the activation of monoaminergic neurotransmission system was common to all. Regrettably, the plants could be toxic when ingested under non-medical conditions. Conclusively, these plants are addictive with potential toxic effects. Therefore, control of the recreational use of these plants should be revamped and overhauled.
Collapse
Affiliation(s)
- Olamide Wilson Fasakin
- Functional Foods, Nutraceuticals and Phytomedicine Unit, Department of Biochemistry, Federal University of Technology, P.M.B. 704, Akure, 340001 Nigeria
| | - Ganiyu Oboh
- Functional Foods, Nutraceuticals and Phytomedicine Unit, Department of Biochemistry, Federal University of Technology, P.M.B. 704, Akure, 340001 Nigeria
| | - Ayokunle Olubode Ademosun
- Functional Foods, Nutraceuticals and Phytomedicine Unit, Department of Biochemistry, Federal University of Technology, P.M.B. 704, Akure, 340001 Nigeria
| |
Collapse
|
6
|
Gómez-Ruiz LM, Marchei E, Rotolo MC, Brunetti P, Mannocchi G, Acosta-López A, Ramos-Gutiérrez RY, Varela-Busaka MB, Pichini S, Garcia-Algar O. Prevalence of Licit and Illicit Drugs Use during Pregnancy in Mexican Women. Pharmaceuticals (Basel) 2022; 15:ph15030382. [PMID: 35337179 PMCID: PMC8953434 DOI: 10.3390/ph15030382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/12/2022] [Accepted: 03/15/2022] [Indexed: 12/15/2022] Open
Abstract
For the first time, the present study employed hair testing to investigate the prevalence of classical drugs of abuse and new psychoactive substances use during gestation in a cohort of 300 Mexican pregnant women. An interview was conducted to collect data on sociodemographic aspects of the patients, and a 9 cm-long hair strand was taken from the back of the head of each mother one month after delivery. A validated ultra-high-performance liquid chromatography−high-resolution mass spectrometry method was used for the screening of classic drugs, new psychoactive substances, and medications in maternal hair. Out of 300 examined hair samples from pregnant women, 127 (42.3%) resulted positive for psychoactive substances: 45 (35.4%) for cannabis only, 24 (18.9%) for methamphetamine only, 13 (10.2%) for cocaine only, 1 (0.3%) for heroin, 1 for N-N-dimethyltryptamine (0.3%), 1 for ketamine (0.8%), and 35 (16.3%) for more than one psychoactive substance. Furthermore, seven samples (2.3%) resulted positive for new psychoactive substances (NPS): two samples for synthetic cannabinoids, two for synthetic cathinones, and three for nor-fentanyl, and 3.3% of women hair resulted positive for anticonvulsant, antidepressant, and antipsychotic medications. Finally, 83 women hair samples (27.7%) tested positive for nicotine. Nonsteroidal anti-inflammatory drugs (NSAIDs) and other painkillers (60.0%), medications for the treatment of nausea and vomiting (12.3%), antihistamines (8.7%) and nasal/sinus decongestants (6.7%), cough suppressants (5.0%), and bronchodilator agents (5.0%) were also detected in pregnant women hair. The gestational use of psychoactive substances and exposure to tobacco smoke, assessed by hair testing, were associated with a significantly younger age and with a low education grade of the mothers (p < 0.005). This study provides a significant preliminary indication of the under-reported gestational consumption of licit and illicit psychoactive and pharmacologically active drugs in a Mexican environment, showing the value of toxicological and forensic analyses in the global effort to determine the health risks caused by classic drugs and new psychoactive substances during pregnancy.
Collapse
Affiliation(s)
- Larissa-María Gómez-Ruiz
- Servicio de Neonatología, División de Pediatría, Nuevo Hospital Civil de Guadalajara “Dr. Juan I. Menchaca”, Guadalajara 44600, Mexico; (L.-M.G.-R.); (A.A.-L.); (R.-Y.R.-G.); (M.-B.V.-B.)
- Departamento de Cirugía y Especialidades Médico-Quirúrgicas, Universidad de Barcelona, 08036 Barcelona, Spain;
| | - Emilia Marchei
- National Centre on Addiction and Doping, Italian National Institute of Health (ISS), V.Le Regina Elena 299, 00161 Rome, Italy; (E.M.); (M.C.R.)
| | - Maria Concetta Rotolo
- National Centre on Addiction and Doping, Italian National Institute of Health (ISS), V.Le Regina Elena 299, 00161 Rome, Italy; (E.M.); (M.C.R.)
| | - Pietro Brunetti
- Unit of Forensic Toxicology, Section of Legal Medicine, Department of Excellence of Biomedical Scienc-Es and Public Health, Marche Polytechnic University, 60126 Ancona, Italy;
| | | | - Aracely Acosta-López
- Servicio de Neonatología, División de Pediatría, Nuevo Hospital Civil de Guadalajara “Dr. Juan I. Menchaca”, Guadalajara 44600, Mexico; (L.-M.G.-R.); (A.A.-L.); (R.-Y.R.-G.); (M.-B.V.-B.)
| | - Ruth-Yesica Ramos-Gutiérrez
- Servicio de Neonatología, División de Pediatría, Nuevo Hospital Civil de Guadalajara “Dr. Juan I. Menchaca”, Guadalajara 44600, Mexico; (L.-M.G.-R.); (A.A.-L.); (R.-Y.R.-G.); (M.-B.V.-B.)
| | - Mary-Buhya Varela-Busaka
- Servicio de Neonatología, División de Pediatría, Nuevo Hospital Civil de Guadalajara “Dr. Juan I. Menchaca”, Guadalajara 44600, Mexico; (L.-M.G.-R.); (A.A.-L.); (R.-Y.R.-G.); (M.-B.V.-B.)
| | - Simona Pichini
- National Centre on Addiction and Doping, Italian National Institute of Health (ISS), V.Le Regina Elena 299, 00161 Rome, Italy; (E.M.); (M.C.R.)
- Correspondence: ; Tel.: +39-064990-6545
| | - Oscar Garcia-Algar
- Departamento de Cirugía y Especialidades Médico-Quirúrgicas, Universidad de Barcelona, 08036 Barcelona, Spain;
- Neonatology Unit, Hospital Clinic-Maternitat, ICGON, BCNatal, C/Sabino Arana 1, 08028 Barcelona, Spain
| |
Collapse
|
7
|
Pélissier-Alicot AL, Piercecchi MD, Gaulier JM, Allorge D, Sastre C, Baillif-Couniou V, Christia MA, Zuck S, Leonetti G. Risque tératogène de la cocaïne ? À propos d’un cas. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2022. [DOI: 10.1016/j.toxac.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
8
|
Cao J, Chen Y, Xia X, Qu H, Ao Y, Wang H. Intergenerational genetic programming mechanism and sex differences of the adrenal corticosterone synthesis dysfunction in offspring induced by prenatal ethanol exposure. Toxicol Lett 2021; 351:78-88. [PMID: 34454011 DOI: 10.1016/j.toxlet.2021.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/11/2021] [Accepted: 08/18/2021] [Indexed: 11/28/2022]
Abstract
We previously found that prenatal ethanol exposure (PEE) induced adrenal dysplasia in offspring, which was related to intrauterine maternal glucocorticoid overexposure. This study investigated the intergenerational genetic effect and sex differences of PEE-induced changes in the synthetic function of adrenal corticosterone in offspring, and to clarify the intrauterine origin programming mechanism. Wistar pregnant rats were gavaged with ethanol (4 g/kg bw/d) from gestation day (GD) 9-20, and F1 generation was born naturally. The F1 generation female rats in the PEE group were mated with normal male rats to produce F2 generation. Serum and adrenal glands of fetal rats and F1/F2 adult rats were collected at GD20 and postnatal week 28. PEE increased the serum corticosterone level, while diminishing the expression of adrenal steroid synthases of fetal rats. Moreover, PEE enhanced the mRNA expression of GR and HDAC1, but inhibited the mRNA expression of SF1 and reduced the H3K9ac level of P450scc in the fetal adrenal gland. In PEE adult offspring of F1 and F2 generation the serum corticosterone level, the H3K9ac level of P450scc and its expression were decreased in males but were increased in females. In NCI-H295R cells, cortisol reduced the production of endogenous cortisol, down-regulated SF1, and up-regulated HDAC1 expression by activating GR, and decreased H3K9ac level and expression of P450scc. In conclusion, PEE could induce adrenal dysplasia in offspring with sex differences and intergenerational genetic effects, and the adrenal insufficiency in male offspring was related to the induction of low functional genetic programming of P450scc by intrauterine high corticosterone through the GR/SF1/HDAC1 pathway.
Collapse
Affiliation(s)
- Jiangang Cao
- Department of Pharmacology, School of Basic Medical Sciences, Wuhan University, Wuhan 430071, China
| | - Yawen Chen
- Department of Pharmacology, School of Basic Medical Sciences, Wuhan University, Wuhan 430071, China
| | - Xuan Xia
- Department of Pharmacology, School of Basic Medical Sciences, Wuhan University, Wuhan 430071, China
| | - Hui Qu
- Department of Pharmacology, School of Basic Medical Sciences, Wuhan University, Wuhan 430071, China
| | - Ying Ao
- Department of Pharmacology, School of Basic Medical Sciences, Wuhan University, Wuhan 430071, China; Hubei Provincial Key Laboratory of Developmentally Originated Disease, Wuhan 430071, China.
| | - Hui Wang
- Department of Pharmacology, School of Basic Medical Sciences, Wuhan University, Wuhan 430071, China; Hubei Provincial Key Laboratory of Developmentally Originated Disease, Wuhan 430071, China.
| |
Collapse
|
9
|
Duko B, Pereira G, Tait RJ, Newnham J, Betts K, Alati R. Prenatal tobacco exposure and the risk of conduct disorder symptoms in offspring at the age of 14 years: Findings from the Raine Study. J Psychiatr Res 2021; 142:1-8. [PMID: 34304077 DOI: 10.1016/j.jpsychires.2021.07.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/30/2021] [Accepted: 07/18/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Emerging epidemiological evidence suggests that offspring born to mothers who smoked tobacco during pregnancy may have elevated risk of developing conduct disorder (CD) symptoms. We examined associations between maternal and paternal tobacco smoking during pregnancy and CD symptoms in offspring at the age of 14 years. METHODS We obtained data from the Raine Study, a multi-generational cohort study based in Western Australia. DSM-oriented scale of the Child Behavior Checklist (CBCL) was used to measure CD symptoms in offspring. Negative binomial regression was used to estimate the rate ratio (risks) (RR) of CD symptoms in offspring. We also produced the E-values to investigate the extent of unmeasured confounding. Paternal smoking during pregnancy was used as a proxy for environmental tobacco smoke exposure. RESULTS Complete data were available for 1747 mother-offspring and 1711 father-offspring pairs. After adjusting for potential confounders, we found elevated risks (rates) of CD symptoms in offspring born to mothers smoking tobacco during the first trimester [RR 1.52 (95 % CI: 1.24-1.87)], third trimester [RR 1.36 (95 % CI: 1.09-1.69)] and during both trimesters of pregnancy [RR 1.50 (95 % CI: 1.19-1.90)]. The rates of CD symptoms in offspring increased with the level of exposure to maternal smoking during pregnancy. However, we noted insufficient statistical evidence for an association between paternal smoking during pregnancy and CD symptoms in offspring. CONCLUSION The associations we found for maternal but not paternal smoking may suggest a biological mechanism for intrauterine tobacco exposure on the risk of CD symptoms in offspring. Early interventions assisting pregnant mothers to quit tobacco smoking, or avoid smoking initiation, have potential to contribute health benefits to both mothers and their offspring.
Collapse
Affiliation(s)
- Bereket Duko
- Curtin School of Population Health, Curtin University, Kent Street, Bentley, WA, 6102, Australia.
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Kent Street, Bentley, WA, 6102, Australia; Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
| | - Robert J Tait
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, 7 Parker Place Building 609, Level 2 Technology Park, Bentley, WA, 6102, Australia
| | - John Newnham
- Division of Obstetrics and Gynaecology, Faculty of Health and Medical Sciences, The University of Western Australia, 17 Monash Ave, Nedlands, WA, 6009, Australia
| | - Kim Betts
- Curtin School of Population Health, Curtin University, Kent Street, Bentley, WA, 6102, Australia
| | - Rosa Alati
- Curtin School of Population Health, Curtin University, Kent Street, Bentley, WA, 6102, Australia; Institute for Social Sciences Research, The University of Queensland, 80 Meier's Rd, Indooroopilly, Queensland, 4068, Australia
| |
Collapse
|
10
|
Unmet Mental Health Care Needs and Illicit Drug Use During Pregnancy. J Addict Med 2021; 15:233-240. [PMID: 33009165 DOI: 10.1097/adm.0000000000000752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The prevalence of drug use is at alarmingly high levels in the United States. Of particular concern is prenatal drug use, which exposes the underdeveloped organ systems of the fetus to harsh chemicals. Identifying factors associated with illicit drug use during pregnancy is critical to identify and treat at-risk pregnant women and improve maternal and infant health outcomes. The goal of this study was to examine the association between unmet mental health care needs and substance use during pregnancy. METHODS The present cross-sectional study analyzed secondary data from the 2002 to 2014 National Survey on Drug Use and Health (n = 10,516). The main outcome of interest was self-reported illicit drug use in the last 30 days. The independent variable was unmet mental health care needs in the last 12 months. RESULTS Overall, 6.4% of the participants reported a history of unmet mental health care needs and 4.5% used a substance during pregnancy. The odds of illicit drug use during pregnancy were higher among women who had an unmet mental health care needs compared to women without a history of unmet mental health care needs, multivariable-adjusted odds ratio (95% CI) 4.06 (3.01 to 5.48; P < 0.001). The observed association between unmet mental health care needs and illicit drug use persisted in subgroup analyses by age, race/ethnicity and education. CONCLUSION In a nationally representative cross-sectional sample of pregnant women, having unmet mental health care needs was positively associated with illicit drug use during pregnancy after adjusting for potential confounders.
Collapse
|
11
|
Lamy S, Hennart B, Houivet E, Marret S, Thibaut F. Étude de prévalence de la consommation d’alcool et de substances psychoactives chez 700 femmes enceintes : résultats préliminaires de l’étude GTOX. Eur Psychiatry 2020. [DOI: 10.1016/j.eurpsy.2013.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
ObjectifsL’usage de substances licites et illicites pendant la grossesse peut avoir de graves conséquences à court et long terme chez l’enfant [3] et constitue une préoccupation majeure de santé publique [1]. L’objectif de notre étude est d’établir la prévalence de la consommation d’alcool et de substances psychoactives chez la femme enceinte en couplant les données déclaratives de la mère avec les dosages toxicologiques réalisés dans le méconium du nouveau-né. C’est la première étude de ce type en France.MéthodesEtude épidémiologique transversale réalisée dans l’ensemble des maternités de Rouen (Seine-Maritime). Elle a été proposée à toutes les femmes ayant accouché au cours des mois d’août 2010 et 2011.RésultatsSept cent vingt-quatre dyades mère/enfant ont été incluses sur les 993 accouchements. Quatre-vingt-quatorze pour cent des femmes interrogées ont accepté de participer. L’âge moyen des femmes est de 30 ans. Les consommations rapportées sont les suivantes : consommation d’alcool 15 %, consommation du tabac 21 %, consommation de cannabis 1 %. Les analyses toxicologiques sont en cours (éthyl glucuronide pour alcool, cotinine pour le tabac et THC-COOH pour le cannabis [2]).
ConclusionLa prévalence de consommation d’alcool et de tabac est élevée dans notre population, ce qui doit encourager à poursuivre les campagnes d’information et de prévention chez les femmes enceintes.
Collapse
|
12
|
Mravčík V, Nechanská B, Gabrhelík R, Handal M, Mahic M, Skurtveit S. Socioeconomic characteristics of women with substance use disorder during pregnancy and neonatal outcomes in their newborns: A national registry study from the Czech Republic. Drug Alcohol Depend 2020; 209:107933. [PMID: 32109712 DOI: 10.1016/j.drugalcdep.2020.107933] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 02/17/2020] [Accepted: 02/18/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Maternal substance use can pose a risk to the fetal health. We studied the background characteristics of women with substance use disorders (SUDs) and selected neonatal outcomes in their children. MATERIAL AND METHODS A database-linkage study was performed. The sample consisted of pregnant women with a SUD during pregnancy (ICD-10 diagnosis F10-F19 except F17, n = 1710), women not diagnosed with a SUD (n = 1,511,310) in Czechia in 2000-2014, and their children. The monitored neonatal outcomes were gestational age, birth weight, preterm birth, and small-for-gestational age (SGA). Binary logistic regression adjusted for age, marital status, education, concurrent substance use, and prenatal care was performed. RESULTS Women with illicit SUDs were younger, more often unmarried, with a lower level of education, a higher abortion rate, a higher smoking rate, and lower compliance to prenatal care than women with a SUD related to alcohol, or sedatives and hypnotics (SH). Women with a SUD had worse socioeconomic situations, poorer pregnancy care, and worse neonatal outcomes than women without a SUD. After adjustment, we found no difference in SGA between the illicit SUD groups and the alcohol and the SH groups. The newborns from all SUD groups had a higher risk of SGA when compared to women without a SUD. However after adjustment, the difference remained significant just in the alcohol group (OR = 1.9, 95 % CI = 1.4-2.6). CONCLUSION Mother's SUD during pregnancy increased risk of fetal growth restriction as measured by SGA. The role of maternal socioeconomic and lifestyle factors for the risk of SGA was substantial.
Collapse
Affiliation(s)
- Viktor Mravčík
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; National Monitoring Centre for Drugs and Addiction, Office of the Government, Prague, Czech Republic.
| | - Blanka Nechanská
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Roman Gabrhelík
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Marte Handal
- Norwegian Institute of Public Health, Oslo, Norway
| | - Milada Mahic
- Norwegian Institute of Public Health, Oslo, Norway
| | - Svetlana Skurtveit
- Norwegian Institute of Public Health, Oslo, Norway; Norwegian Centre for Addiction Research at the University of Oslo, Norway
| |
Collapse
|
13
|
Hetea A, Cosconel C, Stanescu AAM, Simionescu AA. Alcohol and Psychoactive Drugs in Pregnancy. MAEDICA 2019; 14:397-401. [PMID: 32153672 PMCID: PMC7035437 DOI: 10.26574/maedica.2019.14.4.397] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Although often difficult to diagnose, the use of psychoactive drugs during pregnancy has become a commonly encountered occurrence. The present article aims to clarify the effects of alcohol, tobacco, narcotics, antidepressants, stimulants, halucinogenes and canabioids consumption on pregnancy and the newborn. There are differences within the types of drugs consumption: use/abuse/addiction of psychoactive medication during pregnancy. The fetal alcohol syndrome occurs in case of alcohol exposure during pregnancy. It is characterized by fetal alcohol spectrum disorders, lower neurobehavioral scores, mental retardation, heart defects and special facial features. Heroin consumption can lead to prematurity, intrauterine growth restriction, stillbirth or to hemorrhage in the third trimester of pregnancy; it can be associated with malnutrition, venereal diseases, hepatitis, pulmonary complications or preeclampsia. During pregnancy, the effects of cocaine use include cardiovascular complications, neurological complications, infections (sexually transmitted diseases - gonorrhea, Chlamydia infections, syphilis, HPV), obstetric complications (premature birth, fetal death, abruptio placentae). In the fetus, the consequences of cocaine consumption can trigger limb defects, urinary tract malformations, fetal microcephaly, perinatal cerebral infarctions. In conclusion, identifying the profile of pregnant drug users can trigger better care both for the mother, and for the fetus; information and prevention campaigns should provide data on their adverse effects on pregnancy.
Collapse
Affiliation(s)
- Andreea Hetea
- Filantropia Hospital, Department of obstetrics and Gynecology, Bucharest, Romania
| | - Cristiana Cosconel
- "Carol Davila" University of Medicine and Pharmacy, Department of Foreign Languages, Bucharest, Romania
| | | | - Anca A Simionescu
- Filantropia Hospital, Department of obstetrics and Gynecology, Bucharest, Romania
| |
Collapse
|
14
|
Risk factors associated to tobacco and alcohol use in a large French cohort of pregnant women. Arch Womens Ment Health 2019; 22:267-277. [PMID: 30074092 DOI: 10.1007/s00737-018-0892-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 07/11/2018] [Indexed: 01/13/2023]
Abstract
Tobacco and/or alcohol use during pregnancy is a major public health concern. The aim of our study was to identify risk factors associated to maternal alcohol and tobacco use assessed by maternal self-reports combined with biological measurements in meconium samples of cotinine and ethylglucuronide which reflect fetal exposure to tobacco and alcohol, respectively, during the 3rd trimester of pregnancy. We conducted a prospective study in three maternity hospitals in a large urban area during consecutive weeks (2010 and 2011). Maternal sociodemographic and clinical characteristics were assessed after delivery, using the French version of the Addiction Severity Index. Cotinine and ethylglucuronide were measured in meconium samples. Seven hundred and twenty-four women were included, and 645 meconium samples collected. Using multivariate analyses, we found that not being married or having a smoking partner predicts maternal tobacco use. In contrast, a decreased risk was associated with higher education level and wanted pregnancy. The risk for alcohol use increased when the mother had been in conflict with any relative or her partner for a long time throughout her life, as well as in case of previous treatment for any mental or emotional disorder. Using multivariate analyses and cotinine presence in meconium samples, the risks were similar except for marital status, which was not associated to cotinine presence. Community education and prevention programs should urgently be improved for all women of childbearing age with a special focus on those with past histories of mental or emotional disorders and addictive disorders. Smoking cessation should be recommended to both parents.
Collapse
|
15
|
Perception of Environmental Risks and Behavioral Changes during Pregnancy: A Cross-Sectional Study of French Postpartum Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16040565. [PMID: 30781450 PMCID: PMC6406321 DOI: 10.3390/ijerph16040565] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 02/04/2019] [Accepted: 02/07/2019] [Indexed: 12/19/2022]
Abstract
Limiting exposure to environmental hazards during preconception and pregnancy is essential for preventing adverse pregnancy outcomes or developmental defects in offspring. However, the perception of environmental risk and the behavioral changes of women planning or having a pregnancy have rarely been investigated, except for a few risk factors. We thus performed a cross-sectional study of French postpartum women hospitalized in the Bordeaux University Hospital in 2017 by proposing a self-administrated survey. The main objective was to assess their level of awareness concerning a large panel of environmental hazards and modifications in their behavior during pregnancy in occupational and household environments. Among the 121 respondents, most identified the environment as a major factor for a healthy pregnancy but recognized a lack of knowledge regarding environmental risk factors. The internet, television, and magazines were their main sources of information. Most women modified some of their practices at work or home. These measures were rarely implemented in consultation with a health practitioner, which raises concerns about the relevance of the adjustments made. Our findings highlight the need to improve the quality of information available to women and to help them implement preventive measures in consultation with physicians.
Collapse
|
16
|
Thibaut F, Chagraoui A, Buckley L, Gressier F, Labad J, Lamy S, Potenza MN, Rondon M, Riecher-Rössler A, Soyka M, Yonkers K, Yonkers K. WFSBP * and IAWMH ** Guidelines for the treatment of alcohol use disorders in pregnant women. World J Biol Psychiatry 2019; 20:17-50. [PMID: 30632868 DOI: 10.1080/15622975.2018.1510185] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES These practice guidelines for the treatment of alcohol use disorders during pregnancy were developed by members of the International Task Force of the World Federation of Societies of Biological Psychiatry and the International Association for Women's Mental Health. METHODS We performed a systematic review of all available publications and extracted data from national and international guidelines. The Task Force evaluated the data with respect to the strength of evidence for the efficacy and safety of each medication. RESULTS AND DISCUSSION There is no safe level of alcohol use during pregnancy. Abstinence is recommended. Ideally, women should stop alcohol use when pregnancy is planned and, in any case, as soon as pregnancy is known. Detecting patterns of alcohol maternal drinking should be systematically conducted at first antenatal visit and throughout pregnancy. Brief interventions are recommended in the case of low or moderate risk of alcohol use. Low doses of benzodiazepines, for the shortest duration, may be used to prevent alcohol withdrawal symptoms when high and chronic alcohol intake is stopped and hospitalisation is recommended. Due to the low level of evidence and/or to low benefit/risk ratio, pharmacological treatment for maintenance of abstinence should not be used during pregnancy. At birth, foetal alcohol spectrum disorders must be searched for, and alcohol metabolites should be measured in meconium of neonates in any doubt of foetal alcohol exposure.
Collapse
Affiliation(s)
- Florence Thibaut
- a University Hospital Cochin , Faculty of Medicine Paris Descartes, INSERM U 894, Centre Psychiatry and Neurosciences , Paris , France
| | - Abdeslam Chagraoui
- b Neuronal and Neuroendocrine Differentiation and Communication Laboratory , Institute for Research and Innovation in Biomedicine of Normandy (IRIB), Normandie Univ , UNIROUEN, INSERM, U1239, CHU Rouen , Rouen , France ; Department of Medical Biochemistry , Rouen University Hospital , Rouen , France
| | - Leslie Buckley
- c Addiction Services , University Health Network, University of Toronto , Toronto , Canada
| | - Florence Gressier
- d Department of Psychiatry , INSERM UMR1178 CESP, Univ. Paris-Sud , Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre , Le Kremlin Bicêtre , France
| | - Javier Labad
- e Department of Mental Health , Parc Tauli Hospital Universitari, I3PT ; Department of Psychiatry and Legal Medicine , Universitat Autonoma de Barcelona, CIBERSAM, Sabadell , Barcelona , Spain
| | - Sandrine Lamy
- f Department of Addictology , Ramsay- General de Santé, SSR Petit Colmoulins , Harfleur , France
| | - Marc N Potenza
- g Neuroscience and Child Study , Yale University School of Medicine , New Haven , CT , USA
| | - Marta Rondon
- h Instituto Nacional Materno Perinatal , Lima , Peru
| | - Anita Riecher-Rössler
- i Center for Gender Research and Early Detection , University of Basel Psychiatric Hospital , Basel , Switzerland
| | - Michael Soyka
- j University of Munich , Munich, and Medicalpark Chiemseeblick, Bernau , Germany
| | - Kim Yonkers
- k Center for Wellbeing of Women and Mothers, Psychiatry, of Epidemiology (Chronic Diseases) and of Obstetrics, Gynecology, and Reproductive Sciences , Yale University , New Haven , CT , USA
| | - Kim Yonkers
- Center for Wellbeing of Women and Mothers, Psychiatry, of Epidemiology (Chronic Diseases) and of Obstetrics, Gynecology, and Reproductive Sciences, Yale University, New Haven, CT, USA
| |
Collapse
|
17
|
Alcohol consumption during pregnancy and risk of small-for-gestational-age newborn. Women Birth 2018; 32:284-288. [PMID: 30119966 DOI: 10.1016/j.wombi.2018.07.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/24/2018] [Accepted: 07/30/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Contradictory results have been published on the association of alcohol consumption during pregnancy with perinatal outcomes, including the risk of small for gestational age newborn. AIM To determine whether alcohol consumption during pregnancy is associated with the risk of small for gestational age newborn. METHOD A case-control study with 518 pairs of pregnant Spanish women in five hospitals was conducted; cases were women with small for gestational age newborn and age-matched (±2years) controls were women with non-small for gestational age newborn. Data were gathered on demographic characteristics, socioeconomic status, toxic habits, and diet. Alcohol intake was recorded with a self-administered 137 food frequency questionnaire and with a personal interview, Alcohol intake was categorized -. Agreement in alcohol intake results between direct interview and frequency food questionnaire was evaluated with the Kappa index. Crude and adjusted odds ratios and their 95% confidence intervals were estimated by conditional logistic regression. FINDINGS Poor agreement was observed between food frequency questionnaire and personal interview results for both cases (κ=0.23) and controls (κ=0.14). A food frequency questionnaire-recorded intake of less than 4g/day was associated with a significantly lower odds ratios for small for gestational age newborn (odds ratios=0.62, 95% confidence intervals, 0.43-0.88), whereas an interview-recorded intake of <4g/day was not related to small for gestational age newborn (odds ratios=0.86, 95% confidence intervals, 0.49-1.54). CONCLUSIONS A very moderate alcohol intake during pregnancy may have a negative association with the risk of having a small for gestational age newborn.
Collapse
|
18
|
Fanjeaux B, Braconnier A, Clerc-Urmès I, Morel O, Gauchotte E. [Obstetrical follow-up and perinatal prognosis in drug addict pregnant women]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2018; 46:99-104. [PMID: 29373310 DOI: 10.1016/j.gofs.2017.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To identify the factors associated with a good obstetric follow-up and a good perinatal prognosis, in order to adapt the management of pregnant women with addiction to opiates. METHODS A retrospective study was carried out in our maternity between January 2012 and December 2014, including 104 women who were addicted to opiates, whether or not they were substituted, with or without associated consumptions, regardless of the term of delivery beyond 22 weeks of amenorrhea. RESULTS A good obstetrical follow-up was observed by 32.7% of women. The father's presence (OR=3.9; P=0.0113) and investment in pregnancy (OR=4.4; P=0.0029), as well as the desired character of the pregnancy (OR=4.5; P=0.0008) appeared to be associated with the quality of the observed follow-up. Preterm deliveries (11.8 versus 35.8%; P=0.0103), and social measures taken at the discharge of the newborn from the maternity (2.9 versus 24.3%, P=0.0057) were less frequent. A good perinatal prognosis was found for 29.8% of the cases. Associated consumptions <3 (OR=2.6 [1.1-6.2]; P=0.0281) confirmed by negative urine drug screening (OR=2.9 [1.1-7.8]; P=0.0307) were more numerous. CONCLUSION Although the follow-up and the perinatal prognosis of these pregnancies have improved considerably in recent years, it seems necessary to further optimize their management.
Collapse
Affiliation(s)
- B Fanjeaux
- Service de maternité, CHRU de Nancy, 10, rue du Docteur Heydenreich, 54042 Nancy cedex, France; Faculté de médecine, université de Lorraine, 9, avenue de la Forêt-de-Haye, CS 50184, 54505 Vandœuvre-lès-Nancy cedex, France.
| | - A Braconnier
- Service de maternité, CHRU de Nancy, 10, rue du Docteur Heydenreich, 54042 Nancy cedex, France; Faculté de médecine, université de Lorraine, 9, avenue de la Forêt-de-Haye, CS 50184, 54505 Vandœuvre-lès-Nancy cedex, France
| | - I Clerc-Urmès
- Unité MDS, plateforme d'aide à la recherche clinique, CHRU de Nancy, 54511 Vandoeuvre-lès-Nancy, France
| | - O Morel
- Service de maternité, CHRU de Nancy, 10, rue du Docteur Heydenreich, 54042 Nancy cedex, France; Faculté de médecine, université de Lorraine, 9, avenue de la Forêt-de-Haye, CS 50184, 54505 Vandœuvre-lès-Nancy cedex, France
| | - E Gauchotte
- Service de maternité, CHRU de Nancy, 10, rue du Docteur Heydenreich, 54042 Nancy cedex, France
| |
Collapse
|
19
|
Ruisch IH, Dietrich A, Glennon JC, Buitelaar JK, Hoekstra PJ. Maternal substance use during pregnancy and offspring conduct problems: A meta-analysis. Neurosci Biobehav Rev 2018; 84:325-336. [DOI: 10.1016/j.neubiorev.2017.08.014] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 07/27/2017] [Accepted: 08/20/2017] [Indexed: 01/22/2023]
|
20
|
Abstract
Drug abuse and its consequences remain a significant public health issue. An increasing number of individuals are present in the emergency room with life-threatening drug intoxication. It is imperative that emergency room physicians are cognizant of the signs, symptoms, and treatment to improve the chances of early recognition and treatment. As a result, the proportion of lives saved will increase significantly. In this article, we present some of the most prevalent life-threatening drugs that lead to emergency room admission. The signs, symptoms, and treatment modalities are discussed.
Collapse
Affiliation(s)
- Evaristo Akerele
- Department of Psychiatry and Behavioral Health, Interfaith Medical Center, 1545 Atlantic Avenue, Brooklyn, NY 11213, USA.
| | - Tolu Olupona
- Department of Psychiatry and Behavioral Health, Interfaith Medical Center, 1545 Atlantic Avenue, Brooklyn, NY 11213, USA
| |
Collapse
|
21
|
Lamy S, Hennart B, Houivet E, Dulaurent S, Delavenne H, Benichou J, Allorge D, Marret S, Thibaut F. Assessment of tobacco, alcohol and cannabinoid metabolites in 645 meconium samples of newborns compared to maternal self-reports. J Psychiatr Res 2017; 90:86-93. [PMID: 28237885 DOI: 10.1016/j.jpsychires.2017.02.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 02/09/2017] [Accepted: 02/10/2017] [Indexed: 01/28/2023]
Abstract
Prenatal psychoactive substance exposure has significant impact on neonatal health and child development and the development of reliable biomarkers is critical. Meconium presents several advantages for detecting prenatal exposure to psychoactive substances, as it is easy to collect and provides a broad time frame of exposure (third trimester). The aim of our study was to compare the prevalence of alcohol, tobacco and/or cannabis use during the third trimester of pregnancy (using maternal self-reports) with the results of meconium testing of their metabolites in newborns (cotinine, ethyl-glucuronide (EtG) and cannabinoid metabolites). Among all deliveries (993) that occurred in all maternities in Rouen (Normandy) during a defined time period (5 consecutive weeks in August, 2010 and August, 2011), 724 mothers were included and 645 meconium samples were collected. Maternal self-reports, using the Addiction Severity Index (5th edition), and meconium samples were collected within 72 h of delivery. Cotinine detection appears highly correlated to maternal self-reports (Kappa value: 0.79; [95%CI: 0.73-0.85]). Moreover, detection in meconium seems more accurate in the prediction of neonatal consequences of prenatal tobacco exposure as compared to maternal self-reports. In contrast, we have found a lower concordance between maternal self-reports and meconium testing for EtG and cannabinoid metabolites (Kappa value: 0.13; [95%CI: 0.04-0.22] and: 0.30; [95%CI: -0.03-0.63], respectively); however the total number of EtG- and cannabinoid-positive meconium samples was small. Interestingly, meconium samples with the highest levels of EtG mainly corresponded to negative maternal self-reports. Fetal exposure to alcohol, tobacco or cannabis may also considerably differ as displayed in our pairs of dizygotic twins. Finally, a polyconsumption of these psychoactive substances was not frequently observed according to meconium testing. In conclusion, cotinine detection appears as a valuable meconium biomarker. EtG measurement in meconium samples seems interesting if there is any risk of high fetal exposure, whereas assessment of prenatal cannabis exposure, using meconium testing, needs to be improved.
Collapse
Affiliation(s)
- Sandrine Lamy
- Department of Addictology, Ramsay- General de Santé, SSR Petit Colmoulins, Harfleur, France; University Hospital Cochin (site Tarnier), University Sorbonne Paris-Cité (Paris V), Faculty of Medicine Paris Descartes, INSERM U894, Centre Psychiatry and Neurosciences, Paris, France.
| | - Benjamin Hennart
- CHU Lille, Service de Toxicologie-Génopathies, F-59000 Lille, France.
| | - Estelle Houivet
- Department of Biostatistics, University Hospital Rouen, Centre d'Investigation Clinique et de Ressources Biologiques, INSERM CIC-CRB, 1404 Rouen, France.
| | - Sylvain Dulaurent
- Laboratoire de Pharmacologie, Toxicologie et Pharmacovigilance, Hôpital Dupuytren, CHU de Limoges, France.
| | - Heloise Delavenne
- Department of Psychiatry, Faculty of Medicine, Federal University of Minas Gerais, Brazil.
| | - Jacques Benichou
- Department of Biostatistics, University Hospital Rouen, Centre d'Investigation Clinique et de Ressources Biologiques, INSERM CIC-CRB, 1404 Rouen, France.
| | - Delphine Allorge
- CHU Lille, Service de Toxicologie-Génopathies, F-59000 Lille, France; Univ.Lille, EA 4483-IMPECS- IMPact de l'Environnement Chimique sur la Santé humaine, F-59000 Lille, France.
| | - Stéphane Marret
- Department of Neonatal Medicine-Neuropediatrics, Rouen University Hospital and INSERM U 1245, Neovasc Team, Perinatal neurological handicap and Neuroprotection, Institute of Biomedical Research and Innovation, School of Medicine, Normandy University, France.
| | - Florence Thibaut
- University Hospital Cochin (site Tarnier), University Sorbonne Paris-Cité (Paris V), Faculty of Medicine Paris Descartes, INSERM U894, Centre Psychiatry and Neurosciences, Paris, France.
| |
Collapse
|
22
|
Reitan T. Patterns of polydrug use among pregnant substance abusers. NORDIC STUDIES ON ALCOHOL AND DRUGS 2017; 34:145-159. [PMID: 32934478 PMCID: PMC7450863 DOI: 10.1177/1455072516687256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 11/01/2016] [Indexed: 11/17/2022] Open
Abstract
Aim Studies of drug use during pregnancy have generally focused on individual substances or specific combinations of drugs. The aim of this article is to increase our knowledge about polydrug use and pregnancy in a Nordic context by describing the sociodemographic characteristics of a clinical population of pregnant women with severe substance use, examining the scope and type of polydrug use and analysing factors associated with concurrent use of many, as opposed to a few, drugs. Method A cross-sectional study of pregnant women on admission to compulsory care for substance abuse in Sweden between 2000 and 2009 (n = 119 women, representing 128 pregnancies). Data were retrieved from administrative registers and client records. Univariate links between demographic, social, obstetrical, treatment history variables and polydrug use were examined. Binary logistic regression was used to analyse the association between explanatory variables and polydrug use. Results The average number of drugs being used concurrently was 2.65, and injection drug use was recorded in 73% of the pregnancies. Opiates and amphetamines were the most common primary drugs, followed by alcohol. The likelihood of polydrug use increased with first trimester pregnancy, planned (as opposed to emergency) committals, as well as the combination of partner substance abuse and injection drug use. Conclusions Polydrug use was widespread among pregnant substance abusers. Policies, interventions and research often focus on individual drugs separately, but for clinical populations in particular there is a need to address drug use broadly, including a systematic recording of smoking habits. This also entails awarding more attention to those not eligible for established interventions, such as opiate maintenance treatment, and giving more consideration to a variety of life circumstances, such as partner drug use.
Collapse
Affiliation(s)
- Therese Reitan
- Centre for Social Research on Alcohol and Drugs (SoRAD), Stockholm University, Sweden
| |
Collapse
|
23
|
El Ammouri A, Sabir M, Ahid S, Toufiq J, El Omari F. [Non-drug psycho-active substance use and pregnancy]. Encephale 2015; 41:302-8. [PMID: 26383617 DOI: 10.1016/j.encep.2014.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 03/26/2013] [Indexed: 01/18/2023]
Abstract
BACKGROUND The consumption of psycho-active substances (PAS) by pregnant women is in a growing increase around the world. It is a major problem of public health in some countries due to serious and negative consequences for children and society as well as for pregnant women. This problem has also increased among women in Morocco. However, it is still neglected and underrated in the absence of any official statistical data. This is the first study leading to a better profiling of pregnant women who may consume psycho-active substances during their pregnancy; it would permit better medical and psychosocial care of both women and children. OBJECTIVES To determine the prevalence and the factors associated with the psycho-active substances used by pregnant women and describe their socio-demographic characteristics. METHODS AND PATIENTS A trans-sectional study was carried out from September to October 2010, including pregnant women consulting at the obstetrical service of the provincial hospital Moulay Abdellah in the city of Salé. The study included women who were pregnant or had recently given birth, and not having any serious mental disorders that could have upset their cognitive abilities. The data was collected through a straight questionnaire of 25 items specifying the socio-demographic characteristics, data about pregnancy and habits of using psycho-active substances. RESULTS One hundred and fifty pregnant women were included in the study. The majority of them (83.2%) were aged 20 to 40 years old, 94.6% were married, 96% were unemployed and depended on their spouses for their financial resources and 80% had normal domestic relationships (from average to good quality). Among the women, 31.3% of them reported traumatic events in the past. The prevalence of psycho-active substance consumption by the pregnant women of our sample was 11.3%. The used substances were tobacco (9.3%) and cannabis (4%). These women were more likely to have a low level of education (47.1 vs 16.5). They were victims of abuse or neglect in their past (82.3 vs 24.9), and their relationships with their spouses were bad (70.6 vs 13.5) with a lack of desired pregnancy (47.1 vs 27.8) and poor follow-up (47.1 vs 3.8). The results show statistically significant differences. CONCLUSION Not only should decision-makers draw attention to the seriousness of the problem because of the relatively high rate of psycho-active substance consumption, but also they should increase obstetric team's awareness to look systematically for psycho-active substance use.
Collapse
Affiliation(s)
- A El Ammouri
- Hôpital psychiatrique universitaire Ar-razi, CHU Rabat-Salé, rue Ibn-Rochd, 11010 Salé, Maroc.
| | - M Sabir
- Hôpital psychiatrique universitaire Ar-razi, CHU Rabat-Salé, rue Ibn-Rochd, 11010 Salé, Maroc
| | - S Ahid
- Équipe de recherche en pharmaco-épidémiologie & pharmaco-économie, faculté de médecine et de pharmacie, université Mohammed V Souissi, avenue Mohamed Belarbi El Alaoui, B.P. 6203, Rabat, Maroc
| | - J Toufiq
- Hôpital psychiatrique universitaire Ar-razi, CHU Rabat-Salé, rue Ibn-Rochd, 11010 Salé, Maroc
| | - F El Omari
- Hôpital psychiatrique universitaire Ar-razi, CHU Rabat-Salé, rue Ibn-Rochd, 11010 Salé, Maroc
| |
Collapse
|
24
|
Lamy S, Laqueille X, Thibaut F. Conséquences potentielles de la consommation de tabac, de cannabis et de cocaïne par la femme enceinte sur la grossesse, le nouveau-né et l’enfant : revue de littérature. Encephale 2015; 41 Suppl 1:S13-20. [DOI: 10.1016/j.encep.2014.08.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 01/30/2014] [Indexed: 12/17/2022]
|
25
|
McCarthy DM, Kabir ZD, Bhide PG, Kosofsky BE. Effects of prenatal exposure to cocaine on brain structure and function. PROGRESS IN BRAIN RESEARCH 2014; 211:277-89. [DOI: 10.1016/b978-0-444-63425-2.00012-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
|
26
|
Danel T, Plancke L, Amariei A, Benoit E, Gautier S, Capele C, Vaiva G. La prescription de psychotropes durant la grossesse dans le Nord-Pas-de-Calais. Therapie 2013; 68:31-6. [DOI: 10.2515/therapie/2013005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 09/14/2012] [Indexed: 11/20/2022]
|
27
|
Metz V, Köchl B, Fischer G. Should pregnant women with substance use disorders be managed differently? ACTA ACUST UNITED AC 2012; 2:29-41. [PMID: 23243466 DOI: 10.2217/npy.11.74] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Pregnant women with substance use disorders have multiple special needs, which might be best managed within a multiprofessional treatment setting involving medical, psychological and social care. Adequate treatment provision remains a challenge for healthcare professionals, who should undergo special training and education when working with this patient population. Careful assessment and screening is necessary to tailor interventions individually to the woman's needs in order to achieve beneficial clinical outcomes for mothers and newborns, whereas the choice of treatment options highly depends on the type of substance of abuse and evidence-based treatment interventions available. Economic considerations have shown that early multiprofessional treatment might yield better clinical outcomes and save healthcare costs over the lifespan.
Collapse
Affiliation(s)
- Verena Metz
- Department of Psychiatry & Psychotherapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | | | | |
Collapse
|
28
|
Dufour-Rainfray D, Vourc’h P, Tourlet S, Guilloteau D, Chalon S, Andres CR. Fetal exposure to teratogens: Evidence of genes involved in autism. Neurosci Biobehav Rev 2011; 35:1254-65. [DOI: 10.1016/j.neubiorev.2010.12.013] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Revised: 12/08/2010] [Accepted: 12/21/2010] [Indexed: 01/08/2023]
|
29
|
Schmid SM, Lapaire O, Huang DJ, Jürgens FE, Güth U. Cannabinoid hyperemesis syndrome: an underreported entity causing nausea and vomiting of pregnancy. Arch Gynecol Obstet 2010; 284:1095-7. [PMID: 21170540 DOI: 10.1007/s00404-010-1811-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Accepted: 12/06/2010] [Indexed: 10/18/2022]
Abstract
INTRODUCTION In the western world, cannabis is the most widely used drug of abuse. Cannabinoid hyperemesis syndrome, which seems to be a rare paradoxical reaction in individuals with a particular predisposition, is characterized by cyclic severe nausea and vomiting in long-term cannabis users. While the symptoms are unresponsive to antiemetic drugs, compulsive hot baths result in a considerable symptom relief. METHODS We report the first case of cannabinoid hyperemesis syndrome in pregnancy. A 26-year-old patient was admitted to our clinic in the 10th week of gestation. CONCLUSION Before undertaking time-consuming and expensive medical examinations to rule out other medical reasons for therapy-resistant hyperemesis in pregnancy, obstetricians should determine whether compulsive bathing or showering provides symptomatic relief and ask specific questions regarding possible/suspected cannabis consumption.
Collapse
Affiliation(s)
- Seraina M Schmid
- Department of Gynecology and Obstetrics, University Hospital Basel (UHB), Spitalstrasse 21, 4031 Basel, Switzerland
| | | | | | | | | |
Collapse
|
30
|
[Maternal and obstetrical data in a retrospective cohort of 170 newborns from polydrug using mothers, in the Paris area, 1999-2008]. ACTA ACUST UNITED AC 2010; 39:647-55. [PMID: 20708857 DOI: 10.1016/j.jgyn.2010.06.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Revised: 06/15/2010] [Accepted: 06/21/2010] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Polydrug use in pregnancy is harmful. This survey aimed to explore the issue of the associations of substances during pregnancy and to determine the consumer profiles. PATIENTS AND METHODS One hundred and seventy newborns whose mothers were psychoactive substances users were identified over the period 1999 to 2008. The data relating to maternal consumption, their reproductive history, and their living environment were collated. RESULTS At the end of their pregnancy, the mothers reported using on average 3.14 substances. Three profiles were determined: 65 women were heroin users or had consumed it in their lifetime and were currently on substitution treatment, and had a very unfavourable social living environment; 30 women were mainly consumers of alcohol, with or without benzodiazepines or other psychotropic drugs, and had a history of abortions; 75 women were mainly tobacco and cannabis smokers, with or without substitution treatment, had good social living conditions and had wanted the pregnancy. CONCLUSION Polydrug use increases the risk for the women to avoid prenatal care and is often linked with a history of abortions.
Collapse
|
31
|
Raynal P. La consultation préconceptionnelle. ACTA ACUST UNITED AC 2010; 38:481-5. [DOI: 10.1016/j.gyobfe.2010.05.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Accepted: 05/24/2010] [Indexed: 11/25/2022]
|