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Smith BL. Improving translational relevance: The need for combined exposure models for studying prenatal adversity. Brain Behav Immun Health 2021; 16:100294. [PMID: 34589787 PMCID: PMC8474200 DOI: 10.1016/j.bbih.2021.100294] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 12/18/2022] Open
Abstract
Prenatal environmental adversity is a risk factor for neurodevelopmental disorders (NDDs), with the neuroimmune environment proposed to play a role in this risk. Adverse maternal exposures are associated with cognitive consequences in the offspring that are characteristics of NDDs and simultaneous neuroimmune changes that may underlie NDD risk. In both animal models and human studies the association between prenatal environmental exposure and NDD risk has been shown to be complex. Maternal overnutrition/obesity and opioid use are two different examples of complex exposure epidemics, each with their own unique comorbidities. This review will examine maternal obesity and maternal opioid use separately, illustrating the pervasive comorbidities with each exposure to argue a need for animal models of compound prenatal exposures. Many of these comorbidities can impact neuroimmune function, warranting systematic investigation of combined exposures to begin to understand this complexity. While traditional approaches in animal models have focused on modeling a single prenatal exposure or second exposure later in life, a translational approach would begin to incorporate the most prevalent co-occurring prenatal exposures. Long term follow-up in humans is extremely challenging, so animal models can provide timely insight into neurodevelopmental consequences of complex prenatal exposures. Animal models that represent this translational context of comorbid exposures behind maternal obesity or comorbid exposures behind maternal opioid use may reveal potential synergistic neuroimmune interactions that contribute to cognitive consequences and NDD risk. Finally, translational co-exposure models can identify concerning exposure combinations to guide treatment in complex cases, and identify high risk children starting in the prenatal period where early interventions improve prognosis.
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Affiliation(s)
- Brittany L. Smith
- Department of Pharmacology & Systems Physiology, University of Cincinnati, Cincinnati, OH, USA
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2
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Mitchell-Foster SM, Emon CE, Brouwer M, Duncan Elder L, King J. Disconnected perspectives: Patient and care provider's experiences of substance use in pregnancy. Int J Gynaecol Obstet 2021; 155:170-178. [PMID: 34496061 PMCID: PMC9293468 DOI: 10.1002/ijgo.13919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/18/2021] [Accepted: 09/06/2021] [Indexed: 11/30/2022]
Abstract
Objective Generations of colonialism, abuse, racism, and systemic trauma have contributed to Indigenous women in Canada bearing the greatest burden of substance use in pregnancy. Stigma associated with substance use in pregnancy translates into multiple barriers to women engaging in care. Care providers have key interactions that can act as a bridge or a barrier to care. Methods Patient journey maps were created for women living with substance use (n = 3) and semi‐structured interviews (n = 20) were performed to understand perceptions of maternity‐care providers around women with substance use in pregnancy at a regional hospital in northern British Columbia. Results Patient journey maps showed overall emotions of hurt, loss, judgment, and anger at their interface with health care during pregnancy. Providers described gaps in knowledge of substance use in pregnancy and harm reduction. Although care providers overall perceived themselves to be providing compassionate care without bias, the patient journey maps suggested profound judgment on behalf of providers. Conclusion Ongoing cultural humility and trauma‐informed care training along the continuum of care is critical to impacting discrepancies between perceived lack of bias and harm in patient interactions. Acknowledgment of systemic racism's impact on provision of maternity care is critical for health system change. Front‐line care providers and Indigenous women with lived experience of substance use during pregnancy differ markedly in their perceptions of maternity care.
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Affiliation(s)
| | - Carolyn E Emon
- University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Maria Brouwer
- Central Interior Native Health Society, Prince George, British Columbia, Canada
| | | | - Jessie King
- First Nations Studies Faculty, University of Northern British Columbia, Prince George, British Columbia, Canada
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Waddell N, Karatzias T. The relationship between interpersonal trauma and substance misuse in pregnancy. ACTA ACUST UNITED AC 2019. [DOI: 10.12968/bjom.2019.27.9.578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BackgroundThere is a strong body of evidence supporting associations between interpersonal trauma (IPT) and substance use; however, this tends to focus on associations between childhood trauma and substance use in non-pregnant populations. Neonatal and obstetric outcomes are poorer among pregnant women with problematic substance use, yet few studies have explored IPT as a possible mechanism underlying their use of substances.AimTo explore the literature regarding the relationship between IPT and substance misuse among pregnant women.MethodA systematic search of relevant databases was conducted and a narrative review of the literature was undertaken. Titles, abstracts and full articles were screened against inclusion criteria. Data were extracted and quality assessed.FindingsA total of 15 studies were identified that suggested associations between negative life events and substance misuse in pregnant women/new mothers.ConclusionsAlthough a link between IPT and substance misuse is suggested, this review has highlighted a number of important gaps in the literature that warrant further investigation. These include a paucity of UK-based studies, and a lack of research that fully explores possible associations between IPT and substance use in pregnant women. Moreover, research to date has employed quantitative methodology.
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Affiliation(s)
- Naomi Waddell
- Midwifery Lecturer/Researcher, School of Health and Social Care, Edinburgh Napier University
| | - Thanos Karatzias
- Professor and Director of Research, School of Health and Social Care, Edinburgh Napier University
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Alinejad S, Ghaemi K, Abdollahi M, Mehrpour O. Nephrotoxicity of methadone: a systematic review. SPRINGERPLUS 2016; 5:2087. [PMID: 28018795 PMCID: PMC5148752 DOI: 10.1186/s40064-016-3757-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 11/29/2016] [Indexed: 12/18/2022]
Abstract
Background Methadone is commonly administered for chronic pain relief and treatment of opioid dependence. Concurrent with its increased consumption, toxicities and fatalities have increased. One of the adverse effects of opioid analgesics, including methadone, is that of nephrotoxicity. Opioids can have an effect on renal function through several different mechanisms. Methods We searched common bibliographical databases for the terms methadone, toxicity, poisoning, kidney, renal, and nephrotoxicity and summarize our findings in this review. Results Methadone can have both direct and indirect effects on the kidney. These effects include rhabdomyolysis (leading to acute kidney injury), volumetric changes, renal lipidosis and amyloidosis, kidney growth during pregnancy, and kidney transplant rejection. Conclusion Improved understanding of the effects of methadone on kidney function can promote safer and more confident use of the drug.
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Affiliation(s)
- Samira Alinejad
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Moallem Avenue, Birjand, 9713643138 Iran
| | - Kazem Ghaemi
- Atherosclerosis and Coronary Artery Research Centre, Birjand University of Medical Sciences, Birjand, Iran ; Department of Neurosurgery, Birjand University of Medical Science, Birjand, Iran
| | - Mohammad Abdollahi
- Toxicology and Diseases Group, Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Omid Mehrpour
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Moallem Avenue, Birjand, 9713643138 Iran
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Vella AM, Savona Ventura C, Wolff K. Pregnancy outcomes in substance-misusing pregnant women: A 10-year retrospective study. J OBSTET GYNAECOL 2015; 36:468-72. [DOI: 10.3109/01443615.2015.1072805] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Anna Maria Vella
- Sedqa, National Agency for Addiction, Substance Misuse Out-Patients Unit, St Luke's Hospital, Guardamangia, Malta
- Institute of Pharmaceutical Science, King's College London, London, UK
| | | | - Kim Wolff
- Institute of Pharmaceutical Science, King's College London, UK
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Benoit C, Magnus S, Phillips R, Marcellus L, Charbonneau S. Complicating the dominant morality discourse: mothers and fathers' constructions of substance use during pregnancy and early parenthood. Int J Equity Health 2015; 14:72. [PMID: 26303942 PMCID: PMC4548907 DOI: 10.1186/s12939-015-0206-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 08/17/2015] [Indexed: 11/18/2022] Open
Abstract
Introduction Consumption of substances is a highly controversial behaviour, with those who do so commonly viewed as deviants, even criminals, or else as out of control addicts. In other work we showed that the use of substances by women who are pregnant or have recently become parents was mainly viewed by health and social care providers as morally wrong. Problematic substance use was framed through the narrow lens of gendered responsibilisation, resulting in women being seen primarily as foetal incubators and primary caregivers of infants. Methods In this follow-up paper we examine descriptive and qualitative data from a convenience sample of biological mothers and fathers (N = 34) recruited as part of a larger mixed methods study of the development and early implementation of an integrated primary maternity care program. We present a description of the participants’ backgrounds, family circumstances, health status, and perception of drug-related stigma. This is succeeded by a thematic analysis of their personal views on substance use during both pregnancy and the transition to parenthood. Results Our results show that while many mothers and fathers hold abstinence as the ideal during pregnancy and early parenting, they simultaneously recognize the autonomy of women to judge substance use risk for themselves. Participants also call attention to social structural factors that increase/decrease harms associated with such substance use, and present an embodied knowledge of substance use based on their tacit knowledge of wellness and what causes harm. Conclusions While these two main discourses brought forward by parents concerning the ideal of abstinence and the autonomy of women are not always reconcilable and are partially a reflection of the dissonance between dominant moral codes regarding motherhood and the lived experiences of people who use substances, service providers who are attuned to these competing discourses are likely to be more effective in their delivery of health and social services for vulnerable families. More holistic and nuanced perspectives of health, substance use, and parenting may generate ethical decision-making practice frameworks that guide providers in meeting and supporting the efforts of mothers and fathers to achieve well-being within their own definitions of problematic substance use.
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Affiliation(s)
- Cecilia Benoit
- Centre for Addictions Research of BC and Department of Sociology, University of Victoria, PO Box 3050, Victoria, V8W3P5, BC, Canada.
| | - Samantha Magnus
- School of Public Health and Social Policy, University of Victoria, PO Box 1700, Victoria, V8W2Y2, BC, Canada.
| | - Rachel Phillips
- Centre for Addictions Research of BC, Centre for Addictions Research of BC, Victoria, Canada.
| | - Lenora Marcellus
- School of Nursing, University of Victoria, PO Box 1700, Victoria, V8W-2Y2, BC, Canada.
| | - Sinéad Charbonneau
- Faculty of Law, University of Toronto, #1- 328 Arlington Ave, Toronto, M6C2Z9, ON, Canada.
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Schwartz SR, Baral S. Fertility-related research needs among women at the margins. REPRODUCTIVE HEALTH MATTERS 2015; 23:30-46. [PMID: 26278831 DOI: 10.1016/j.rhm.2015.06.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 05/29/2015] [Accepted: 06/08/2015] [Indexed: 11/15/2022] Open
Abstract
Fertility-related research encompasses fertility intentions, preconception care, research amongst pregnant women, and post-partum outcomes of mothers and children. However, some women remain under-represented within this domain of study. Women frequently missing within fertility-related research include those who are already the most vulnerable to health disparities, including female sex workers, lesbian, gay, bisexual, and transgender women, women living with HIV, and women who use drugs. Yet characterization of the needs of these women is important, given their unique fertility-related concerns, including risks and barriers to care emanating from social stigmas and discrimination. This synthesis provides an overview of fertility-related evidence, highlighting where there are clear research gaps among marginalized women and the potential implications of these data shortfalls. Overall, research among marginalized women to date has addressed pregnancy prevention and in some cases fertility intentions, but the majority of studies have focused on post-conception pregnancy safety and the well-being of the child. However, among female sex workers specifically, data on pregnancy safety and the well-being of the child are largely unavailable. Within each marginalized group, preconception care and effectiveness of conception methods are consistently understudied. Ultimately, the absence of epidemiologic, clinical and programmatic evidence limits the availability and quality of reproductive health services for all women and prevents social action to address these gaps.
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Affiliation(s)
- Sheree R Schwartz
- Assistant Scientist, Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Stefan Baral
- Associate Professor, Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Midwives experiences of establishing partnerships: Working with pregnant women who use illicit drugs. Midwifery 2014; 30:1082-7. [DOI: 10.1016/j.midw.2013.06.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 06/26/2013] [Accepted: 06/30/2013] [Indexed: 11/23/2022]
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Goettler SM, Tschudin S. Care of Drug-Addicted Pregnant Women: Current Concepts and Future Strategies – an Overview. WOMENS HEALTH 2014; 10:167-77. [DOI: 10.2217/whe.14.7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This review focuses on drug use during pregnancy and the perinatal period, a constellation that is seen more often. Drug use in pregnant women poses an increased risk for adverse health outcomes both for the mother and child. Care is often complicated by social and environmental factors, as well as psychiatric comorbidities. It is, therefore, very important to provide drug-using pregnant women with optimal ante-, peri- and post-natal care. Health professionals should approach them in a nonjudgmental and supportive way, and provide them with the same care and attention as nondrug-using women. Adequate care requires interdisciplinary teams. Ideally, healthcare providers should be specialized in the care of drug-using pregnant women.
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Affiliation(s)
- Simone M Goettler
- Department of Obstetrics & Gynecology, University Hospital Basel, Basel, Switzerland
| | - Sibil Tschudin
- Department of Obstetrics & Gynecology, University Hospital Basel, Basel, Switzerland
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Benoit C, Stengel C, Marcellus L, Hallgrimsdottir H, Anderson J, MacKinnon K, Phillips R, Zazueta P, Charbonneau S. Providers' constructions of pregnant and early parenting women who use substances. SOCIOLOGY OF HEALTH & ILLNESS 2014; 36:252-263. [PMID: 24528306 DOI: 10.1111/1467-9566.12106] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The research literature indicates that problematic substance use as a form of health behaviour is poorly understood, being sometimes viewed as deviance, at other times as a disease, and most often as a combination of these states. The use of substances by women who are pregnant or new parents is often conceptualised within an individualised framework. Yet drinking alcohol and using other drugs during pregnancy and early parenthood cuts across social divisions and is shaped by socio-structural contexts including health care. There is a growing body of literature that critically examines public health interventions that are aimed at implementing harm reduction and health promotion techniques in service delivery to help pregnant and early parenting women who are identified as problem substance users. We examine qualitative data from representatives of a recent harm reduction intervention, focusing, in particular, on providers' individual conceptualisations of the problematic behaviour. Our results show that most study participants regard any substance use during pregnancy, birth and the postpartum period as fundamentally unacceptable. This framing of problematic substance use is accomplished via gendered responsibilisation of women as foetal incubators and primary caregivers of infants. We discuss our results in light of the current literature and suggest policy implications.
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Affiliation(s)
- Cecilia Benoit
- Centre for Addictions Research of British Columbia and Department of Sociology, University of Victoria, Canada
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12
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Holden KB, McKenzie R, Pruitt V, Aaron K, Hall S. Depressive symptoms, substance abuse, and intimate partner violence among pregnant women of diverse ethnicities. J Health Care Poor Underserved 2012; 23:226-41. [PMID: 22643473 DOI: 10.1353/hpu.2012.0022] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This study examines the relationship between self-reported depressive symptoms, substance abuse and intimate partner violence among 602 African American, Hispanic, White, Asian American, American Indian/Alaskan Native, Native Hawaiian/Pacific Islander pregnant women who are clients of the Augusta Partnership for Children, Inc., a nonprofit collaborative that works with agencies, organizations, and individuals to improve the lives of children and families in Augusta-Richmond County, Georgia. Descriptive statistics and significant relationships among selected variables using correlation and regression analyses were conducted. Findings are intended to inform strategies for community-based programs better to assist women of diverse ethnicities with addressing depression, substance abuse, and intimate partner violence during their pregnancies, with the ultimate aim of improving health and mental health outcomes for women and children.
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Affiliation(s)
- Kisha B Holden
- Department of Psychiatry and Behavioral Sciences at Morehouse School of Medicine, Atlanta, GA 30331, USA
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Black KI, Stephens C, Haber PS, Lintzeris N. Unplanned pregnancy and contraceptive use in women attending drug treatment services. Aust N Z J Obstet Gynaecol 2012; 52:146-50. [DOI: 10.1111/j.1479-828x.2012.01413.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Accepted: 12/25/2011] [Indexed: 01/06/2023]
Affiliation(s)
- Kirsten I. Black
- Discipline of Obstetrics, Gynaecology and Neonatology; Central Clinical School, Royal Prince Alfred Hospital, University of Sydney; Camperdown
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Miles M, Chapman Y, Francis K. Making a Difference: The Experiences of Midwives Working With Women Who Use Illicit Drugs. INTERNATIONAL JOURNAL OF CHILDBIRTH 2012. [DOI: 10.1891/0886-6708.2.4.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM:This article describes the experiences of midwives who choose to work with pregnant women who use illicit drugs.BACKGROUND:Pregnant women who use illicit drugs present complex challenges for those who choose to work with them. Society’s views on illicit drug use fluctuate from acceptance and harm minimization to reprimand and retribution.METHOD:Qualitative interviews were conducted between June and August 2009 with 12 Australian midwives. A thematic analysis method informed by hermeneutic phenomenology was applied to interpret this data to explicate lived experiences and gain deeper understanding and meanings of this phenomenon.FINDINGS:Three major themes encapsulated the experience: making a difference, making partnerships, and learning to let go. The focus of this article, “making a difference,” included two subthemes of “working on the margins” and “transition and transformation.” The midwives were both rewarded and challenged by the needs of women who use illicit drugs and by the systems in which they worked.CONCLUSIONS:The midwives acknowledged that their aspirations “to make a difference” was not always sufficient when working with women who use illicit drugs. They also require the establishment of maternity services that are compassionate and accessible, including woman–care provider partnerships and continuity of the care environments.
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Thajam D, Atkinson DE, Sibley CP, Lavender T. Is Neonatal Abstinence Syndrome Related to the Amount of Opiate Used? J Obstet Gynecol Neonatal Nurs 2010; 39:503-9. [DOI: 10.1111/j.1552-6909.2010.01174.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Friedman SH, Heneghan A, Rosenthal M. Characteristics of Women Who Do Not Seek Prenatal Care and Implications for Prevention. J Obstet Gynecol Neonatal Nurs 2009; 38:174-81. [DOI: 10.1111/j.1552-6909.2009.01004.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Abstract
PURPOSE OF REVIEW The present article is an update on the effects of drug abuse on pregnancy outcome. RECENT FINDINGS Substance abuse in pregnancy is on the increase worldwide. Simultaneously, there is great variability in prevalence rates in different countries, regions of countries and in different ethnic groups. In the United States nearly 90% of drug-abusing women are of reproductive age. Substances most commonly abused in pregnancy include cocaine, amphetamines, opioids, marijuana, ethanol, tobacco, caffeine, and toluene-based solvents. Polysubstance abuse is very common. SUMMARY Substance abuse in pregnancy is associated with significant maternal and fetal morbidity. Risk factors suggesting substance abuse in pregnancy include lack of prenatal care, history of premature labor, and cigarette smoking. In the United States the American College of Obstetricians and Gynecologists has made multiple recommendations regarding management of parturients with drug abuse during pregnancy. Women who acknowledge use of illicit substance during pregnancy should be counseled and offered necessary treatment. The American College of Obstetricians and Gynecologists also acknowledged that some states consider intrauterine fetal drug exposure to be a form of child neglect or abuse under the law.
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