Obstetrical issues in substance abuse
Glantz, J.C.; Woods, J.R.
Pediatric Annals 20(10): 531-539
1991
ISSN/ISBN: 0090-4481 PMID: 1945532 Document Number: 382805
Substance abuse during pregnancy is a continuing problem for the obstetrician and for society. Ideally, pregnant women should not use any drug or substance unless it is absolutely necessary for the heath of the mother or fetus. Reality is that all too commonly the fetus is exposed to multiple substances during gestation that can affect its growth and development. The average pregnant women will use four or five drugs during her pregnancy, with 82% of women taking a drug prescribed by a doctor and 65% using non-prescription medications. Illicit drug use is thought to occur in as many as 24% of pregnancies, although this figure varies among populations. A high index of suspicion must be maintained to determine which pregnant women are at risk for drug abuse. The obstetrician must first obtain an accurate history in a straightforward, nonjudgemental manner, noting signs of unorthodox behavior or appearance, anger, manipulative behavior, a history of prostitution or petty crime, or a history of physical abuse. The patient's past medical history should be evaluated for hepatitis, endocarditis, cellulitis, sexually transmitted diseases, phlebitis, and poor prenatal care or outcome. Physical signs suggestive of drug use include sclerosed veins or needle "tracks", nasal septal lesions or rhinitis, cutaneous abscesses, hepatosplenomegaly, rales, poor dentition, or icterus. The obstetrician should determine whether drug testing is appropriate (approximately 50% of those women who test positive deny drug use). Risks should be assessed, the patient should be educated regarding these risks, and a plan or appropriate referral should be made. Unfortunately, women most involved in substance abuse often are the same ones who register late for or refuse any prenatal care. Moreover, substance-abusing women who do register for prenatal care tend to be less compliant about follow-up visits than nondrug.