Maternal and Neonatal Effects of Substance Abuse during Pregnancy: Our Ten-year Experience

Neonatal Intensive Care Unit, Department of Obstetrics and Gynecology, Split University Hospital, Split, Croatia.
Yonsei Medical Journal (Impact Factor: 1.29). 10/2008; 49(5):705-13. DOI: 10.3349/ymj.2008.49.5.705
Source: PubMed


The aim of the study was to assess perinatal outcome of pregnancy burdened with maternal addiction in comparison with an unselected population from a European transition country.
Data on pregnancies complicated by illicit drug abuse (n = 85) managed during a 10-year period (1997-2007) at Split University Hospital were analyzed. Data on the type of drug, course of gestation and labor, and on perinatal outcome were considered. Data on all non-dependence pregnancies recorded during the study period were used as a control group.
During the study period, there were 85 dependence-complicated pregnancies (0.2%). Use of heroin alone during pregnancy was recorded in 51 women (50%), methadone alone in 6 (7%), and a combination of heroin and methadone in 9 (11%). Premature delivery was significantly more common in the group of pregnant addicts (21% vs. 6%); 49% of pregnant addicts were carriers of hepatitis C virus (HCV) and 14% of hepatitis B virus (HBV). Neonatal abstinence syndrome developed in 61 infants (7%) born to addicted mothers. There were 4 cases (4.6%) of early neonatal death; 7 neonates had 5-minute Apgar score < or = 7 (8%); 29 neonates had low birth weight for age (33%); and 7 neonates had congenital anomalies (8%). The risk of various congenital anomalies was 3-fold in the group of children born to addicted mothers.
Addiction pregnancies present a small but high-risk group according to perinatal outcome. Appropriate obstetric and neonatal care can reduce the rate of complications in these pregnancies and improve perinatal outcome.

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    • "The analysis revealed that the women are young mothers, with low educational level, as well as a higher rate of adverse pregnancy outcomes (e.g., stillbirth rate, 0.84 % versus 0.37 % (in 2009)—0.44 % (in 1995) in the general population) and a lower rate of multiple births (0.48 % versus 1.72 % (in 2009)) compared to the general population of Austria (Statistik Austria 2011a, b). However, the smoking and hepatitis C rate, as well as the prescription rate of psychotropic medications in the sample were high and comparable to those of other opioid-dependent pregnant populations (Kashiwagi et al. 2005; Vucinovic et al 2008; McCarthy et al. 2005; Jones et al. 2010; Seligman et al. 2010; Mayet et al. 2008). "
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    ABSTRACT: This study investigated pregnant opioid-dependent women undergoing maintenance therapy, applying a multidisciplinary, case-management approach at the Addiction Clinic of the Medical University of Vienna, Austria. It aimed at characterizing the patients' basic demographic and clinical parameters and evaluating their overall quality of life (QoL) prepartum and postpartum. Three hundred ninety women were treated between 1994 and 2009 with buprenorphine (n = 77), methadone (n = 184), or slow-release oral morphine (SROM) (n = 129) on an outpatient basis throughout their pregnancy and postpartum period. All patients were subject to standardized prepartum and postpartum medical and psychiatric assessments, including QoL assessments using a German adaptation of the Lancashire QoL Profile (Berliner Lebensqualitaetsprofil), and regular supervised urine toxicologies. No medication group differences were revealed regarding basic demographic or clinical data. Mean maintenance doses (SD) at time of delivery were as follows: 64 mg (36 mg) methadone, 10 mg (6 mg) buprenorphine, 455 mg (207 mg) SROM. However, buprenorphine-medicated women showed significantly less concomitant benzodiazepine consumption than methadone- or SROM-maintained women (p = 0.005), and significantly less concomitant opioid consumption than methadone-maintained women (p = 0.033) during the last trimester. Overall QoL was good prepartum and postpartum in all measured domains except "finances" and "prospect of staying in the same housing situation," and no differences were observed in QoL among the three medication groups (p = 0.177). QoL improved significantly after delivery in most of the domains (p < 0.001). Although opioid-dependent pregnant women face high-risk pregnancies and show variability in addiction severity, they report good QoL independent of the medication administered. These results show that individually tailored treatment interventions are effective for this patient population and suggest a QoL improvement after delivery.
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    • "Several studies were done to investigate the effect of prenatal use of morphine before and during gestation on neonatal cerebellum which decided structural and behavioral changes in the neonatal periods (Vucinovic et al., 2008; Sadraie et al., 2008). To best of our knowledge little are known about the long–term effect of prenatal use of morphine on the offspring. "
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    ABSTRACT: Morphine is the strongest known analgesic compound. Intrauterine morphine exposure is one of the most important risk factors for adverse pregnancy outcomes. Several studies were done to investigate the effect of morphine use before and during pregnancy on cerebella of neonates of these mothers, which reported structural and behavioral changes in the neonatal period. The aim of this study was to follow the sequential histological changes occurred in cerebella of 21- day- old rat offspring which were born to mothers received morphine sulfate before and during pregnancy by both light and transmission electron microscopic (TEM) examinations. Female rats randomly selected and equally divided into 2 groups: a saline-treated group (n=10); received daily injections of equivalent volume of normal saline intraperitoneally (ip) and morphine sulfate-treated group (n= 10) that was given 10 mg/Kg/body weight morphine sulfate ip for 2 weeks before mating, 1 week of mating and 3 weeks of pregnancy. After parturition, pups of saline treated mothers were named saline-treated control group (group I) and those of morphine treated mothers were named morphine experimental group (group II). The offspring were kept alive for 21 days without further morphine administration then sacrificed where cerebella were removed and processed for light microscopic examination and TEM study. Results demonstrated that early intrauterine morphine sulfate exposure caused long-lasting histological alterations in Purkinje, molecular and granular cell layers of the cerebella of 21 –day- old rat offspring. It could be concluded that administration of morphine sulfate before and during pregnancy has a neurotoxic effect on postnatal day-21 rat cerebella of offspring even with discontinuation of postnatal exposure.
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    • "Opium substance consumption in young people is increased in comparison with last decade. More than 90 percent of women consuming Morphine Sulfate as a component of opium takes place in childbearing age (Vucinovic et al., 2008; Dehghan et al., 2010). "

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