OB Substance Abuse

What defines substance abuse?

Continued use of substances despite social, physical, or interpersonal problems.

Why is the first trimester critical in substance use?

It's when fetal development is most vulnerable to adverse effects.

How do substances affect the fetus?

They cross the placenta and can impair fetal growth and development.

What childhood factors increase substance abuse risk in women?

History of sexual or physical abuse.

Why might pregnant women not disclose substance use?

Fear of judgment or consequences.

What factors influence fetal impact from substance exposure?

Type of substance, dosage, and gestational timing.

Why is birth control essential with Accutane?

Accutane can cause fetal damage; contraception is mandatory.

How can antibiotics affect birth control?

They may reduce effectiveness—condoms should be used.

Why might substance-using women delay prenatal care?

Fear, stigma, or lack of awareness—some wait until labor.

What is a key nursing approach to discussing substance use?

Use nonjudgmental language to encourage honest disclosure.

What facility treats pregnant women with addiction in NC?

Walter B. Jones Center has a dedicated unit.

Effects of smoking during pregnancy?

↓ placental perfusion, low birth weight, prematurity, ↑ SIDS risk.

How does caffeine affect pregnancy?

May impair placental perfusion; intake should be reduced.

What should nurses advise about caffeine at prenatal visits?

Encourage reduced intake to protect fetal health.

What disorder is linked to prenatal alcohol exposure?

Fetal Alcohol Syndrome—neuromuscular disorders.

How is alcohol withdrawal managed in pregnancy?

Benzodiazepines—short-term use is safer than continued alcohol.

Is breastfeeding safe with alcohol use?

Alcohol passes into breast milk; wait 4 hours before feeding.

Does marijuana cause birth defects?

Not directly, but often co-used with other substances.

How can marijuana affect labor?

May interfere with medication effectiveness.

What does cocaine do during pregnancy?

Causes vasoconstriction, placental abruption, ↓ uterine blood flow.

Neonatal signs of cocaine exposure?

Shrill cry, poor feeding, hyperactivity, ↑ SIDS risk.

Effects of meth use in pregnancy?

Preterm birth, IUGR, microcephaly, placental abruption.

Why is meth use a management challenge?

Causes hallucinations and hypersexuality, complicating care.

What substances cross into breast milk?

Most—including alcohol, cocaine, and medications.

When is breastfeeding contraindicated?

If mom is HIV+ or actively using drugs.

Effects of breastfeeding after cocaine use?

Baby may be irritable, have dilated pupils, apnea.

Why is methadone used in pregnancy?

Safer for fetus than acute withdrawal from opiates.

Why did the FDA revise drug labeling?

To support informed decisions for pregnant and childbearing women.

What does Category A indicate?

Controlled studies show no risk to the fetus; considered safe.

What does Category B indicate?

No fetal risk in animal studies; human studies are lacking but presumed safe.

What does Category C indicate?

Animal studies show adverse effects; no human studies—use only if benefits outweigh risks.

What does Category D indicate?

Positive evidence of human fetal risk; may be used in life-threatening situations.

What does Category X indicate?

Proven fetal risk; contraindicated in pregnancy—risks outweigh any possible benefit.

What is the purpose of FDA pregnancy categories?

To classify drugs based on their potential risk to the fetus and guide safe prescribing during pregnancy.