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Substance abuse 

Substance abuse
Substance abuse

Ross Junkin

and Elizabeth M. McGrady

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date: 24 November 2020

Substance abuse in pregnancy is a cause of maternal and neonatal morbidity and mortality. It can lead to a wide range of health, social, and psychological problems. Many of these mothers are young, single, socially deprived, and often present late for antenatal care. The prevalence is unclear as substance abuse is often concealed, but it is most common in young adults, and may be around 4% in the United Kingdom and 6% in the United States. It is estimated that 200,000–300,000 children living in England and Wales have one or both parents with a drug problem. Patterns and prevalence of substance abuse vary between and within countries, but polysubstance abuse is common. Obstetric anaesthetists may be involved in care of mothers who have known or covert substance abuse. Common problems include poor nutrition, dentition, difficult intravenous access, immunosuppression, and altered drug metabolism. Use of some illicit drugs can cause obstetric complications, and others can mimic serious issues such as pre-eclampsia. The incidence of emergency caesarean delivery is higher. Neonates tend to be premature, small for gestational age, at risk of withdrawal, and have ongoing health issues throughout life. Healthcare workers should enquire about tobacco, alcohol, and illicit drug use early in pregnancy as advice and support may motivate women to alter their lifestyle. The impact of tobacco, caffeine, alcohol, marijuana, solvents, opioids, cocaine, and amphetamine use on the mother and fetus, and the implications for the obstetric anaesthetist, are presented.

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