Maternal Exposure and Neonatal Effects of Drugs of Abuse

Pathologies in a preterm infant exposed to methamphetamine in utero: Case report and literature review

Methamphetamine (M-AMP) use among women of childbearing age is a growing global concern Herein we present an unusual clinical presentation in a preterm infant born to a mother who used M-AMP during pregnancy. A 26-year-old woman, with no prenatal care, presented to the emergency department with aggressive behavior and visible skin wounds led to suspicion of substance abuse. Urine analysis confirmed high levels of amphetamines (2000 ng/mL). The infant was delivered by cesarean section at 30 + 5/7 weeks, with a birth weight of 1580 grams. The infant, admitted to the NICU due to respiratory distress and prematurity, initially required nasal CPAP and exhibited transient tachypnea. Enteral feeding was initiated at 24 hours of life but was halted due to feeding intolerance. Once the baby's symptoms subsided, enteral feeding was gradually reintroduced and slowly increased. The infant successfully transitioned to full enteral feeding by the 15th postnatal day. Cranial ultrasound revealed hyperechoic areas in the right parietal lobe, and subsequent MRI showed millimetric T1 hyperintense areas, indicative of parenchymal microischemia. Preterm infants exposed to methamphetamine in utero may not show typical withdrawal symptoms. Diagnostic challenges arise from prematurity, with significant impacts on brain development and potential neurocognitive deficits.

Substance Misuse, Executive Function, and Young Adult Intimate Partner Violence: Direct and Indirect Pathways

Intimate partner violence (IPV) is a significant issue in young adult relationships, with immediate and long-term health and well-being consequences. The factors contributing to IPV are complex and span from the level of individual neurobiology to the wider socioecological system. The interplay across these domains in predicting IPV has been understudied. We, therefore, aimed to examine the factors contributing to IPV risk among young adults, adopting a holistic approach considering direct and indirect contributions of socioecological influences in a cohort of high-risk subjects. Data were from a longitudinal birth cohort established in 1991 comparing the developmental trajectories of individuals prenatally exposed to substances including cocaine and nonexposed individuals. Using data from a subsample of 206 participants followed between 2010 and 2020, we implemented path analysis to examine direct and indirect pathways between prenatal drug exposure (PDE) and young adult IPV. We considered the contributions of childhood maltreatment, maternal education, ethnicity, early adolescent substance use, and late adolescent executive function. Sex-specific effects were also explored. There were no significant direct or indirect associations between PDE and IPV. There was evidence of an indirect effect of low maternal education on IPV via effects on early adolescent substance use and subsequent effects on executive function in late adolescence. There was tentative evidence of an effect of ethnicity on IPV risk and of sex differences in the pathways contributing to IPV risk among males and females. We highlight the importance of executive function in young adult IPV risk and suggest considering maternal education and early adolescent substance use as additional contributors to IPV risk. Preventing IPV among young adults may involve enhancing executive functioning and preventing early substance misuse. When examining pathways contributing to IPV risk, it is necessary to adopt a framework integrating the wider socioecological environment.

Reimagining Supportive Approaches at the Intersection of Mandatory Reporting Policies for the Mother-Infant Dyad Affected by Substance Use

BACKGROUND

As rates of substance use during pregnancy persist, the health and optimal development of infants with prenatal substance exposure remain a key priority. Nurses are tasked with identifying and reporting suspected cases of child maltreatment, including abuse and neglect, which is often assumed to be synonymous with substance use during pregnancy. While policies aimed at protecting infants from child abuse and neglect are well intentioned, literature regarding the short- and long-term social and legal implications of mandatory reporting policies is emerging.

PURPOSE

In this article, we explore the intersections between the condition of substance use in pregnancy and policies related to mandatory reporting.

METHODS

We provide an overview of historical and current trends in mandatory reporting policies for nurses related to substance use in pregnancy and related ethical and social implications for mother-infant dyads.

RESULTS

Nurses often function at the intersection of healthcare and social services, underscoring the important role they play in advocating for ethical and equitable care for both members of the mother-infant dyad affected by substance use.

IMPLICATIONS FOR PRACTICE AND RESEARCH

We offer recommendations for practice including the integration of respectful care and family-centered support for the mother-infant dyad affected by substance use. Cross-sectoral collaborations, inclusive of the family, are important to the advancement of evidence-based and equity-focused research, advocacy, and policy initiatives to support familial preservation and reduce mother-infant separation.

Motivations and expectations of pregnant women using psychoactive substances during prenatal care: phenomenological study

Objective

Understand the motivations and expectations of pregnant women using psychoactive substances during prenatal care.

Methods

A qualitative study developed in the light of Alfred Schütz's Theoretical Framework of Phenomenological Sociology, in which 25 pregnant women using psychoactive substances, belonging to a Family Health Strategy, participated. Data production took place between August and November 2022.

Results

Two units of meanings emerged: (i) social influences for the performance of prenatal care and (ii) expectation regarding the care to be received by the health professional. Pregnant women do pre-natal due to family influences, for fear of losing their children due to loss of guardianship and concern about the well-being and development of the baby. And, the expectations are that they receive good attention, feel safe when they are attended to by health professionals and also that they are understood and have a relationship of trust.

Conclusion

Pregnant women who use psychoactive substances bring motivations for prenatal care linked to the past, such as influences from family members and previous experiences. As for expectations, they are related to the child's health and the care expected by professionals. Finally, strategies to reduce harm during pregnancy of users of psychoactive substances are fundamental for the effectiveness of care.

Hair testing applied to the assessment of in utero exposure to drugs: Critical analysis of 51 cases of the University Hospital of Verona

The work discusses the results of hair and urine testing performed in 51 cases of suspected in utero drug exposure handled at the University Hospital of Verona from 2016 to 2022. On the day of birth or the day after birth, urine from mother and newborn (UM and UN) and hair from mother (HM), newborn (HN) and father (HF), if possible, were collected. Urine underwent immunoassay and GC-MS analysis, whereas hair underwent LC-MS/MS and GC-MS/MS analysis. In 50 out of 51 cases, HM and/or HN were available. In 92% of them, hair testing resulted in a positive, often (>50% cases) for more than one class of substance. The most detected substances were cocaine, opiates, methadone and cannabinoids. Maternal segmental analysis showed a prevalent decreasing concentration trend during pregnancy in case of positivity for one class of substances, whereas, as expected, a neatly prevalent increasing trend in the case of positivity for more than one class of substances. In nine cases, HF was also available, resulting in all being positive, usually for the same classes of substances identified in HM, thus questioning parental responsibility. In 33 cases, urine samples from the mother or newborn were also collected. Of them, 27 cases (82%) tested positive, showing peri-partum drug consumption and then confirming the severity of the addiction. Hair testing showed to be a reliable diagnostic tool to investigate in utero drug exposure because of the possibility of obtaining a complete picture of maternal addictive behaviour and family background, thanks to segmental maternal hair analysis and father hair testing.

Trends in Drug Tests among Children: A 22-Year Retrospective Analysis

There are several pathophysiological outcomes associated with substance abuse including metabolic disbalance, neurodegeneration, and disordered redox. Drug use in pregnant women is a topic of great concern due to developmental harm which may occur during gestation and the associated complications in the neonate after delivery. We sought to determine what the trajectory of drug use is like in children aged 0-4 years and mothers of neonates. Urine drug screen (UDS) results were obtained of our target demographic during 1998-2011 and 2012-2019 from LSU Health Sciences Center in Shreveport (LSUHSC-S). Statistical analysis was performed using R software. We observed an increase in cannabinoid-positive UDS results in both Caucasian (CC) and African American (AA) groups between 1998-2011 and 2012-2019 periods. Cocaine-positive UDS results decreased in both cohorts. CC children had higher UDS positive results for opiates, benzodiazepines, and amphetamines, while AA children had a higher percentage for illicit drugs such as cannabinoids and cocaine. Neonate's mothers had similar UDS trends to that in children during 2012-2019. Overall, while percentage of positive UDS results for both AA and CC 0-4 year old children started to decline for opiate, benzodiazepine, and cocaine during 2012-2019, cannabinoid- and amphetamine (CC)-positive UDS steadily increased. These results suggest a shift in the type of drug use by mothers from opiates, benzodiazepines, and cocaine to cannabinoids and/or amphetamines. We also observed that 18-year-old females who tested positive for opiates, benzodiazepine, or cocaine had higher than average chances of testing positive for cannabinoids later in life.