[Consequences of cocaine addiction during pregnancy on the development in the child]

[Non-drug psycho-active substance use and pregnancy]

BACKGROUND

The consumption of psycho-active substances (PAS) by pregnant women is in a growing increase around the world. It is a major problem of public health in some countries due to serious and negative consequences for children and society as well as for pregnant women. This problem has also increased among women in Morocco. However, it is still neglected and underrated in the absence of any official statistical data. This is the first study leading to a better profiling of pregnant women who may consume psycho-active substances during their pregnancy; it would permit better medical and psychosocial care of both women and children.

OBJECTIVES

To determine the prevalence and the factors associated with the psycho-active substances used by pregnant women and describe their socio-demographic characteristics.

METHODS AND PATIENTS

A trans-sectional study was carried out from September to October 2010, including pregnant women consulting at the obstetrical service of the provincial hospital Moulay Abdellah in the city of Salé. The study included women who were pregnant or had recently given birth, and not having any serious mental disorders that could have upset their cognitive abilities. The data was collected through a straight questionnaire of 25 items specifying the socio-demographic characteristics, data about pregnancy and habits of using psycho-active substances.

RESULTS

One hundred and fifty pregnant women were included in the study. The majority of them (83.2%) were aged 20 to 40 years old, 94.6% were married, 96% were unemployed and depended on their spouses for their financial resources and 80% had normal domestic relationships (from average to good quality). Among the women, 31.3% of them reported traumatic events in the past. The prevalence of psycho-active substance consumption by the pregnant women of our sample was 11.3%. The used substances were tobacco (9.3%) and cannabis (4%). These women were more likely to have a low level of education (47.1 vs 16.5). They were victims of abuse or neglect in their past (82.3 vs 24.9), and their relationships with their spouses were bad (70.6 vs 13.5) with a lack of desired pregnancy (47.1 vs 27.8) and poor follow-up (47.1 vs 3.8). The results show statistically significant differences.

CONCLUSION

Not only should decision-makers draw attention to the seriousness of the problem because of the relatively high rate of psycho-active substance consumption, but also they should increase obstetric team's awareness to look systematically for psycho-active substance use.

Complementary therapies to reduce physiological stress in pregnancy

Pregnancy is a period of enormous physio-pathological and psychosocial adaptation in a woman's life. Although it is usually a time of joy and anticipation, many women experience some degree of anxiety, concern and fear regarding their own health and that of their babies, as well as the approaching labour. Worry about social, financial, occupational and relationship issues can often add to their stress levels which increases the possibility of pregnancy complications. However while mild to moderate stress facilitates successful adjustment to these demands, a significant increase in the levels of stress hormones may compromise the health of both mother and fetus. Complementary therapies are increasingly popular with expectant mothers and are gradually being integrated into conventional maternity care, primarily by midwives. However, there is debate about whether these therapies simply provide a form of relaxation for pregnant women with psychological stress or whether they could-or should-be used more constructively to deal with physio-pathological stress. This paper considers the physiological effects of certain complementary therapies in reducing the impact of stress in pregnancy.

Attitudes of staff towards mothers affected by substance abuse

The purpose of this study was to explore the influence of education and experience on the attitudes of neonatal nurses/midwives when caring for mothers and infants affected by substance abuse. A self-report questionnaire was completed by 50 nurses/midwives. The attitude of nurses/midwives towards mothers affected by substance abuse was generally negative/judgemental, and their knowledge base was low. The most experienced nursing staff generally had a more negative attitude than those nurses/midwives with less neonatal experience. Formal neonatal education did not appear to have a positive effect on knowledge base or attitudes; however, results implied that in-service education on substance abuse might have a mildly positive effect on attitudes. Results indicate a need for formal education on substance abuse and its effect on the neonate and mother, and that specialist education on substance abuse may influence attitudes.

The intersection of stress, drug abuse and development

Use or abuse of licit and illicit substances is often associated with environmental stress. Current clinical evidence clearly demonstrates neurobehavioral, somatic growth and developmental deficits in children born to drug-using mothers. However, the effects of environmental stress and its interaction with prenatal drug exposure on a child's development is unknown. Studies in pregnant animals under controlled conditions show drug-induced long-term alterations in brain structures and functions of the offspring. These cytoarchitecture alterations in the brain are often associated with perturbations in neurotransmitter systems that are intimately involved in the regulation of the stress responses. Similar abnormalities have been observed in the brains of animals exposed to other adverse exogenous (e.g., environmental stress) and/or endogenous (e.g., glucocorticoids) experiences during early life. The goal of this article is to: (1) provide evidence and a perspective that common neural systems are influenced during development both by perinatal drug exposure and early stress exposure; and (2) identify gaps and encourage new research examining the effects of early stress and perinatal drug exposure, in animal models, that would elucidate how stress- and drug-induced perturbations in neural systems influence later vulnerability to abused drugs in adult offspring.