Inhaling heroin during pregnancy: effects on the baby

Drug abuse in pregnancy: obstetric and neonatal problems. Ten years' experience

Drug abuse is an increasing problem and approximately 80% of female drug abusers are of childbearing age. This retrospective case note study reviews 10 years' experience of the management of pregnant drug abusers (n = 57) in the obstetric hospital of a London teaching hospital. Surprisingly, in view of other reports of high morbidity, no significantly increased rates of obstetric and neonatal problems were found when this group was compared with case-matched controls. Thirty-nine per cent of drug abusers managed to reduce and stop their drug use. However, 56% of the infants of drug abusers had withdrawal symptoms. Concern for her unborn child can motivate the pregnant drug abuser to comply with treatment and thus improve the outcome of pregnancy.

Comparison of a rocking bed and standard bed for decreasing withdrawal symptoms in drug-exposed infants

PURPOSE

To determine if the use of a mechanical rocking bed with maternal intrauterine sounds would decrease symptoms of withdrawal and promote neurobehavioral adaptation in drug-affected infants.

METHODS

This was a repeated measures experimental design, with infants randomized to a standard bed or a rocking bed. The sample consisted of 14 full-term infants who were prenatally exposed to methadone plus other illicit drugs.

RESULTS

Infants receiving the rocking bed therapy experienced a significant increase in withdrawal symptoms and sleep deprivation and displayed suboptimal neurobehavioral functioning on day 7 of life.

IMPLICATIONS

The results suggest that the use of a mechanical rocking bed may be overstimulating for these fragile infants during the acute period of withdrawal.

Adolescent heroin use: a review

Use of heroin by American teenagers is beginning to show disturbing increases in national and statewide surveys. According to data from the 1997 National Institute on Drug Abuse monograph Monitoring The Future, heroin use by American high school 12th graders was 100% higher than it was from 1990 to 1996 (0.90-1.8%). In 1997, there was a further increase to 2.1%. Additional support for an increase in heroin use in the United States comes from analysis of recent survey data from California, Texas, and Maryland. Heroin imported from Colombia and from Mexico is now cheaper and of high potency, permitting novices to start with nasal administration of the drug. Most American adolescents now initiate heroin use by snorting it; however, frequent use of heroin by any route rapidly leads to tolerance and intense drug craving. Psychological dependence to heroin, and to the often exciting yet chaotic lifestyle of a heroin addict, is very difficult to overcome. Acute heroin withdrawal syndrome is usually not severe and most addicts in withdrawal can be managed in an outpatient setting. Naloxone must be used with great restraint and in smaller than usual doses in known heroin addicts. Successful long-term management often includes acute detoxification followed by long-term residential drug treatment. Managed care payment issues have impeded placement in appropriate treatment programs. Additional long-term management issues include regular attendance at 12-step meetings (Alcoholics Anonymous or Narcotics Anonymous), biweekly urine tests for drugs of abuse, attention to issues of dual diagnosis (group or family therapy), and reapproachment with family, school, and straight friends.

The developmental outcome of children born to heroin-dependent mothers, raised at home or adopted

In the present investigation we were interested to study the possible role of in-utero exposure to heroin and of the home environmental in the etiology of long-term developmental problems in children born to heroin-dependent parents in comparison to matched controls. The children were examined at .5-6 years of age by a developmental pediatrician and a developmental psychologist using, for the children up to 2.5 years of age, the Bayley Developmental Scales, and for children aged 3-6 years the McCarthy Scales for Children's Abilities. We examined 83 children born to heroin-dependent mothers, and compared the results to those of 76 children born to heroin-dependent fathers and to three control groups; 50 children with environmental deprivation, 50 normal children from families of moderate or high socioeconomic class, without environmental deprivation, and 80 healthy children from kindergartens in Jerusalem. There were five children (6.0%) with significant neurological damage among the children born to heroin-dependent mothers and six (7.9%) children among those born to heroin-dependent fathers. The children born to heroin-dependent mothers had a lower birth weight and a lower head circumference at examination when compared to controls. The children born to heroin-dependent parents also had a high incidence of hyperactivity, inattention, and behavioral problems. The lowest DQ or IQ among the children with cognitive levels above 70 was found in the children with environmental deprivation, next was the DQ or IQ of children born to heroin-dependent fathers, then the DQ or IQ of the children born to heroin-dependent mothers. When the children born to heroin-dependent mothers were divided to those that were adopted at a very young age and to those raised at home, the adopted children were found to function similarly to the controls while those not adopted functioned significantly lower. Our results show that the developmental delay and behavioral disorders observed among children born to drug-dependent parents raised at home may primarily result from severe environmental deprivation and the fact that one or both parents are addicted. The specific role of the in-utero heroin exposure in the determination of the developmental outcome of these children (if they do not have significant neurological damage), seems to be less important in comparison to the home environment.

Establishment of a liaison service for pregnant opiate-dependent women

A pregnancy liaison and outreach service was developed as part of a community drug team to attract pregnant drug-dependent women into treatment. Women were provided with information on harm reduction, safer drug use and offered treatment for drug dependence. In total, 43 women (45 pregnancies) presented to the service over a 30-month period. Thirty-four women began out-patient treatment of opiate dependence. There was a significant reduction in maternal methadone dose by delivery. Of the 45 pregnancies, four women had therapeutic abortions, two first trimester and two second trimester spontaneous abortions and 34 live births (three women remained untraceable). All the pregnancies that continued to the third trimester proceeded uneventfully with a consequent live birth. Mean gestational age was 37.9 +/- 3.7 weeks, mean birth weight was 2863 +/- 526 g, 10 of the babies were small for gestational age. Fifteen babies required medication for neonatal withdrawal symptoms; mothers whose babies exhibited withdrawal symptoms were using significantly higher doses of methadone at delivery than mothers whose babies did not withdraw. The importance of providing this type of service for women drug users in the 1990s is discussed.

Geographic distribution of newborn HIV seroprevalence in relation to four sociodemographic variables

The geographic distribution of newborn human immunodeficiency virus seroprevalence at zip code level was compared with the distribution of four sociodemographic variables. For New York City significant univariate correlations were found between HIV and low birthweight, drug use (as measured by hospital discharges), maternal education less than 12 years, and race/ethnicity. Less significant correlations were found for New York State exclusive of New York City. For New York City a model comprising low birthweight and all drug discharges was shown by multiple regression analysis to be most strongly associated with HIV status (r2 = .77). Elsewhere a model comprising race/ethnicity (percent Black, percent Hispanic) and cocaine drug discharges had the best, but less strong association (r2 = .39). However, because of intercorrelations, race/ethnicity added little when the other variables were included first. Knowledge of the geographic association between HIV seroprevalence and sociodemographic status can be useful in designing and focusing prevention efforts in areas at highest risk for future HIV/AIDS activity.

Disposition of morphine-3-glucuronide in the pregnant rhesus monkey

Morphine-3-glucuronide (M3G) is the major metabolite of morphine and is present in the circulation of persons treated with morphine or abusing heroin. This project was designed to study the kinetics of M3G in the foeto-maternal compartment, since this metabolite may be of relevance for the abstinence syndrome observed in neonates of pregnant abusers. The kinetics of M3G were studied in two non-pregnant and four pregnant Rhesus monkeys. M3G was given as a bolus injection in four of the animals and as a long-term infusion for 12 hr in two animals. M3G passed slowly across the placenta to the foetus and amniotic fluid. After 10 hr of M3G infusion, the foetal plasma M3G concentration was measured in two cases and found to be 37% and 72%, respectively, of the maternal concentration.