Screening and Management of Substance Use in Pregnancy: A Review

Substance use during pregnancy has important implications for health care providers, policy makers, and can negatively impact a woman's health and the health of her children. Understanding trends, patterns of use and outcomes are critical to prevention campaigns, building awareness, and providing effective care. This review will discuss the current therapeutic approaches and recommendations for screening and patient management for substance use in pregnancy and during the postpartum period, and it is geared towards any care providers who care for patients or those who may care for patients who may be at risk for substance use during pregnancy.

Health professionals working with First Nations, Inuit, and Métis consensus guideline

OBJECTIVE

Our aim is to provide health care professionals in Canada with the knowledge and tools to provide culturally safe care to First Nations, Inuit, and Métis women and through them, to their families, in order to improve the health of First Nations, Inuit, and Métis.

EVIDENCE

Published literature was retrieved through searches of PubMed, CINAHL, Sociological Abstracts, and The Cochrane Library in 2011 using appropriate controlled vocabulary (e.g.,cultural competency, health services, indigenous, transcultural nursing) and key words (e.g., indigenous health services, transcultural health care, cultural safety). Targeted searches on subtopics (e.g., ceremonial rites and sexual coming of age) were also performed. The PubMed search was restricted to the years 2005 and later because of the large number of records retrieved on this topic. Searches were updated on a regular basis and incorporated in the guideline to May 2012. Grey (unpublished) literature was identified through searching the websites of selected related agencies (e.g., Campbell Collaboration, Social Care Online, Institute for Healthcare Improvement).

VALUES

The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task force on Preventive Health Care (Table).

Cystic fibrosis carrier testing in pregnancy in Canada

OBJECTIVE

To assess the role of cystic fibrosis (CF) testing within the Canadian health care environment.

METHODS

The Genetics and Maternal Fetal Medicine Committees of the Society of Obstetricians and Gynaecologists of Canada (SOGC) reviewed Preconception and Prenatal Carrier Screening for Cystic Fibrosis Clinical and Laboratory Guidelines produced by the American College of Obstetricians and Gynecologists (ACOG) and the American College of Medical Genetics (ACMG) and other educational material from ACOG and ACMG.

RESULTS

Background information related to cystic fibrosis, genetic mutation analysis, and one large clinical cystic fibrosis screening trial are reviewed.

EVIDENCE

The quality of evidence reported in this document has been described using the Evaluation of Evidence criteria outlined in the report of the Canadian Task Force on the Periodic Health Exam.

RECOMMENDATIONS

1. CF testing in pregnancy is indicated for individuals who may be at increased risk for CF due to considerations of family history or clinical manifestations. (II-2A). 2. Before CF screening could be undertaken, each province/territory would have to review the ethnic diversity of its reproductive population to ensure that CF screening would be appropriate. (III-C). 3. Screening of all women during pregnancy for CF carrier status cannot be recommended at this time. (III-C).