Addiction and Pregnancy, Prof.F.Thibaut, Athens Conference

This doctor was a remarkable presenter of a very important topic.  (She not only provided a thorough and moving overview of the research but she also handled extremely well the many questions and positive comments that followed)

Addictions and Pregnancy

Professor F. Thibaut

University Hospital

INSERM, Rouen , France

Epidemiological data

Tobacco and Pregnancy

France

-25% of pregnant women smoke

Ireland

-37% pregnant women smoke

USA

-52% of pregnant women smoke

Alcohol and pregnancy

USA

8-30% - 1 to 6% binge drinking

Australia - 14%

Russia 35%

Chile 57%

Ireland - 89% - 10% binge drinking

Sweden - 23 to 30% regularly

France - 53% not drinking

20-30% 1-4 drinks

14% 1 binge drinking episode during pregnance

Drugs and Pregnancy

USA 1996

 19% cannabis

5% daily

USA 2006

3 to41% 

BRazil 

4% cannabis, 2% cocaine, .3% both

Barcelona 2005

6% opioids, 3% cocaine, 1.5 % both

France 2006

3-10 % cannabis

3-5% cocaine

Consequences of exposure to children

Dose and pattern of use

Timing of exposure

Frequence and duration

Polyconsumption

metabolism of mother and infant

Consumption after delivery

Family environment - violence, personality disorders, psychiatric disorders

75% exposed versus 27% non exposed have medical problems at birth

Alcohol in utero

Fetal alcoholism

1.6 per thousand Sweden

2-7 per thousand USA

1-3 per thousand France

Fetal alcohol spectrum 1-5

Prematurity

FAS - 

Preventable mental retardation

45% of FAS go to committ crimes against persons

Tobacco in utero

Withdrawal at birth

-crying irritability, sleep and digestive disorders

 Cotinine in meconium or hair

-increased risk of sudden death

-growth impairment

-respiratory disorders

-cleft palate

• cognitive disorders 
• language impairment
• dyscalculia
• memory deficits, 
• problem solving
• attention deficit disorders
• pscyhiatric disorders
• addictive disorders

Cannabis in utero

Hypotrohy reduced head size

increased risk of sudden death

Withdrawal at birth ?

learnig impairments

Short term memory disorder

 language impairments

Attention disorders

psychiatric disorders - depression and anxiety

Cocaine in utero

in utero death

growht ipairment

cognitive 

language

ADHD

Behaviour disorders

identification of at risk women

Addiction Severity Index

AUDIT, Fagerstrom, Cannabis Abuse Screen Tests

Mother’s consumption often underestimated by 2-3 factor

At Risk Women

polyconsumption

low socioeconomic statu

single

low education

white women in us - alcohol and cannabis

black women in us - cocaine

psychiatric comorbidity

Conclusion

Avoidance of maternal consumption, tobacco, alcohol, drugs, during pregnancy is necessary

Methadone "Carries"

When people begin on the methadone maintenance program to stop opiate drug use, especially IV heroin addiction, they are required to get their methadone daily. It also must be witnessed daily by the pharmacist dispensing the methadone.  This is called DWI, or daily witnessed ingenstion.
"Carries" refer to the "Carry Policy" of the Methadone Maintenance Program. A carry is a dose of methadone that is mixed in Tang and dispensed at the drug store but the patient is allowed to take it home rather than ingest it there.
As with the whole methadone program, it is a privilege and carries are a 'priviledge' which reflects that a person is doing well with the program.
The criteria for initating carries require that the doctor decide that 'carries' are both safe for the patient and safe for society.  A person must be clinically stable, well established on a methadone dose which eliminated craving and also withdrawal symptons.  The patient must also demonstrate social, cognitive and emotional stability.  Egs which doctors use for this include, appointment schedule maintenance, reports of improved social relationships, better mental status examination, no illegal behaviour.  Most importantly a person must have urine drug screens which are free of all mood altering substances for a minimum of 12 weeks.
In addition they must have the ability to store methadone safelty.  The methadone must be stored in a safe and secure place where it will not be stolen and is not a danger to others especially children.  This requires that a person be in safe, supportive housing.
Reasons for giving carries are school, work, caring for young children, travel etc.
It is further recommended that carries not exceed 4 days or 400 mg whichever is less.
If a person has had methadone carries and relapsed the carry privilege must be reassessed.  They must then return to daily witness ingestion and demonstrate that they are 'stable' again. This includes at least 4 weeks of urines which are clean for mood altering drugs.
Further urine testing is being done not only to ensure no drug abuse but to confirm methadone in the urine indicating that it isn't being diverted.