PUBH 3003 1st Edition Lecture 13Outline of Last Lecture I. MethII. Stimulantsa. Stimulants and the bodyb. Dangerous aspectsc. Approved useIII. Stimulants and alcoholIV. Cocainea. From leavesb. Your brain on cocaineV. Caffeinea. Your brain on caffeineb. Contentc. Health effectsd. Energy drinksOutline of Current Lecture I. Drugs and birth defectsa. Effects on pregnant motherII. Fetal Alcohol DisordersIII. Brain changes IV. Alcohol and PregnancyV. Prevention Current Lecture: Societal Issue: Alcohol, Drugs, and Birth DefectsDrugs and Birth Defects- What should we do with pregnant women who abuse alcohol or drugs during pregnancy?- How often do birth defects occur?- When do birth defects occurBenzodiazepines - Lorazepam (Ativan), diazepam (valium), Clonazepam (Klonopin) - Use during or prior to labor can result to “floppy baby syndrome”- Neonatal withdrawal- Use while breastfeeding may cause lethargy and weight loss in babies These notes represent a detailed interpretation of the professor’s lecture. GradeBuddy is best used as a supplement to your own notes, not as a substitute.Opiates: Morphine, heroin, codeine, oxycodoneEffects on fetus/ baby:- Miscarriage- Placental separation- Malformations- Restricted growth/ low birth weight- Neonatal abstinence syndrome (NAS)- Sudden infant death syndrome (SIDS)Effects on pregnant mother:Acute withdrawal can cause:- Uterine irritability - Abdominal cramping- Tremors- Elevated heartbeat- Vomiting diarrhea Opioid Dependency TreatmentsMethadone - Has been the recommended standard of care for opioid dependent in pregnant women since the 1960s - Minimal adverse effects on fetal development - Can suppress fetal breathing and heart rate Buprenorphine - Significantly less morphine was needed for treatment of NAS- A significantly shorter period of NAS treatment- A significantly shorter hospital stay for neonates Nicotine- Increased risk of miscarriage- Increased risk of having a stillborn child- Premature birth- Low birth weight- Increased heart rate in baby- Lack of oxygen available for the developing baby - Development of respiratory problemsCocaine - Cognitive performance, information processing and attention to tasks Of all the substances of abuse (Including cocaine, heroin, and marijuana) alcohol produces by far the most serious neurobehavioral effects in the fetusParental Exposure:- There is no identified safe level of drinking during pregnancy- Severity of effects on fetus primarily depends on quantity, frequency, and timing o Fetal alcohol syndrome (FAS)o Fetal alcohol effects (FAE)Fetal Alcohol Spectrum Disorders- Parietal FAS- partial signs/ symptoms but not all three- Alcohol related birth defects (ARBD)o Alcohol related physical abnormalities: heart, kidney and bone problems, difficulty seeing and hearing- Alcohol related neurodevelopmental disorder (ARND)o Central nervous system abnormalities and or cognitive and behavioral problems- Range of developmental, cognitive, and behavioral problems- Reduced immunity- Central nervous system disorder- People with FASD have difficulty with:o Coordinationo School worko Emotional controlo Socializationo Holding a jobWhen pregnancy is unknown What if a woman drinks before she knows she is pregnant:- Embryonic stage: 3rd post conception week is considered most critical for alcohol teratogens o More severe features of FASo Average of 3 drinks per day following conception increases risk of having a child with FAS- Alcohol diffuses through the placenta- Concentration in fetal blood same as mothers within a few minutes- Fetus is able to metabolize alcohol 10% as fast as the motherFetal Alcohol Syndrome- Alcohol use during pregnancy is leading known cause of intellectual disability in the U.S- Alcohol related birth defects 100% preventable- FAS prevalence 0.5 to 2.0 per 1,000 live births- Specific pattern of facial features - Growth defects (prenatally and after birth)- Central nervous system issues Brain Changes Clinically significant brain abnormalities observable through imaging techniques - Reduction in size of the brain, areas of the brain- Change in or absence of corpus callosum- Change in cerebellum or basal ganglia FASD- related problems- Learning and remembering- Understanding and following directions- Attachment disorder- Shifting attention- Controlling emotions and impulsivity- Communicating and socializing- Inability to discern consequence of actions; problems with reasoning and judgments - Practicing daily life skills, including bathing, feeding, counting money, telling time, minding personal safety Developmental Issues- Delayed development- ADHD/ADD- Speech/ language disorders- Motor functioning delays (difficulties with feedings, poor suck, poor dexterity, difficulty in writing or drawing, balance problems)- Tactile dysfunction/ overly stimulated- Cognitive or intellectual deficits- Impaired visual skills- Neurosensory hearing loss- Learning and rememberingMaternal Characteristics - Poor nutrition- Lower than average weight, height, BMI- Being a smoker- Being older- Multiple pregnancies and birthsEnvironmental Factors - Lacking prenatal care- Experiencing social isolation- Little awareness of FASD- Living where binge/ heavy drinking is common/ accepted A hidden Disability- FAS may be incorrectly labeled as behavior disorder- There may be no visible indicators of the disability- Many cases of FAS go undiagnosed - FASD- many children have no facial abnormalities Outcomes - Very greatly among individuals - Diagnosis not an endpoint- Co-occurring mental disorders- Likely to need services throughout life Positive Outcomes - Children with FAS tend too Be caring and creativeo Determined and eager to pleaseo Respond well to structure, consistency and close supervision o Respond well to concrete communicationNegative Outcomes- Children with FAS may haveo Disrupted school experiences o Mental health problemso Substance abuse problemso Inappropriate sexual behavioro Dependent, unemploymentProtective Factors - Stable and nurturing home environment - Early diagnosis (by age 6)- Absence of exposure to violence - Eligibility of social and educational services Foster Care System- Many foster and adoptive families do not receive education about FAS- The child’s family history is often unknown - Prevalence of children with FAS in foster care system estimated to be 10 times greater than in general