1 décembre 2022

Substance Abuse during Pregnancy Laws Canada

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Last month, cannabis use among pregnant women aged 18 to 44 increased from about 3% to 7% between 2002 and 2017.17 Among pregnant teens, use was even higher in the past month (15%).18 A recent cross-sectional study with data from 367,403 pregnancies in 276,991 Northern California women found that weekly and monthly cannabis use before and during pregnancy increased between 2009 and 2017. The analysis involved 1,441 children who had been prescribed methadone during pregnancy and 842 children whose mothers had not received methadone.25 Children exposed to methadone appeared to be at increased risk of neurodevelopmental disorders, with lower scores on the Mental Development Index and the Psychomotor Development Index. as well as visually evoked atypical potentials, strabismus and nystagmus. However, these results on impairment may be biased, as studies do not take factors other than methadone into account. In fact, the results of this meta-analysis confirm the need for further research and the many factors that can influence pregnancy outcomes. Successful supportive care for infants exposed to opioids during pregnancy depends on a number of factors, such as providing appropriate medications, proper planning, using an accurate tool to measure and assess symptom severity, creating a compatible physical environment, and a competent and experienced health care team. Involvement of interprofessional team members (i.e. specializes in nursing, neonatal medicine, social work, pharmacy, nutrition, and community resources) is essential to ensure the seamless treatment and discharge of these vulnerable infants [15]. Treatment goals include preventing complications associated with RNA and restoring normal neonatal activities such as sleep, proper nutrition, weight gain, and adaptation to the environment. Alcohol, tobacco and cannabis are the most commonly used substances during pregnancy, and pregnancies exposed to opioids have quadrupled. The aim of this review is to describe the prevalence and consequences of prenatal exposure to alcohol, tobacco, cannabis and opioids.

Currently available screening questionnaires for prenatal substance use are summarized and compared to available interventions for prenatal alcohol use. Since screening for prenatal alcohol and substance use is only a prelude to efforts to mitigate possible adverse consequences, attempts to mitigate these consequences are briefly reviewed. In addition, future research areas related to the criminalization of prenatal substance use will be discussed, which may impede both investigation and disclosure. Indeed, the full potential of effective interventions has not yet been realized. Prenatal alcohol screening questionnaires have been well studied. For example, a systematic review of short screening questionnaires to identify alcohol problems during pregnancy evaluated seven instruments administered to 6,724 participants.39 Interventions included TWEAK (Tolerance, Worried, Revelation, Amnesia, K/Cut Down); T-ACE (tolerance [number of drinks], anger, cut, revelation); CAGE (cut, annoyed, guilty, revealing), NET (normal drinker, revealing, tolerance); AUDIT (alcohol use disorder identification test); AUDIT-C (AUDIT Alcohol Consumption Questions) and SMAST (Short Michigan Alcoholism Screening Test). The screening questionnaires were compared to a structured interview to determine alcohol consumption status as a reference standard. T-ACE, AUDIT-C and TWEAK were the three questionnaires identified as the most promising screening tools for identifying unsafe alcohol use among pregnant women. However, the sensitivity and specificity of these three questionnaires outside the United States are unknown.

Antepartum smoking is common. According to the 2017 report of the National Survey on Drug Use and Health, tobacco use among pregnant women was about 15% last month.13 Tobacco products include the use of alternative forms of nicotine, such as e-cigarettes and vaping, which until recently were considered less harmful. In 2015, for example, 7% of women who gave birth alive in Oklahoma and Texas reported using an e-vaping product sometime before, during, or after pregnancy.14 Data specific to the effects of prenatal use of e-vaping products are scarce. However, the Centers for Disease Control and Prevention has issued preliminary guidelines that e-cigarette products should never be used by pregnant women or adults who do not currently use tobacco products, as they are studying more than 200 cases of severe lung disease associated with their use.15 Another prospective cross-sectional study on screening accuracy compared five screening instruments in terms of ability to identify illicit drugs. The use of opioids and alcohol respects privacy expectations, consistent with current practice. Participants included 1,220 pregnant women treated in Boston, MA; Detroit, MI; or New Haven, CT. Women were socio-economically diverse and had an average age of 29. The study used a reference standard for substance use in three classes (i.e., illicit drugs, opioids and alcohol); Results were found to be positive when use was evident through a 30-day calendar reminder or urine toxicology analysis.46 The gold standard for illicit drug use included marijuana, cocaine, heroin, amphetamines, barbiturates and hallucinogens.

The five screening tools for substance use during pregnancy were SURP-P; CRAFFT, a filter of five articles with articles related to the car, relaxation, loneliness, forgetfulness, friends and troubles; 5Ps, with articles about parents, peers, partner, pregnancy, past (i.e. an adaptation of 4P`s Plus©); Wayne Indirect Drug Use Screener (WIDUS); and NIDA Quick Screen–ASSIST. None of the five measurements showed both high sensitivity and high specificity, and the area under the curve was low for almost all measurements, suggesting that none could be recommended for practice with pregnant women. The association between prenatal cannabis use and maternal, perinatal and neonatal outcomes is unclear.21 A 2016 systematic review and meta-analysis concluded that maternal marijuana use during pregnancy was not an independent risk factor for adverse neonatal outcomes such as low birth weight or preterm birth after adjusting for confounders such as smoking.22 Limitations of The generalizability of this meta-analysis, however, are the relatively small number of women in the risk-adjusted group, suggesting that the meta-analysis was not able to stratify all secondary outcomes of interest. Another systematic review and meta-analysis from the same period found that pregnant women who used marijuana were more likely to become anemic and that infants exposed to cannabis in utero had reduced birth weight and were more likely to require neonatal intensive care.23 The researchers in this review acknowledged that, Since many cannabis users often also use tobacco and alcohol, it was not possible to determine a pure effect of cannabis. A population-based cohort study of 661,617 women in Ontario, Canada, showed that the percentage of preterm birth among self-reported cannabis users was 12%, compared to 6% among non-female users, although this increase continued even after adjusting for confounders.24 Until there is definitive evidence of the safety of prenatal marijuana use, Be concerned that marijuana may harm neurodevelopment and have other effects. led to the American College of Obstetricians. and gynecologists (ACOG), who advise pregnant women or those considering doing so to avoid using marijuana and other cannabinoids.25 There is no known safe drinking during pregnancy.38 Alcohol is a teratogen; In other words, it is able to disrupt the development of the fetus, leading to birth defects. Although the impact of light alcohol consumption among women, defined as consumption of up to 32 g of alcohol per week, on pregnancy outcome remains uncertain in the absence of sufficient evidence, the potential for harm cannot be excluded.12 Therefore, ACOG recommended that all women seeking obstetric gynaecological care be screened for alcohol use annually and during the first trimester of the pregnancy.

Pregnant women with opioid dependence should be advised to continue or begin an opioid maintenance treatment program [9]. Methadone is often recommended for pregnant women dependent on opioids [10] and some studies suggest buprenorphine as an alternative treatment [11]. The literature indicates that opioid substitution therapy during pregnancy can reduce the use of other opioids and illicit drugs and improve prenatal care, including access to education, counselling and support services [12][13].

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