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IMPACT OF SUBSTANCE ABUSE ON THE MOTHER AND FETUS

IMPACT OF SUBSTANCE ABUSE ON THE MOTHER AND FETUS. Siva Thiagarajah , M.D. Gary D. Helmbrecht, M.D. Prenatal Diagnosis Center Charlottesville, VA. DRUG ADDICTION IS A COMPLEX ILLNESS. www.drugabuse.gov. The drug dominates control of the reward center. This brain has been hijacked!.

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IMPACT OF SUBSTANCE ABUSE ON THE MOTHER AND FETUS

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  1. IMPACT OF SUBSTANCE ABUSE ON THE MOTHER AND FETUS Siva Thiagarajah, M.D. Gary D. Helmbrecht, M.D. Prenatal Diagnosis Center Charlottesville, VA

  2. DRUG ADDICTION IS A COMPLEX ILLNESS www.drugabuse.gov

  3. The drug dominates control of the reward center. This brain has been hijacked! • Continued use of the drug makes the body • rely on the presence of the drug to maintain • rewarding feelings and other normal behaviors. • The person is no longer able to • feel the benefits of natural rewards (food, water, sex) • can't function normally without the drug present. Gary D. Helmbrecht, M.D. www.Prenataldiagnosiscenter.com

  4. How Does Drug Abuse Affect Pregnancy? • Cocaine and other stimulants • Maternal catecholamine release • Direct effect on vascular smooth muscle • Maternal hypertensive crisis • Placental hypoxia • Opiates • Withdrawal leads to maternal catecholamine release • Trauma • Alcohol • FASD • IUGR

  5. Common Medical Problems Among Opiate Addicted Gravidas Gary D. Helmbrecht, M.D. www.Prenataldiagnosiscenter.com

  6. Obstetric Complications in the Opiate Addicted Gravida Gary D. Helmbrecht, M.D. www.Prenataldiagnosiscenter.com

  7. Obstetric Complications in the Opiate Addicted Gravida Placental insufficiency IUGR/IUFD Abruption Preterm labor Hypoxia Repeated withdrawal Concurrent Stimulant abuse Hypertensive crisis Spontaneous abortion Preterm rupture of membranes Preterm labor and delivery Chorioamnionitis Post partum hemorrhage Inflammatory Infectious complications Cytokines Gary D. Helmbrecht, M.D. www.Prenataldiagnosiscenter.com

  8. Placental Abruption and Infarction Gary D. Helmbrecht, M.D. www.Prenataldiagnosiscenter.com

  9. Intrauterine Growth Restriction Umbilical Artery Middle Cerebral Artery Gary D. Helmbrecht, M.D. www.Prenataldiagnosiscenter.com

  10. PRINCIPLES OF EFFECTIVE TREATMENT • Non judgmental approach to the patient. • Open communication between providers. • Effective case management. • Positive reinforcement with the patient. • Appropriate antepartum testing and timing of delivery.

  11. PRINCIPLES OF EFFECTIVE TREATMENT • Medication assisted treatment options • Opiate addictions • Methadone • Buprenorphine (Subutex) • Cocaine • Topamax • Baclofen

  12. PRINCIPLES OF EFFECTIVE TREATMENT • Alcohol • Detoxification • Benzodiazepines (Librium, Klonopin) • Carbemazepam (Tegretol) • Maintenance • Disulfiram (Antibuse) • Topiramate (Topamax) • Naltrexone (Vivitrol)

  13. PRINCIPLES OF EFFECTIVE TREATMENT • Appropriate antepartum testing • Non Stress Test • Biophysical Profile • Doppler • Umbilical artery • Middle cerebral artery • Timing of delivery

  14. PERINATAL ADDICTION If you learn nothing else today, remember this: No matter what, these patients deserve our compassion and respect. Addiction is a genetic disease. Like diabetes, the addict did not choose to become addicted. Good people can do some very bad things while in the active phase of their disease. The disease drives the behavior; the behavior does NOT drive the disease. Gary D. Helmbrecht, M.D. www.Prenataldiagnosiscenter.com

  15. Gary D. Helmbrecht, M.D. www.Prenataldiagnosiscenter.com

  16. www.drugabuse.gov

  17. www.drugabuse.gov

  18. www.drugabuse.gov

  19. Positron Emission Tomography (PET) www.drugabuse.gov

  20. control on cocaine www.drugabuse.gov

  21. Release signal Dopamine Dopamine receptor Gary D. Helmbrecht, M.D. www.Prenataldiagnosiscenter.com

  22. Gary D. Helmbrecht, M.D. www.Prenataldiagnosiscenter.com

  23. www.drugabuse.gov

  24. www.drugabuse.gov

  25. www.drugabuse.gov

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