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Emergency Management of Substance Use in Pregnant Patients

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Substance Use and the Acute Psychiatric Patient

Part of the book series: Current Clinical Psychiatry ((CCPSY))

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Abstract

Substance use disorders during pregnancy are common and are often associated with increased maternal and fetal risk. In the emergency department (ED), a physician must try to engage these patients in treatment while safely managing intoxication and withdrawal to mitigate risk. In this chapter, the emergency management of various substance use disorders (specifically alcohol, benzodiazepines, cannabis, opioids, stimulants, and nicotine) in the care of the pregnant patient is reviewed. This review includes assessment of risks to both mother and fetus, recommendations for acute management, and disposition considerations for treatment.

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References

  1. Center for Substance Abuse Treatment. Substance abuse treatment for persons with co-occurring disorders. Treatment Improvement Protocol (TIP) Series 42. DHHS Publication No. (SMA) 05-3922. Rockville: Substance Abuse and Mental Health Services Administration; 2005.

    Google Scholar 

  2. Wilson J, Thorp Jr. J. Glob libr women’s med, (ISSN: 1756-2228) 2008. https://doi.org/10.3843/GLOWM.10115.

  3. Whitlock EP, Polen MR, Green CA, Orleans T, Klein J, U. S. Preventive Services Task Force. Behavioral counseling interventions in primary care to reduce risky/harmful alcohol use by adults: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2004;140(7):557–68.

    Article  Google Scholar 

  4. Stinson FS, Grant BF, Dawson DA, Ruan WJ, Huang B, Saha T. Comorbidity between DSM-IV alcohol and specific drug use disorders in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Drug Alcohol Depend. 2005;80(1):105–16. https://doi.org/10.1016/j.drugalcdep.2005.03.009.

    Article  PubMed  Google Scholar 

  5. World Health Organization (WHO). Guidelines for the identification and management of substance use and substance use disorders in pregnancy. Geneva: World Health Organization (WHO); 2014.

    Google Scholar 

  6. Bertrand J, Floyd RL, Weber MK, O’Connor M, Riley P, Johnson KA, Cohen DE, National Task Force on FAS/FAE. Fetal alcohol syndrome: guidelines for referral and diagnosis. Atlanta: Centers for Disease Control and Prevention; 2004.

    Google Scholar 

  7. Bellantuono C, Tofani S, Di sciascio G, Santone G. Benzodiazepine exposure in pregnancy and risk of major malformations: a critical overview. Gen Hosp Psychiatry. 2013;35(1):3–8.

    Article  Google Scholar 

  8. Chisolm MS, Payne JL. Management of psychotropic drugs during pregnancy. BMJ. 2016;532:h5918.

    Article  Google Scholar 

  9. National Guideline Clearinghouse (NGC). Guideline summary: Guidelines for the identification and management of substance use and substance use disorders in pregnancy. In: National Guideline Clearinghouse (NGC) [Web site]. Rockville: Agency for Healthcare Research and Quality (AHRQ); 2014 Jan 01. Available: https://www.guideline.gov.

  10. McElhatton PR. The effects of benzodiazepine use during pregnancy and lactation. Reprod Toxicol. 1994;8(6):461–75.

    Article  CAS  Google Scholar 

  11. National Institute on Drug Abuse. Trends & Statistics. Retrieved from https://www.drugabuse.gov/related-topics/trends-statistics on 28 Aug 2016.

  12. Passey ME, Sanson-Fisher RW, D’Este CA, Stirling JM. Tobacco, alcohol and cannabis use during pregnancy: clustering of risks. Drug Alcohol Depend. 2014;134:44–50.

    Article  Google Scholar 

  13. Marijuana use during pregnancy and lactation. Committee Opinion No. 637. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2015;126:234–8.

    Google Scholar 

  14. van Gelder MM, Reefhuis J, Caton AR, Werler MM, Druschel CM, Roeleveld N, National Birth Defects Prevention Study. Characteristics of pregnant illicit drug users and associations between cannabis use and perinatal outcome in a population-based study. Drug Alcohol Depend. 2010;109:243–7.

    Article  Google Scholar 

  15. Maeda A, Bateman BT, Clancy CR, Creanga AA, Leffert LR. Opioid abuse and dependence during pregnancy: temporal trends and obstetrical outcomes. Anesthesiology. 2014;121(6):1158–65.

    Article  Google Scholar 

  16. Wilder CM, Winhusen T. Pharmacologic management of opioid use disorder in pregnant women. CNS Drugs. 2015;29(8):625–36.

    Article  CAS  Google Scholar 

  17. Forray A, Foster D. Substance use in the perinatal period. Curr Psychiatry Rep. 2015;17:91.

    Article  Google Scholar 

  18. The American College of Obstetricians and Gynecologists (ACOG): Committee Opinion. Opioid Abuse, Dependence, and Addiction in Pregnancy. 2014. Number 524.

    Google Scholar 

  19. Mozurkewich EL, Rayburn WF. Buprenorphine and methadone for opioid addiction during pregnancy. Obstet Gynecol Clin N Am. 2014;41(2):241–53.

    Article  Google Scholar 

  20. Noormohammadi A, Forinash A, Yancey A, Crannage E, Campbell K, Shyken J. Buprenorphine versus methadone for opioid dependence in pregnancy. Ann Pharmacother. 2016;50(8):666–72.

    Article  CAS  Google Scholar 

  21. Zedler BK, Mann AL, Kim MM, Amick HR, Joyce AR, Murrelle EL, et al. Buprenorphine compared with methadone to treat pregnant women with opioid use disorder: a systematic review and meta-analysis of safety in the mother, fetus, and child. Addiction. 2016;111:2115. https://doi.org/10.1111/add.13462. [Epub ahead of print].

    Article  PubMed  PubMed Central  Google Scholar 

  22. D’Apolito K. Breastfeeding and substance abuse. Clin Obstet Gynecol. 2013;56(1):202–11.

    Article  Google Scholar 

  23. Bagley SM, Wachman EM, Holland E, Brogly SB. Review of the assessment and management of neonatal abstinence syndrome. Addict Sci Clin Pract. 2014;9(1):19.

    Article  Google Scholar 

  24. Young JL, Martin PR. Treatment of opioid dependence in the setting of pregnancy. Psychiatr Clin N Am. 2012;35(2):441–60.

    Article  Google Scholar 

  25. Kwiatkowski MA, Roos A, Stein DJ, Thomas KG, Donald K. Effects of prenatal methamphetamine exposure: a review of cognitive and neuroimaging studies. Metab Brain Dis. 2014;29(2):245–54.

    Article  CAS  Google Scholar 

  26. Ladavac AS, Dubin WR, Ning A, Stuckeman PA. Emergency management of agitation in pregnancy. Gen Hosp Psychiatry. 2007;29(1):39–41.

    Article  Google Scholar 

  27. Rayburn WF, Bogenschutz MP. Pharmacotherapy for pregnant women with addictions. Am J Obstet Gynecol. 2004;191(6):1885–97.

    Article  CAS  Google Scholar 

  28. The American College of Obstetricians and Gynecologists (ACOG): Committee Opinion. Smoking Cessation During Pregnancy. 2010. Number 471.

    Google Scholar 

  29. Coleman T, Chamberlain C, Davey MA, Cooper SE, Leonardi-Bee J. Pharmacological interventions for promoting smoking cessation during pregnancy. Cochrane Database Syst Rev. 2015;(12):CD010078.

    Google Scholar 

  30. Berard A, Zhao JP, Sheehy O. Success of smoking cessation interventions during pregnancy. Am J Obstet Gynecol 2016. pii: S0002-9378(16)30432-X. https://doi.org/10.1016/j.ajog.2016.06.059. [Epub ahead of print].

    Article  Google Scholar 

  31. Forray A. Substance use during pregnancy. F1000Res. 2016;5:F1000 Faculty Rev-887.

    Article  Google Scholar 

  32. Gopman S. Prenatal and postpartum care of women with substance use disorders. Obstet Gynecol Clin N Am. 2014;41(2):213–28.

    Article  Google Scholar 

  33. McLafferty LP, Becker M, Dresner N, Meltzer-Brody S, Gopalan P, Glance J, et al. Guidelines for the management of pregnant women with substance use disorders. Psychosomatics. 2016;57(2):115–30.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Perinatal Psychiatry, MGH Center for Women’s Mental Health, Boston, MA, USA

    Allison S. Baker & Charlotte S. Hogan

  2. Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA

    Allison S. Baker & Charlotte S. Hogan

Authors
  1. Allison S. Baker
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  2. Charlotte S. Hogan
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Corresponding author

Correspondence to Charlotte S. Hogan .

Editor information

Editors and Affiliations

  1. Massachusetts General Hospital, Boston, MA, USA

    Abigail L. Donovan

  2. Massachusetts General Hospital, Boston, MA, USA

    Suzanne A. Bird

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Baker, A.S., Hogan, C.S. (2019). Emergency Management of Substance Use in Pregnant Patients. In: Donovan, A., Bird, S. (eds) Substance Use and the Acute Psychiatric Patient. Current Clinical Psychiatry. Humana, Cham. https://doi.org/10.1007/978-3-319-23961-3_13

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  • DOI: https://doi.org/10.1007/978-3-319-23961-3_13

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  • Publisher Name: Humana, Cham

  • Print ISBN: 978-3-319-23960-6

  • Online ISBN: 978-3-319-23961-3

  • eBook Packages: MedicineMedicine (R0)

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