Substance Use by Homeless Pregnant Mothers

161 Presentation SUBSTANCE USE BY HOMELESS PREGNANT MOTHERS JANET DOUGHERTY WAGNER, Ph.D., R.N. Assistant Professor EDNA MAE MENKE, Ph.D., R.N. Associate Dean The Ohio State University College of Nursing 1585 Neil Avenue Columbus, OH 43210 Substance USE DURING pregnancy has become an area of increasing concern among health care professionals. The adverse effects on both the mother and the neonate of drinking alcohol, smoking cigarettes, smoking marijuana, and using other substances have been widely documented. These effects may be exacerbated in such underprivileged populations as the homeless, because mothers in this category are at risk for experiencing inadequate prenatal care, poor nutritional status, concomitant chronic illness, or additional coexisting complications of pregnancy.1 The literature on homeless pregnant women is sparse. However, there is an extensive body of knowledge about the effects of substance use on the pregnant woman and her developing infant. The following review highlights relevant studies on homelessness and substance use during pregnancy. Studies correlating alcohol ingestion with poor pregnancy outcomes suggest that mothers who consume alcoholic beverages have increased risk of abruptio placenta (premature detachment of the placenta) and miscarriage.2'3 The fetus is also at risk for developing various abnormalities that include fetal alcohol syndrome (FAS)4, fetal alcohol effects (FAE), attention deficit disorder1, and hyperactivity.5 Use of opiates (e.g., opium or heroin) during pregnancy is related in the mother to spontaneous abortion, miscarriage, stillbirth, toxemia of pregnancy, Journal of Health Care for the Poor and Underserved, Vol. 3, No. 1, Summer 1992 162 Substance Use by Homeless Pregnant Mothers and intrauterine growth deficiency. After birth, the developing child may ultimately experience low birthweight, drug withdrawal, behavioral disturbances , and developmental delays.6·7 Pregnant mothers using cocaine increase their likelihood of experiencing increased blood pressure, increased uterine contractions, premature delivery, and miscarriage. Full-term infants of cocaine-abusing or ^dependent mothers may have decreased length, smaller head circumference, and decreased birthweight compared to other infants.8 They are frequently irritable and difficult to soothe. They are more likely to experience sudden infant death syndrome, congenital cardiac anomalies, impaired state regulation ability (inability to selfsoothe or bond with mother)8, and by school age, they may be hyperactive or withdrawn and unable to form emotional attachments.9 Studies of the use of cannabinoids (e.g., marijuana) during pregnancy have demonstrated presumptive evidence of adverse effects on the growth and development of the fetus. Researchers report that these neonates are shorter in stature and lighter in weight.10 Nicotine can also affect the development of complications of pregnancy and poor reproductive outcomes. Smoking during pregnancy increases the incidence of placenta previa, abruptio placentae, fetal death, spontaneous abortion, premature birth, small-for-gestational-age babies, and intellectually impaired infants.11 The relationship of caffeine intake to pregnancy outcome has been less systematically studied than most other substances, and the results are inconsistent .12 Barr et al.13 reported no correlation between moderate to heavy caffeine drinking and adverse reproductive outcomes. Caan and Goldhaber14, however, reported somewhat contradictory findings, suggesting that caffeine consumption may be positively correlated to low birthweight. Both prescription and over-the-counter medicines can be harmful to the mother or the developing fetus or both.15 For example, propranolol, a widely used beta blocker, was in one report linked to intrauterine growth retardation, hypoglycemia, bradycardia, hyperbilirubinemia, and respiratory depression at birth.16 Tetracycline, a commonly prescribed antibiotic, has been associated with maternal hepatotoxicity leading to prematurity and stillbirths, maternal liver toxicity, and adverse effects on fetal deciduous teeth.1718 Aspirin, the most widely used antipyretic, has been shown in some cases to inhibit prostogladin synthetase production in the mother, leading to prolonged labor.19 Its effect on the fetus is increased risk of patent ductus arteriosus .20 Additionally, high doses of salicylates have been associated with congenital salicylate intoxication and intrauterine growth retardation20, as well as bleeding complications such as intraventricular hemorrhage.21 Homeless pregnant women appear to be at high risk for the development of drug-related problems. Although the literature contains no formal studies on the drug-seeking and drug-taking behaviors of homeless women who are pregnant, research concerning drug use and pregnancy indicates that...