Substance Use in: Alcohol, Opioids And

Fetal Alcohol Spectrum Disorders (FASD):

- No safe amount of alcohol at any point in pregnancy - Teratogenic throughout gestation; 1st trimester = highest risk for structural defects - Leading preventable cause of intellectual disability in the US - Fetal alcohol syndrome (FAS): diagnostic criteria: Growth restriction (prenatal/postnatal LBW) Facial features: smooth philtrum, thin vermilion border (upper lip), small palpebral fissures CNS abnormalities: microcephaly, intellectual disability, behavioral disorders, learning disabilities - FASD spectrum: partial FAS, neurodevelopmental disorder without facial features Opioids: - Use in pregnancy rising dramatically (opioid crisis) - Risks: fetal growth restriction, preterm birth, placental abruption - Neonatal Opioid Withdrawal Syndrome (NOWS/NAS): Onset: 24–72 hours after birth (heroin), 2–4 days (methadone) Symptoms: tremors, high-pitched cry, poor feeding, sneezing, yawning, rhinorrhea, seizures Assessment: Finnegan Neonatal Abstinence Scoring System (NAS score) Treatment: non-pharmacological first (swaddling, low stimulation, skin-to-skin, feeding on demand); pharmacological (morphine, methadone) if NAS score criteria met - Medication-assisted treatment (MAT) in pregnancy: Methadone or buprenorphine: standard of care for opioid use disorder in pregnancy * Reduces illicit drug use,...