Drug abuse is a serious worldwide problem nowadays. This tragedy cuts across all the socioeconomic classes and ethnic groups all over the world (Kronstadt, 1991, p.36). Exposure to drugs can affect persons throughout the whole life, starting from intranatal period of development (National Institute on Drug Abuse, 2011, 1). Drug abuse of pregnant women is directly associated with deleterious effects on fetus. All the drugs can pass through the hemato-placental barrier and provide harmful effect on fetal organism. The severity of harm depends on the period of pregnancy (the early, the middle, or the last one), concentration of drug, its kind, way of ingestion, etc. Investigation of substance abuse effect on the fetal organism development started in the 1960-s. Those were reports concerning nicotine, opiate, and alcohol use during pregnancy (Behnke & Smith, 2013, e1009). Fetal alcohol syndrome was described in 1973; neonatal abstinent syndrome was described by Finnegan et al. in 1975 (Behnke & Smith, 2013, e 1013). It is necessary to remember that drug abused pregnant women have poor nutrition, increased infections that also may influence the fetus. Drug abuse by pregnant women is a very important problem to be solved because the main result of drug addiction during pregnancy is an ill and poor nation without any perspective for the development.
Mechanisms of Action of Drugs on the Fetus
It is possible to define different ways of drug influence on the fetus. The effect may be direct and indirect. Direct prenatal drug effect on a fetal organism takes place when drugs passing through the hemato-placental barrier directly influence the development of fetus organs. The indirect influence of prenatal drug abuse means that drugs exert some toxic effect on the mother’s organism, and these changes influence the fetus development. Among indirect effects, we can define placental insufficiency, altered behaviors of mother such as poor nutrition, etc. (Behnke & Smith, 2013, e 1011). We cannot say about dominance of one kind of effect over the other one. The level of fetus development impairment also depends on the pregnancy period when the drug was used. It may vary from embryotoxicity and teratogenicity to intrauterine growth retardation (Behnke & Smith, 2013, e1011). For instance, cocaine can easily cross the blood-placental and blood-brain barrier of fetus and cause severe teratogenic effect on a developing fetus. Nicotine concentrations are higher in fetal serum than in maternal serum. Nicotine provides direct vasoconstrictor effect on the placental and umbilical vessels, which causes hypoxia and undernourishment of the fetus. Nicotine prenatal abuse is also associated with oral facial clefts (Behnke & Smith, 2013, e1012).
Identification of Prenatal Drug Abuse Effect on Fetus
Two main methods are used to identify drug abusers: self-report and analysis of biological specimens, such as urine, meconium, and hair. However, any of them is not accepted as “the gold standard”. It is rather difficult to define parameters for screening for drug abuse because all the issues concerning biological specimens’ analysis are complicated by legal, ethical, social, and scientific concerns, which are to be taken into consideration by obstetricians, neonatologists, and pediatricians in order to develop adequate protocols for revealing prenatal drug exposure (Behnke & Smith, 2013, e1010). None of biological specimens detects prenatal drug use with 100% accuracy; a negative drug screening result is not a verdict of a drug free pregnancy (Behnke & Smith, 2013, e1011). Total screening of pregnant women is not cost-effective. Targeted screening of high-risk women is problematic because of numerous legal, ethical, individual, environmental, and social factors, such as nutritional status, neglect of abuse, socioeconomic conditions, etc. (Kronstadt, 1991, p.38).
Postnatal Evidence of Prenatal Drug Abuse Effect on Fetus
The common sign that is typical almost for all kinds of prenatal drug abuse influencing the fetus is low birth weight, small-sized heads at birth, and intrauterine growth retardation (Kronstadt, 1991, p.39). Congenital developmental malformations also may affirm prenatal drug exposure in the first and second trimesters. Some researches prove that CNS damages in prenatal polydrug-exposed children cause later developmental disorders. There is a great risk for the future developmental problems, such as mental retardation, seizure disorder, and even a cerebral palsy (Kronstadt, 1991, p.39). For prenatal polydrug-exposed infants, periods of sleeping, wakefulness, and crying are typical. They demonstrate irritability, feeding and sleeping problems, tremulousness, hyperactivity, increased or decreased muscle tone, etc. These children may show a prolonged persistence of early reflexes (Kronstadt, 1991, p.40).
Neonatal abstinent syndrome in infants of addict mothers includes a complex of physiologic and neurobehavioral symptoms such as sweating, irritability, feeding problems, increased muscle tone and activity, seizers, and diarrhea (Behnke & Smith, 2013, e1013). Such newborns with neonatal abstinent syndrome usually need prolonged hospitalization and special nurse and medical care. They even require some medications in order to decrease the level of intoxication, especially if this syndrome is caused by such heavy drugs as opiates.
Long-Term Effects of Prenatal Drug Exposure
According to the data of the Chicago’s Center for Perinatal Addiction at Northwestern Hospital, drug-exposed children are within the standard normal range of cognitive and motor skills development. However, 30% - 40% of these children demonstrate delayed language and speech development, distractibility, and lack of tolerance for frustration (Kronstadt, 1991, p.40). The most revealing long-term effects of prenatal drug exposure are behavioral and intellectual ones. Usually, behavioral outcomes appear to last from early childhood into adulthood in the form of disrupted school experiences, delinquency, criminal behavior, and substance abuse. Thus, a vicious circle emerges. These children, who have undergone prenatal drug exposure, usually show abnormalities in learning and memory, poor language and speech development, poor task organization, emotional problems, non-genetic intellectual disability, deficit math skills, low IQ, impaired cognition. Because of their learning disabilities, these children usually require an individualized educational plan (Behnke & Smith, 2013, e 1014).
Appropriate Nursing Actions
The risk of further developmental problems in prenatal polydrug-exposed children strongly depends on the child’s caregiving environment. It is necessary to create a service to decrease the negative influence of prenatal drug exposure. This service has to start from the early childhood intervention, even in the hospital just after birth. Two main directions have to be defined in the work of this service: the first one means profound professional work with parents or caregivers, including preventive measures and trainings before childbirth during pregnancy. This direction also has to include consulting sessions for future parents. The focus of these measurements is to form the idea of future parenthood and pay attention to the importance of personal maturity of the future parents. All women have to be informed about consequences of their drug addiction and all the possible deleterious effects of drugs on their fetus. Parent education has to start as quickly as possible after birth in order to reinforce appropriate caregiving, diminish compounding the problems, and facilitate the contact between the mother/caregiver and the baby (Kronstadt, 1991, p.45).
The next direction of the service work is a direct work with a child, starting from the time of birth. Nurses themselves and other caregivers have to help the infant to relax, protect it from noise, bright light, employ frequent warm bathing, and emphasize gentle handling and care in order to create a comfortable, harmless, and relaxing environment for the infant. Later on, these children need good professional support of psychologists in order not to repeat the experience of their parents (Kronstadt, 1991, p.46).
The problem of prenatal polydrug exposure is a very serious problem of today’s life. It has to be solved because of numerous serious consequences reflected in the national health and development in general. The important role of nurses in this work is undisputable due to their ability to provide quality professional primary and secondary interventions for the prevention of drug exposure and treatment of prenatal polydrug-exposed children.