DRUG ABUSE RELATED HEALTH ISSUES AMONG PREGNANT WOMEN

Introduction

Drugs can be defined as chemical substances that affect the way and manner in which living things and organisms such as viruses, fungi, and bacteria function (Bloom & Thomas, 2023). They are generally used by people and for plants and animals for the sake of maintaining good health. Drugs are effective substances that are being used to either cure illnesses or maintain a healthy life (Adepeju & Osamaoye, 2022). They are used for therapeutic purposes which are quite beneficial for humans. However, drugs can also become malevolent to humans, animals, and plants when they are abused (Odo, 2009).

Drug abuse refers to the manipulative, excessive, and addictive use of drugs for non-medical reasons, not minding the physical, social, and psychological challenges that come with it. It also involves the process of using abused substances such as anabolic steroids, heroin, cocaine, alcohol, and cannabis, amongst others for unhealthy purposes that often result in chronic health challenges like liver damage, heart disease, kidney failure, and mental disorders (Britannica, 2023).

Drug and substance abuse is prevalent in the international community among men, women, and young people such that it has plagued society and caused the world population a great deal of mental disorders, among other physical, social, and physiological problems. It has caused many to lose their consciousness while others have been left to suffer hardship, addiction, and health (Fagbe, 2019). Ritchie & Roser (2018) reported a perceived increase in the prevalence of drug abuse globally. Furthermore, they reported that in 2017, drug users represented about 0.9% of the world’s population. While alcohol abuse accounted for about 3.3 Million deaths yearly, 31 million people suffered from drug abuse (Onoja, 2010). Additionally, according to the World Health Organization, more than 2.6 million people between the ages of 10-24 die annually from drug abuse (WHO, 2019).

Drug abuse in Nigeria has become a scourge, especially among women (old and young). This is evident in the United Nations Office on Drugs and Crime 2018 report which stated that in Nigeria, one in selected people aged between 15 and 64 years had used a drug (except tobacco and alcohol in the past year), and among every four drug users in Nigeria, one is a woman. The report also revealed that in Nigeria, Cannabis is used seven times more among men (18.8 percent) and 2.6 percent by women. Also, the report mentioned that the non-medical use of pharmaceutical Opioids such as tramadol, marked 6% among men, and 3.3% among women while the misuse of cough syrups marked 2.3% among men and 2.5% among women (UNODC, 2018).

While the argument among scholars on the prevalence of drug abuse among men and women specifically on which gender surpasses the other persists, the truth remains that both genders are discouragingly involved in drug abuse. However, what seems more unfortunate about the situation is that even pregnant women are involved. For instance, Olofintuyi (2019) revealed that substance abuse in the United States is more prevalent among pregnant women than the general population. Furthermore, he noted that more than 50% of pregnant women were current alcohol consumers, 20% used tobacco products, and about 13% used illicit drugs. Based on this background, this seminar seeks to critically explore drug abuse-related issues among pregnant women in Nigeria.

THE MOST COMMONLY ABUSED DRUGS DURING PREGNANCY

This section of the seminar will focus on commonly abused drug substances like stimulants e.g. Cocaine Methamphetamine, Marijuana; Opioids/Opiates: and Alcohol.

Stimulants: Cocaine and Methamphetamine. This is a class of drugs that comprises Cocaine, Methamphetamine, and Caffeine, among other prescription drugs. (Ologintuyi, 2019). In 2014, it was reported that about 1.6 million people in the United States use stimulants for non-medical use (Center for Behavioural Health Statistics and Quality, 2015). What these stimulants do to the body is to increase dopamine – a chemical in the brain that causes pleasure, attention, and movement levels in the brain (National Institute of Drug Abuse, 2014). However, it must not be forgotten that dopamine can be beneficial when consumed at low levels in line with professional guidance.

However, when it is consumed in excess, it causes increased heart rate, increased blood pressure, irregular heartbeat, and even seizures (SAMHSA, 2016). As a nervous system stimulant, Cocaine powder can be snorted or dissolved into water and injected while ‘crack’ cocaine can be smoked. On the other hand, Methamphetamine is also a stimulant manufactured in illegal laboratories using combinations of many household products and stimulants. When manufactured, it either takes the form of powder pills or glassy rocks. These can be consumed orally and through smoking and injection (SAMHSA, 2016). The chronic use of Cocaine or Methamphetamine causes loss of appetite, weight loss, anxiety, insomnia, confusion, and violent behavior (NIDA, 2013).

Opioids and Opiates: Opioids can be described as a class of drugs used for pain relief with effects that are similar to that of Opium (a narcotic substance derived from a specific poppy plant). In another event, Opiates are drugs from opium (NIDA, 2016). For instance, Heroin are drug made from the opioid morphine, which can be smoked, injected, swallowed, or sniffed by pregnant women. Heroin affects the brain and causes addiction and suppression of breathing (NIDA, 2014). Taking it in excess or overdoses reduces the amount of oxygen that reaches the brain and this could cause permanent brain damage or lead to coma.

Alcohol: This can be a very dangerous substance when abused and drank excessively. According to Olofintuyi (2019), about 2.6 million women who are put to bed each year use alcohol at some point during their pregnancy and about 1 million children annually are exposed to alcohol, tobacco, and other illicit drugs during gestation. Given such a risky situation, the National Health Service (2023) advises women who are pregnant or are planning to be pregnant are seriously not to drink alcohol because drinking during pregnancy can result in long-term harm to the baby. This is explained as follows:

“When a pregnant woman drinks alcohol, it passes from her blood through the placenta to the baby. Given the fact that the baby’s system cannot process alcohol, its development can be severely affected and this can lead to miscarriage, premature birth, and low birth weight”. NHS (2023) further revealed that drinking alcohol during pregnancy can cause the fetus to develop fetal alcohol spectrum disorder (FASD) which in turn results in speech problems, learning, and behavior problems, problems with emotional management and social skill development, joint muscles, and bones, and hyperactivity/impulse control.

Marijuana – Cannabis:  Marijuana was the most commonly used illicit drug in the year 2014. It is usually smoked or ingested and according to the Center for Behavioural Health Statistics and Quality (2015), 80% of all people who used at least one type of a drug for non-medical purposes between 2018 and 2019 used Marijuana. The usage rate in people has increased over time to 48.4% from 5.8-6.2% from 2002 to 2007. Also, women who use Marijuana during pregnancy tend to be younger or lower party than men and have higher rates of cigarette smoking, alcohol, caffeine, and illicit drug use during pregnancy than mothers who do not use Marijuana (Fergusson, Horwood & Northston, 2002). Other drugs that have the ability to cause health-related complications for pregnant women during pregnancy include the following:

Anti-anxiety drugs – Benzodiazepines (such as diazepam, alprazolam, or lorazepam). When consumed late during pregnancy, these drugs are likely to cause slow breathing, which in turn may result in shaking and exaggerated reflexes in the newborn (MSD, 2022).

Antibiotics – Aminoglycosides (such as amikacin, gentamicin, neomycin, streptomycin, and tobramycin). When abused, these drugs cause damage to the Fetus’s ear, thus resulting in deafness. There are other antibiotics like chloramphenicol (which causes a breakdown of the red blood cells and leads to the birth of a gray baby as well as Fluoroquinolones (such as ciprofloxacin, ofloxacin levofloxacin, and norfloxacin). When these drugs are abused, they cause bone and joint abnormalities. Furthermore, antibiotics like sulfasalazine and trimethoprim-sulfamethoxazole cause jaundice and brain damage to the baby when administered late in pregnancy.

Anticoagulants such as Rivaroxaban increase the risk of bleeding in the pregnant women or fetus; Heparin causes a decrease in the number of platelets which helps clot blood in pregnant women; and Warfarin causes intellectual disability, and cataracts, amongst other problems with the eyes in the fetus.

Antidepressants like Bupropion cause both defects in newborns; Citalopram causes heart defects, anxiety, dizziness, fatigue, nausea, chills, muscles, aches, and limited blood flow to the lungs and narrowed arteries and lungs; Escitalopram causes persistent pulmonary hypertension in the newborn while  Fluoxetine causes discontinuation syndrome.

Antifungal drugs like Fluconazole increase the risk of birth defects such as abnormalities in the heart, skull, face, ribs, and libs when taken overdose.

Antihistamines like Loratadine cause a birth defect of the pregnant woman’s urethra – a situation in which the opening of the urethra is in the wrong position on the hypospadias.

Antihypertensive drugs such as Angiotensin – Converting enzyme (ACE) inhibitors cause kidney damage in the fetus, a decrease in the amount of fluid around the developing fetus (amniotic fluid), and defects of the face, limbs, and lungs when taken late in pregnancy. Also, drugs such as Beta-blockers causes low blood sugar level, slowed heart rate, growth restriction in the fetus, and low blood pressure in pregnant women when taken during pregnancy. Furthermore, calcium channel blockers cause defects in the fingers and toes when taken during the first three months of pregnancy. Also, when they are taken later in pregnancy, they cause inadequate growth of the fetus.

Antipsychotic drugs such as Haloperidol cause an increased risk of repetitive involuntary movement of the baby, restlessness, irritability, shaking, and difficulty in breathing when taken during the third trimester of pregnancy. This is equally similar to what Lurasidone, Olanzapine, and Risperidone do to the body of pregnant women.

Antiseizure drugs such as Carbamazepine increase the risk of birth defects, including neural tube defects like spina bifida and bleeding problems in the newborn. Also, Levetiracetam causes minor bone abnormalities; phenytoin increases the risk of birth defects like cleft lip and heart problems; Trimethadione increases the risk of birth defects like cleft palate defects of the heart, skull, face, hands, and abdomen, as well as the risk of a miscarriage when abused.

Chemotherapy drugs such as Busulfan cause birth defects like underdevelopment of the lower jaw, and cleft palate as well as abnormal development of the skull bones, spinal defects, ear defects, club foot, and inadequate growth of the fetus. On the other hand, Doxorubicin increases the risk of heart problems, depending on the dosage that was consumed.

Mood-stabilizing drugs such as Lithium increase the risk of birth defects when abused. When Lithium is consumed later in pregnancy, it causes poor feeding, lethargy, underactivity of the thyroid gland, and nephrogenic diabetes insipidus in the newborn.

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as Aspirin cause miscarriage during the first trimester, a delay in the start of labor, premature closing of the connection between the aorta and artery to the lungs, damage to the lining of the intestine, and occasionally brain damage in the fetus and bleeding problem in the woman during and after delivery and/or in the newborn. In occasions where the drug is taken late in pregnancy, it causes a reduction in the amount of fluid around the developing fetus.

Skin treatment medicine such as isotretinoin increases the risk of birth defects like heart defects small ears, intellectual disability, and miscarriage when abused.

Sex Hormone drugs like Danazol cause masculinization of a female fetus’s genitals which sometimes require surgery for correction when taken very early in pregnancy.

Thyroid drugs such as Methimazole and Propylthiouracil increase the risk of an emerging thyroid gland in the fetus as well as liver damage in the pregnant woman when taken in excess. In another event, radioactive iodine and Triiodothyronine increase the high risk of destruction of the thyroid gland in the Fetus as well as an overactive thyroid gland in the fetus (Gunatilake & Patils, 2021).

MATERNAL HEALTH-RELATED ISSUES OF DRUGS ABUSED BY PREGNANT WOMEN

Rosenak et al., (1990) explained that although some studies have unveiled evidence of a greater prevalence of health issues in pregnant women who use certain substances, especially stimulants, these health issues may also be caused by other health factors that could be more prevalent in women who are more likely to use such drugs, rather than the drugs themselves. According to Singer et al., (2002), women who used cocaine during their pregnancies may be at slightly higher risk for Mood Disorder Postpartum (MDP) As a matter of fact, a study revealed that Maternal Psychological Distress Postpartum (MPDP) was 20% higher in women who used cocaine than in their non-using high-risk counterparts (Singer et al., 2002) while another credited the depressed mood of post-partum cocaine-using mothers to a lower level of circulating oxytocin (Light et al., 2004).

In another event, the maternal and fetal implications of Methamphetamine are like those of cocaine as both are in the same class of drugs and also affect the body in a similar way. However, it is important to note that 89% of women who use Methamphetamine also use other drugs concurrently, including legal drugs like alcohol and tobacco (Della Grotta et al., 2010). Furthermore, Amphetamine use can reduce breast milk supply (Anderson, 1991 and women who use it do not breastfeed because the concentration of Amphetamine is higher in breast milk than in plasma, and street drugs often include unknown substances that may cause harm to both mother and child (American College of Obstetricians and Gynecologists, 2011).

The consumption of Heroin causes addiction in pregnant women. When taken in overdose, in combination with other drugs, it reduces the amount of oxygen that reaches the brain thus causing hypoxia. Again, heroin use among pregnant women damages the brain’s white matter which may affect their decision-making abilities, the ability to coordinate behavior, and responses to stressful situations (Darke, 2013). Additionally, Heroin consumption causes miscarriage and infectious diseases like hepatitis and HIV (NIDA, 2014) in pregnant women. Chromic users of this substance stand the risk of developing infection of the heart lining and valves, collapsed veins, abscess, constipation and gastrointestinal cramping, and liver or kidney disease.

For pregnant women, the consumption of alcohol obstructs the brain’s communication pathway which in turn, affects the way the brain functions. Consequently, these disruptions can easily change these women’s moods and behavior and make it difficult to think clearly and move with coordination. A data presented by Pruett, Waterman & Caughey, (2013) show that prenatal clinics and post-natal studies suggest that 20-30% of women take alcohol during pregnancy. Similarly, the Centre for Disease and Control (CDC) released a report on women’s contraceptive use and drinking habits which was used to calculate how many women were at risk of exposing their fetuses to alcohol because they are drinking, sexually active, and not using birth control to prevent pregnancy (CDC, 2022). Based on this report, it was concluded that women may not be aware that drinking alcohol at any stage of pregnancy can result in a range of disabilities for their babies (CDC, 2022).

In regard to the consumption of Marijuana, it is reported that women who use Marijuana during pregnancy end up hurting themselves and their babies. According to the Substance Abuse and Mental Health Services Administration (2022), Marijuana is an illegal drug that is not safe for pregnant women as it poses a great danger to their health and life in general. When eaten in food, smoked or vaped as the case may be, Marijuana affects the brain and by extension, the developing fetus’s wellbeing. Comprising about five hundred chemicals, including Tetrahydrocannabino) (THC) – a mind–shifting compound, Marijuana passes through a pregnant woman’s placenta to her baby during pregnancy. And this results in a variety of health challenges, including loss of weight before birth (Fetal growth restriction), stillbirth, pre-term birth (being born prior to thirty-seven (37) weeks of gestation, long-term brain development issues affecting learning, memory, and behavior (SAMHSA, 2022).

MANAGEMENT AND TREATMENT OF DRUG ABUSE HEALTH RELATED ISSUES AMONG PREGNANT WOMEN

Wilson & Thorp (2023) recommends that abstinence remains the ultimate way to prevent, treat, and manage substance abuse during pregnancy. They noted that participating in pre-natal care alone can improve the outcome of the substance abuse during pregnancy and that ceasing to use of drugs use during pregnancy can further decrease pre-natal morbidity. However, it should be noted that most newborns exposed to drugs still have good outcomes, and early neonatal interventions can prevent or lessen neurodevelopmental problems (Miller & Hyatt, 1992).

The treatment of pregnant women who use and abuse drugs is somewhat difficult as it comes with several challenges like, poor social support systems, failure to identify substance abusers during pregnancy, and inadequate financial resources (stein & Cyr, 1997). In the United States for instance, there is a shortage of treatment programs organized for pregnant women. Evidentially, scholars such as Breibart conducted a study to assess the availability of substance abuse treatment programs for pregnant women in five United States cities. At the end of the study, he found that eighty percent of the program surveyed acknowledged that it is yet to be unraveled where proper arrangements is made in regard to the official treatment of pregnant women who are involved in drug abuse across different countries of the globe (Wilson & Thorp, 2023).

Nevertheless, it was concluded that a residential treatment program combined with regular outpatient follow-up remains the best way to prevent or decrease maternal drug use. Furthermore, other treatment options include self-help groups, formal counseling programmes, women’s shelters, and halfway houses. However involuntary treatment should be considered only when the drug abuser refuses to accept a treatment program, and when her behavior causes significant problems for herself and the fetus.

CONCLUSION

This seminar examined drug abuse-related health issues among pregnant women. Having described drugs as substances that affect the manner in which living things, including plants, animals, organisms, and bacteria operate, it also defined drug/substance abuse as the excessive, manipulative, and addictive usage of drugs mainly for non-medical reasons irrespective of the inherent dangers that come with such act.

The seminar x-rayed the unfortunate prevalence of drug abuse in the international system among young people and worse still, pregnant women. Condemning the unhealthy and illegal act among pregnant women, the seminar meticulously highlighted the dangers attached to drug abuse especially, the level of damage it does, not only to a pregnant woman, but also to the fetus. Furthermore, the study mentioned and explicitly discussed the most commonly abused drugs by pregnant women all over the world, categorizing them according to their different classes, functions, and implications as follows: Stimulants e.g. Cocaine and Methamphetamine, Opioids and opiates e.g. Heroin, Alcohol, Marijuana e.g Cannabis, Anti-anxiety drugs e.g Benzodiazepines and lorazepam, Antibiotics e.g Gentamicin, Streptomycin and Amikacsin, Anti-coagulants e.g Rivaroxaban, Antidepressants e.g Buproprican, among others.

The study also explored in details, the health-related challenges of drug abuse for pregnant women spanning from addiction to hypoxia, miscarriage birth defects, stillbirth, poor fetal growth, premature death (sudden infant death syndrome, behavioral challenges, among others. Additionally, the seminar discussed issues bordering on the management and treatment of drug abuse and health-related challenges among pregnant women. Citing that there is yet to be any country in the world that has come up with an official and well-organized health strategy and solution to treat pregnant women who are victims of drug abuse, the seminar revealed that abstinence remains the fundamental solution to drug abuse-related complications among pregnant women.

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Photo Credit: https://pharmacy.ufl.edu/2022/02/10/uf-study-finds-1-in-16-women-take-harmful-drugs-during-pregnancy/