Table Of ContentDRUGS, ALCOHOL,
PREGNANCY
AND PARENTING
To Joel, Ari, and Gabriel
Children bring out the best in us all.
DRUGS, ALCOHOL,
PREGNANCY AND
PARENTING
Edited by
Ira J Chasnoff, MD
Associate Professor of Pediatrics and Psychiatry
and Behavioral Sciences
Northwestern University Medical School
Director, Perinatal Center for Chemical Dependence
Northwestern Memorial Hospital
Chicago, Illinois, USA
KLUWER ACADEMIC PUBLISHERS
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for all other countries: K1uwer Academic Publishers Group, Distribution Center, PO Box 322,
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British Library Cataloguing in Publication Data
Drugs, alcohol, pregnancy and parenting.
1. Man. Foetuses. Effects of alcohol
consumption of mothers 2. Man.
Foetuses. Effects of drug addiction
of mothers
1. Chasnoff, Ira J., 1947-
618.3'2
ISBN-13: 978-94-010-7685-2 e-ISBN-13: 978-94-009-2627-1
DOl: 10.1007/978-94-009-2627-1
Copyright
(01988 by Kluwer Academic Publishers
Softcover reprint ofthe hardcover I st edition 1988
Reprinted 1989
Reprinted 1991
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system,
or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or
otherwise, without prior permission from the publishers, K1uwer Academic Publishers BY,
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Published in the United Kingdom by K1uwer Academic Publishers, PO Box 55, Lancaster, UK.
K1uwer Academic Publishers BY incorporates the publishing programmes of D. Reidel,
Martinus Nijhoff, Dr W. Junk and MTP Press.
Contents
Foreword
Greetings from Mrs Nancy Reagan to participants in the
National Conference on Drug Use in Pregnancy Vll
List of Contributors ix
Introduction: The Interfaces of Perinatal Addiction
Ira J Chasnojf 1
1. Psychosocial Characteristics of Pregnant Women Addicts
in Treatment
Amin N Daghestani 7
2. Drug Abuse in Pregnancy
Louis G Keith, Scott N MacGregor and John J Sciarra 17
3. Nursing Interventions: A Treatment Model of Nursing Care for
Pregnant Chemical Abusers
Bonnie Michaels, Melinda Noonan, Sandy Hojfman
and Rita Allen Brennan 47
4. Drug Addiction and Pregnancy: The Newborn
Loretta P Finnegan 59
5. Marijuana and Cigarette Smoking During Pregnancy:
Neonatal Effects
Barry Zuckerman 73
6. Cocaine: The Drug of Choice
William T Atkins 91
7. Cocaine: Effects on Pregnancy and the Neonate
Ira J Chasnojf 97
v
DRUGS, ALCOHOL, PREGNANCY AND PARENTING
8. The Effects of Perinatal Cocaine Exposure on Infant Neurobehavior
and Early Maternal-Infant Interactions
Dan R Griffith 105
9. Motor Assessment and Parent Education Beyond the
Newborn Period
Jane W Schneider 115
10. FAS: Clinical Perspectives and Prevention
Lyn Weiner and Barbara A Morse 127
11. Breastfeeding by the Chemically Dependent Woman
Jeanne M Wilton 149
12. Parenting Dysfunction in Chemically Dependent Women
William J Bums and Kayreen A Bums 159
13. Viral Hepatitis in Pregnancy
Dietra Delaplane Millard 173
14. AIDS in Pregnancy and the Newborn
Ellen Gould Chadwick 191
Appendix: Suggested Protocol for Reporting and Management of
Suspect Drug/Alcohol-Related Child Abuse and Neglect 197
Index 201
Vl
THE WHITE HOUSE
September 8, 1987
Dear Friends:
Although I cannot be with you, this
brings my warm greetings to all those
participating in the National Conference
on Drug Use in Pregnancy. I am
delighted to serve as Honorary Chairman
of this very important conference.
Substance abuse has become a national
epidemic in our country and no where is
its impact more profound than on the
lives of innocent children born to women
who abuse alcohol and drugs. Through
the tireless dedication of individuals
such as those gathered here today, an
intensive cooperative effort has been
launched to educate women about the
potentially fatal effects of drug use
to unborn children.
You have my heartfelt thanks for your
loving dedication to this new
generation of Americans. With best
wishes for continued success,
Sincerely,
National Conference on Drug
Use in Pregnancy
List of Contributors
William T Atkins Ira J Chasnoff
Director, Illinois Department of Associate Professor of Pediatrics
Alcoholism and Substance Abuse and Psychiatry and Behavioral
100 W. Randolph Street Sciences
Chicago, Illinois 60601, USA Northwestern University Medical
School
Rita Allen Brennan Director, Perinatal Center for
Supervisor, Special Care Nursery Chemical Dependence
St. Joseph Hospital and Health Northwestern Memorial Hospital
Care Center 215 East Chicago Avenue
Chicago, Illinois 60614, USA Chicago, Illinois 60611, USA
Kayreen A Burns Amin N Daghestani
Assistant Professor of Psychiatry Associate Professor of Psychiatry
and Behavioral Sciences and Loyola University Stritch School of
Pediatrics Medicine
Northwestern University Medical 2160 South First Avenue
School Maywood, Illinois 60153, USA
Child Development Clinic
Prentice Women's Hospital Loretta P Finnegan
333 East Superior Street Professor of Pediatrics and
Chicago, Illinois 60611, USA Psychiatry and Human Behavior
Jefferson Medical College
William J Burns Thomas Jefferson University
Assistant Professor of Psychiatry Department of Pediatrics, Family
and Behavioral Sciences and Center Program
Pediatrics Philadelphia, Pennsylvania 19107,
Child Development Clinic USA
Prentice Women's Hospital
333 East Superior Street Dan R Griffith
Chicago, Illinois 60611, USA Perinatal Center for Chemical
Dependence
Ellen Gould Chadwick 215 East Chicago Avenue
Assistant Professor of Pediatrics Chicago, Illinois 60611, USA
Division ofInfectious Diseases
Children's Memorial Hospital
2300 Children's Plaza
Chicago, Illinois 60614, USA
ix
DRUGS, ALCOHOL, PREGNANCY AND PARENTING
Sandy HolTman Melinda Noonan
Outreach Education Coordinator, Perinatal Instructor
Women and Infants Health Prentice Women's Hospital
Prentice Women's Hospital 333 East Superior Street
333 East Superior Street Chicago, Illinois 60611, USA
Chicago, Illinois 60611, USA
Jane W Schneider
Louis G Keith Perinatal Center for Chemical
Professor of Obstetrics and Dependence
Gynecology 215 East Chicago Avenue
Northwestern University Medical Chicago, Illinois 60611, USA
School
Prentice Women's Hospital John J Sciarra
333 East Superior Street Professor and Chairman
Chicago, Illinois 60611, USA Department of Obstetrics and
Gynecology
Scott N MacGregor Northwestern University Medical
Department of Obstetrics and School
Gynecology 333 East Superior Street
Evanston Hospital Chicago, Illinois 60611, USA
2650 Ridge Avenue
Evanston, Illinois 60203, USA Lyn Weiner
Fetal Alcohol Education Program
Bonnie Michaels 7 Kent Street
Director, Perinatal and Gynecologic Brookline, Massachusetts 02146,
Nursing USA
Prentice Women's Hospital
333 East Superior Street Jeanne M Wilton
Chicago, Illinois 60611, USA Lactation Consultant
Prentice Women's Hospital
Dietra Delaplane Millard 333 East Superior Street
Assistant Professor of Pediatrics Chicago, Illinois 60611, USA
Division of Neonatalogy
Prentice Women's Hospital Barry Zuckerman
333 East Superior Street Associate Professor of Pediatrics
Chicago, Illinois 60611, USA Boston University School of
Medicine
Barbara A Morse Director, Division of
Fetal Alcohol Education Program Developmental and Behavioral
7 Kent Street Pediatrics
Brookline, Massachusetts 02146, Boston City Hospital
USA 818 Harrison Avenue
Boston, Massachusetts 02118, USA
x
Introduction
The Interfaces of Perinatal Addiction
Ira J ChasnofT
In the last few years, problems associated with drug use in pregnancy have
become endemic. As cocaine has become the drug of choice for millions of
Americans, including pregnant women, as AIDS has become more
commonly recognized in women and infants, and as legal cases have begun to
raise the question of fetal abuse, no professional group has come forward to
serve as advocate for this special population of substance abusers.
Meanwhile, however, physicians, nurses, social service agencies and public
health officials have all been faced with increasing numbers of infants
showing the detrimental effects of their mothers' drug use.
Although problems of substance abuse in pregnancy have received
increasing attention in the medical literature since the early 1970s, there has
recently been a very rapid increase in the number of articles published
related to this field. The reasons for this new interest are easily understood
when current statistics from the National Institute on Drug Abuse are
reviewed 1. Although patterns of abuse of alcohol, marijuana, heroin and
other substances by women of childbearing age have changed very little over
the last ten years, the incidence of cocaine use in this special population has
been rising rapidly, a reflection of cocaine's increasing popularity among the
general population of the United States.
Additionally, our concept of teratology has changed in that we now
recognize that, although most drugs of use and abuse do not produce
congenital malformations, there are definite behavioral and neurological
effects that place the neonate, infant and child at risk for developmental
abnormality.
PATTERNS OF DRUG USE
Early studies evaluating drug use by women during pregnancy revealed that
around 50-60% of women used some analgesic during pregnancy, and
sedative drug use by pregnant women ranged around 25%2. The majority of
the women involved in studies such as these were women who were receiving
prenatal care and were obtaining many of the medications by prescription
1
Description:The Interfaces of Perinatal Addiction Ira J ChasnofT In the last few years, problems associated with drug use in pregnancy have become endemic. As cocaine has become the drug of choice for millions of Americans, including pregnant women, as AIDS has become more commonly recognized in women and infan
