Drug use during pregnancy has myriad implications for both mother and fetus, including the likelihood of developmental and behavioural changes for the newborn.
Encouraging women to use alternatives – such as methadone or buprenorphine instead of heroin – can negate or reduce some of the potential impacts, but not all.
Neonatal Abstinence Syndrome remains a significant risk (in fact methadone can actually increase the severity of NAS compared with heroin) and the use of opioids to control NAS can cause other problems by requiring new babies to spend a long time in hospital.
Dr Andrea Fielder hopes to help find a way through this complex web by determining whether the genetic makeup of either the mother or the child affects a baby’s response to drugs and predisposes it to acquiring NAS.
As we release this edition of Health Horizons, she is preparing to present the data collection and analysis from her current research to a meeting of the College on Problems of Drug Dependence in Puerto Rico.
“By finding an association between genetic variability and treatment requirement for NAS, genetic markers could be used as predictive tools to better manage NAS, reduce infant hospital stays and improve infant outcomes through more tailored NAS treatment and increased mother infant bonding,” she said.
Leader of member of our Mothers, Babies and Families Health research group, Dr Fielder is currently working at the University of North Carolina (UNC) as a Fulbright Fellow.
UNC is considered a leader in the research and treatment of issues related to drug dependence during pregnancy and has run an on-site, multi-disciplinary treatment centre – UNC Horizons – for more than 20 years.
It is the kind of facility that is common in the US and Europe but, according to Dr Fielder, sadly lacking in Australia.
“About 120 drug-exposed infants are born each year just in Adelaide alone, yet little research is conducted in Australia observing the health impact of illicit substance use during pregnancy,” she said.
“This has resulted in significant gaps, shortfalls in service delivery and standards of practice of care in Australia of pregnant substance using women and their exposed infants.”
Dr Fielder said experience in the US and Europe showed that treating pregnancy and substance abuse issues in the same setting not only provided for better responses because the full clinical picture could be incorporated into decision making, it also led to cost savings.
“Assistance and support services for all substance using women during pregnancy are pivotal for primary proactive prevention, and may reduce the demand for secondary reactive interventions,” she said.
Not all is plain sailing, however. Dr Fielder watched on with alarm from North Carolina as the neighbouring state of Tennessee recently became the first in the US to pass laws allowing prosecutors to charge women with criminal assault if their fetus or newborn is deemed to have been harmed by their use of illicit substances during pregnancy.
This decision was taken against the advice of doctors, addiction experts, reproductive health groups and even the White House Office of National Drug Control Policy.
“It is a punitive and dangerous move that flies in the face of current thinking,” Dr Fielder said. “Criminalising pregnant women will only discourage them from seeking prenatal care and substance abuse treatment, which will have long-term implications for their babies.”
For more information on the Sansom Institute research activities please visit our webpage.