Alcohol and Marijuana During Pregnancy

Alcohol and Marijuana during Pregnancy

Introduction

Marijuana has been used for thousands of years for both medical and recreational purposes. Because the pharmacological actions of marijuana are complex and include a unique blend of effects of alcohol, opioids, tranquilisers and hallucinogens, the clinical picture could be very unpredictable and the diagnosis is often difficult.1 As a result, this form of chemical dependency may continue undetected in pregnancy, significantly affecting pregnancy outcome and peripartum obstetric and anaesthetic management of these patients. However, there appears to be an absence of uniform guidelines for obstetric and anaesthetic management of pregnant patients with a history of marijuana abuse. A Medline search for articles highlighting drug abuse in pregnancy, with particular emphasis on marijuana abuse in pregnancy, with associated obstetric and anaesthetic implications was performed. This article briefly reviews the anaesthetic implications of recreational marijuana use in pregnancy.

Definition and Diagnosis of Substance Abuse During Pregnancy

By definition, substance abuse is described as “self- administration of various drugs that deviates from socially or medically accepted use, which if prolonged can lead to the development of psychological and physical dependence”.2 This disease process, often referred to as chemical dependency, is characterised by periodic or continuous impaired control over drug(s) intake (despite awareness of adverse consequences), preoccupation with the drug(s) acquisition and distortions of mental capacity, most notably denial.1 Most often, chemical substance use or dependence is first suspected or diagnosed during medical management of another condition, such as hepatitis, human immunodeficiency virus syndrome or pregnancy. Psychological and personality characteristics seem to predispose an individual to, rather than result from, substance addiction. Regardless of the drug or drugs ingested and the clinical manifestations, it is always difficult to predict the anaesthetic implications in chemically- dependent patients. The prevalence of recreational drug abuse among young adults, including women, has increased markedly over the last 2 decades. Nearly 90% of these women are of childbearing age. Consequently, it is not uncommon to find pregnant women who abuse drugs and numerous reports of cases of drug abuse in pregnancy have been

published.

Anaesthesia providers become involved in the care of drug-abusing patients either in emergency situations, such as fetal distress, or in more controlled situations, such as request for labour analgesia. Substances most commonly used in pregnancy include ethanol, tobacco, caffeine, marijuana, cocaine, ampheta- mines and opioids. Poly-substance abuse is very com- mon.1,12 The majority of patients with a history of drug abuse or substance addiction deny it when interviewed preoperatively by anaesthesiologists.4,13 Therefore, a high index of suspicion for drug abuse in pregnancy, combined with non-judgemental questioning of every parturient, is necessary. Risk factors that suggest substance abuse in pregnancy include lack of prenatal care, history of prema- ture labour and cigarette smoking.14,15 In the United States (US), the American College of Obstetricians and Gynecologists (ACOG) has made multiple recommenda- tions regarding management of patients with drug abuse during pregnancy. Women who acknowledge use of an illicit substance during pregnancy should be counselled and offered the necessary ...