Client should be assessed for any prescription or over the counter medications she is taking to determine if these would have any adverse effect on her pregnancy. If so, she should be advised accordingly. Teach the client not to take any medicines unless her physician directs her to do so. Questions should include any immunizations such as DT, Rubella, flu, etc., and dates these were administered, medications since last conception, allergies to drugs, foods, dust, lint, etc., home remedies, folk remedies The extent of specific interactions depends on such variables as age, weight, gender, dosage, body size and overall health. Caffeine and alcohol influence the intensity of food-drug interactions. Instruct the client to always ask the pharmacist about possible food-drug interactions when purchasing any medicine.
During the preconception visit, a drug history and risk assessment should be completed for all women and counseling should be provided to prevent drug use during pregnancy A toxicology screen should be done on those women where a risk is indicated (e.g. all women in high drug use areas and in high-risk populations, and women whose risk assessment indicated need for validation). Provide a referral to a drug treatment program for a thorough drug history, diagnosis, and drug treatment if indicated.
At first prenatal visit, the drug history should be completed for all women either as part of the initial protocol, or if the client had a preconception visit then the protocol should be updated. Again, consultation to prevent drug use during pregnancy should be provided. For all subsequent prenatal visits, the drug history and risk assessment should be updated for all women. If drug use is suspected, the previously discussed procedures for validation and referral should be completed. From some women if drug abuse is occurring and referral has already been made, drug testing and counseling in support of referral to drug treatment and compliance with drug treatment protocol should be carried out each visit.
During prenatal visits in the last trimester, continue to update the drug history and risk assessment for all women. If drug use is suspected, the previously discussed procedures for validation and referral should be completed. Counseling should include effects of drugs on prematurity, complications in labor and delivery, for the neonate, for breastfeeding, and care of the infant.
If the woman is abusing drugs, each visit could be the last before delivery. Update history, risk assessment, drug testing , compliance with drug referral and treatment, and counseling regarding effects of drug abuse in premature labor, or labor and delivery, the neonate and breastfeeding. Guidance regarding childbirth and infant care should be well in advance of that scheduled for healthy pregnant women. Counseling should include the effects of passive exposure to drugs in the home environment on the infant and young child.
Maternal drug abuse is a national problem requiring the coordinated efforts of all levels of government and the private sector. These efforts should focus on early identification of pregnancy among drug-abusing and drug-dependent women and the development of effective case management systems for these women and their children to ensure proper follow-up treatment. Three major points of entry in the health system exist for drug-abusing and drug-dependent pregnant women.
Drug programs in which the drug problem has been identified, but there is no knowledge of the pregnancy.
The health care system in which the pregnancy has been identified, but there is no knowledge of the drug abuse problem.
Screen and treat sexually transmitted diseases.
If the woman is pregnant and abusing drugs, the situation is more complex. Maternal withdrawal and detoxification from some drugs involves risk of fetal withdrawal, possibly resulting in death. Maternal withdrawal also constitutes fetal risk due to the possible effects of the mother's behavior on the well-being of the fetus. The drug-abusing woman rarely seeks or complies with prenatal care and drug treatment. Listed below are some commonly used drugs, with information about their effect(s) on the developing fetus.