Geburtshilfe. Schwangerenbetreuung bei Drogenkonsum

In Deutschland werden jährlich ca. 2000 Kinder drogenabhängiger Mütter geboren. Eine deutlich höhere Dunkelziffer bei drogenkonsumierenden Schwangeren ist zu befürchten. Durch Mischkonsum mit vielfältiger Auswirkung auf das Kind sowie psychosoziale und körperliche Besonderheiten der Schwangeren stellt die Betreuung dieser Schwangerschaften suchttherapeutisch und geburtshilflich eine Herausforderung dar. Die vorliegende Arbeit möchte Gynäkologen und Geburtshelfern sowie Neonatologen eine Hilfestellung für die komplexe peripartale Betreuung suchtkranker Frauen geben.

• Literatur

• 1 Fachverband Drogen und Rauschmittel e. V.. Positionspapier Drogen-Schwangerschaft-Kind.. 2009 Online: http://fdr-online.info/media/Texte/Positionspapier_D_S_K(1).pdf Stand: 10.03.2015
• 2 Die Drogenbeauftragte der Bundesregierung. Drogen- und Suchtbericht. 2012 Online: http://www.drogenbeauftragte.de/fileadmin/dateien-dba/Presse/Downloads/12-05-22_DrogensuchtBericht_2012.pdf Stand: 10.03.2015
• 3 Bell J, Harvey-Dodds L. Pregnancy and injecting drug use. BMJ 2008; 336: 1303-1305
• 4 Substance Abuse and Mental Health Services Administration. Results from the 2010 National Survey on Drug Use and Health: summary of national findings. NSDUH Series H-41, HHS Publication No. (SMA) 11-4658. Rockville, MD: SAHMSA; 2011. Online: http://www.oas.samhsa.gov/NSDUH/2k10NSDUH/2k10Results.pdf Stand: 10.03.2015
• 5 Lester BM, ElSohly M, Wright LL et al. The Maternal Lifestyle Study: drug use by meconium toxicology and maternal self-report. Pediatrics 2001; 107: 309-317
• 6 Sanaullah F, Gillian M, Lavin T. Screening of substance misuse during early pregnancy in Blyth: an anonymous unlinked study. J Obstet Gynaecol 2006; 26: 187-190
• 7 Calvin C, Moriarty H. A special type of ‘hard-to-reach’ patient: experiences of pregnant women on methadone. J Prim Health Care 2010; 2: 61-69
• 8 Bessa MA, Mitsuhiro SS, Chalem E et al. Underreporting of use of cocaine and marijuana during the third trimester of gestation among pregnant adolescents. Addict Behav 2010; 35: 266-269
• 9 Winklbaur B, Kopf N, Ebner N et al. Treating pregnant women dependent on opioids is not the same as treating pregnancy and opioid dependence: a knowledge synthesis for better treatment for women and neonates. Addiction 2008; 103: 1429-1440
• 10 NICE-Guidelines. Pregnancy and complex social factors. A model for service provision for pregnant women with complex social factors. National Institute for Health and Clinical Excellence. 2010 110. 49-73 Online: http://www.nice.org.uk/guidance/cg110 Stand: 10.03.2015
• 11 Opioid abuse, dependence and addiction in pregnancy. ACOG Committee Opinion Nr. 524, May 2012.. Online: https://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Health_Care_for_Underserved_Women/Opioid_Abuse_Dependence_and_Addiction_in_Pregnancy%231 Stand: 10.03.2015
• 12 Kästner R, Härtl K, Lieber A et al. Substitutionsbehandlung von opiatabhängigen Schwangeren – Analyse der Behandlungsverläufe an der 1. UFK München. Geburtsh Frauenheilk 2002; 62 (Suppl. 01) 32-36
• 13 Norman RE, Byambaa M, De R et al. The long-term health consequences of child physical abuse, emotional abuse, and neglect: a systematic review and meta-analysis. PLoS Med 2012; 9: e1001349
• 14 Velez ML, Montoya ID, Jansson LM et al. Exposure to violence among substance-dependent pregnant women and their children. J Subst Abuse Treat 2006; 30: 31-38
• 15 Cavanaugh CE, Latimer WW. Recent sex trade and injection drug use among pregnant opiate and cocaine dependent women in treatment: the significance of psychiatric comorbidity. Addict Disord Ther Treat 2010; 9: 32-40
• 16 Fenton MC, Keyes K, Geier T et al. Psychiatric comorbidity and the persistence of drug use disorders in the United States. Addiction 2012; 107: 599-609
• 17 Rementeriá JL, Nunag NN. Narcotic withdrawal in pregnancy: stillbirth incidence with a case report. Am J Obstet Gynecol 1973; 116: 1152-1156
• 18 Bart G. Maintenance medication for opiate addiction: the foundation of recovery. J Addict Dis 2012; 31: 207-225
• 19 Jones HE, Finnegan LP, Kaltenbach K. Methadone and buprenorphine for the management of opioid dependence in pregnancy. Drugs 2012; 72: 747-757
• 20 Jones HE, Kaltenbach K, Heil SH et al. Neonatal abstinence syndrome after methadone or buprenorphine exposure. N Engl J Med 2010; 363: 2320-2331
• 21 McCance-Katz EF. Drug interactions associated with methadone, buprenorphine, cocaine, and HIV medications: implications for pregnant women. Life Sci 2011; 88: 953-958
• 22 Schmitz S, Poehlke T, Siedentopf J-P et al. Therapieempfehlungen zur Anwendung von Buprenorphin/Naloxon in der Substitutionsbehandlung von Patienten mit Opioidabhängigkeit. ZGN 2013; 15: 190-201
• 23 Konijnenberg C, Melinder A. Prenatal exposure to methadone and buprenorphine: a review of the potential effects on cognitive development. Child Neuropsychol 2011; 17: 495-519
• 24 Lund IO, Fischer G, Welle-Strand GK et al. A Comparison of Buprenorphine + Naloxone to Buprenorphine and Methadone in the Treatment of Opioid Dependence during Pregnancy: Maternal and Neonatal Outcomes. Subst Abuse 2013; 7: 61-74
• 25 Newman RG, Gevertz SG. Comment on “a comparison of buprenorphine + naloxone to buprenorphine and methadone in the treatment of opioid dependence during pregnancy: maternal and neonatal outcomes”. Subst Abuse 2013; 7: 107-108
• 26 Jones HE, OʼGrady KE, Malfi D et al. Methadone maintenance vs. methadone taper during pregnancy: maternal and neonatal outcomes. Am J Addict 2008; 17: 372-386
• 27 Metz V, Köchl B, Fischer G. Should pregnant women with substance use disorders be managed differently?. Neuropsychiatry (London) 2012; 2: 29-41
• 28 Schmittner J, Schroeder JR, Epstein DH et al. Menstrual cycle length during methadone maintenance. Addiction 2005; 100: 829-836
• 29 Sharpe TT, Velasquez MM. Risk of alcohol-exposed pregnancies among low-income, illicit drug-using women. J Womens Health (Larchmt) 2008; 17: 1339-1344
• 30 Irner TB. Substance exposure in utero and developmental consequences in adolescence: a systematic review. Child Neuropsychol 2012; 18: 521-549
• 31 Mactier H. Neonatal and longer term management following substance misuse in pregnancy. Early Hum Dev 2013; 89: 887-892
• 32 Spiteri Cornish K, Hrabovsky M, Scott NW et al. The short- and long-term effects on the visual system of children following exposure to maternal substance misuse in pregnancy. Am J Ophthalmol 2013; 156: 190
• 33 Europäische Beobachtungsstelle für Drogen und Drogensucht. Drogenangebot in Europa. In: Europäische Beobachtungsstelle für Drogen und Drogensucht (EMCDDA), Hrsg. Europäischer Drogenbericht 2013: Trends und Entwicklungen. Luxemburg: Amt für Veröffentlichungen der Europäischen Union; 2013: 28-29
• 34 Hermanns-Clausen M, Kneisel S, Szabo B et al. Acute toxicity due to the confirmed consumption of synthetic cannabinoids: clinical and laboratory findings. Addiction 2013; 108: 534-544
• 35 de Castro A, Jones HE, Johnson RE et al. Methadone, cocaine, opiates, and metabolite disposition in umbilical cord and correlations to maternal methadone dose and neonatal outcomes. Ther Drug Monit 2011; 33: 443-452
• 36 Deutsche Hauptstelle für Suchtfragen e. V.. Du bist schwanger…und nimmst Drogen. Informationen und Hilfen für Drogen, Alkohol und Nikotin konsumierende Schwangere. Broschüre. 2012.
• 37 DGGG. Ultraschalldiagnostik im Rahmen der Schwangerenvorsorge. AWMF 015/044 (S1).
• 38 López M, Coll O. Chronic viral infections and invasive procedures: risk of vertical transmission and current recommendations. Fetal Diagn Ther 2010; 28: 1-8
• 39 Minkoff H, Zhong Y, Strickler HD et al. The relationship between cocaine use and human papillomavirus infections in HIV-seropositive and HIV-seronegative women. Infect Dis Obstet Gynecol 2008; 2008: 587082
• 40 Wissenschaftliches Kuratorium der Deutschen Hauptstelle für Suchtfragen e.V.. Drogenabhängigkeit. Band 4. Hamm: Deutsche Hauptstelle für Suchtfragen e. V.; 2006: 54-55
• 41 Pinto SM, Dodd S, Walkinshaw SA et al. Substance abuse during pregnancy: effect on pregnancy outcomes. Eur J Obstet Gynecol Reprod Biol 2010; 150: 137-141
• 42 DGGG. Standards in der Perinatalmedizin-Dopplersonografie in der Schwangerschaft. Geburtsh Frauenheilk 2003; 63: 21-25
• 43 Kaltenbach K, Holbrook AM, Coyle MG et al. Predicting treatment for neonatal abstinence syndrome in infants born to women maintained on opioid agonist medication. Addiction 2012; 107 (Suppl. 01) 45-52
• 44 Winklbaur B, Baewert A, Jagsch R et al. Association between prenatal tobacco exposure and outcome of neonates born to opioid-maintained mother. Implications for treatment. Eur Addict Res 2009; 15: 150-156
• 45 Heberlein A, Leggio L, Stichtenoth D et al. The treatment of alcohol and opioid dependence in pregnant women. Curr Opin Psychiatry 2012; 25: 559-564
• 46 Ghamar Chehreh ME, Tabatabaei SV, Khazanehdari S et al. Effect of cesarean section on the risk of perinatal transmission of hepatitis C virus from HCV-RNA+/HIV- mothers: a meta-analysis. Arch Gynecol Obstet 2011; 283: 255-260
• 47 Mehta V, Langford RM. Acute pain management for opioid dependent patients. Anästhesia 2006; 61: 269-276
• 48 Jones HE, OʼGrady K, Dahne J et al. Management of acute postpartum pain in patients maintained on methadone or buprenorphine during pregnancy. Am J Drug Alcohol Abuse 2009; 35: 151-156
• 49 Kork F, Kleinwächter R, Kaufner L et al. Kreißende mit Substanzkonsum-Bedeutung in der geburtshilflichen Anästhesie. Anästhesiol Intensivmed Notfallmed Schmerzther 2011; 46: 640-646
• 50 Höflich AS, Langer M, Jagsch R et al. Peripartum pain management in opioid dependent women. Eur J Pain 2012; 16: 574-584
• 51 Meyer M, Paranya G, Keefer Noris A et al. Intrapartum and postpartum analgesia for women maintained on buprenorphine during pregnancy. Eur J Pain 2010; 14: 939-943
• 52 Meyer M, Wagner K, Benvenuto A et al. Intrapartum and postpartum analgesia for women maintained on methadone during pregnancy. Obstet Gynecol 2007; 110: 261-266
• 53 Begg EJ, Malpas TJ, Hackett LP et al. Distribution of R- and S-methadone into human milk during multiple, medium to high oral dosing. Br J Clin Pharmacol 2001; 52: 681-685
• 54 Lindemalm S, Nydert P, Svensson JO et al. Transfer of buprenorphine into breast milk and calculation of infant drug dose. J Hum Lact 2009; 25: 199-205
• 55 Jones HE, Heil SH, Baewert A et al. Buprenorphine treatment of opioid-dependent pregnant women: a comprehensive review. Addiction 2012; 107 (Suppl. 01) 5-27
• 56 Kashiwagi M, Schäfer C, Kästner R et al. Opiatabhängigkeit und Stillen - Literaturübersicht und Empfehlungen. Geburtsh Frauenheilk 2005; 65: 938-941
• 57 Stillen und Rauchen. Aktualisierte Empfehlung der Nationalen Stillkommission.. 2006 Online: http://www.bfr.bund.de/cm/343/stillen_und_rauchen.pdf Stand: 10.03.2015
• 58 Laufs R, Polywka S. Risiko der Hepatitis-C-Übertragung durch Stillen. Dt Ärztebl 2000; 97: A2462-A2463
• 59 Hepatitis C und Stillen. Zweite ergänzende Empfehlungen der Nationale Stillkommission vom 30. Mai 2008.. Online: http://www.bfr.bund.de/cm/343/hepatitis_c_und_stillen_zweite_ergaenzung.pdf Stand: 10.03.2015
• 60 Cleary BJ, Donnelly J, Strawbridge J et al. Methadone dose and neonatal abstinence syndrome-systematic review and meta-analysis. Addiction 2010; 105: 2071-2084
• 61 Chisolm MS, Acquavita SP, Kaltenbach K et al. Cigarette smoking and neonatal outcomes in depressed and non-depressed opioid-dependent agonist-maintained pregnant patients. Addict Disord Their Treat 2011; 10: 180-187
• 62 Wachman EM, Hayes MJ, Brown MS et al. Association of OPRM1 and COMT single-nucleotide polymorphisms with hospital length of stay and treatment of neonatal abstinence syndrome. JAMA 2013; 309: 1821-1827
• 63 Keegan J, Parva M, Finnegan M et al. Addiction in pregnancy. J Addict Dis 2010; 29: 175-191
• 64 Ramsey SE, Bell KM, Engler-Field PA. HIV risk behavior among female substance abusers. J Addict Dis 2010; 29: 192-199
• 65 Heil SH, Jones HE, Arria A et al. Unintended pregnancy in opioid-abusing women. J Subst Abuse Treat 2011; 40: 199-202
• 66 Welle-Strand GK, Waal H, Bakstad B et al. Neonatal outcomes following in utero exposure to methadone or buprenorphine: a national cohort study of opioid-agonist treatment of pregnant women in Norway from 1996 to 2009. Drug Alcohol Depend 2013; 127: 200-206
• 67 Holbrook AM, Kaltenbach KA. Effectiveness of a smoking cessation intervention for methadone-maintained women: a comparison of pregnant and parenting women. Int J Pediatr 2011; 2011: 567056
• 68 Massey SH, Liebermann DZ, Reiss D et al. Association of clinical characteristics and cessation of tobacco, alcohol and illicit drug use during pregnancy. Am J Addict 2011; 20: 143-150
• 69 Delano K, Gareri J, Koren G. Rates of fetal polydrug exposures in methadone-maintained pregnancies from a high-risk population. PLoS One 2013; 8: e82647
• 70 McCarthy JJ. Intrauterine abstinence syndrome (IAS) during buprenorphine inductions and methadone tapers: can we assure the safety of the fetus?. J Matern Fetal Neonatal Med 2012; 25: 109-112
• 71 Anstice S, Strike CJ, Brands B. Supervised methadone consumption: client issues and stigma. Subst Use Misuse 2009; 44: 794-808
• 72 Morton J, Konrad SC. Introducing a caring/relational framework for building relationships with addicted mothers. J Obstet Gynecol Neonatal Nurs 2009; 38: 206-213