ORIGINAL ARTICLE

 

Perception of pregnant on consumption of illicit drugs in pregnancy

 

Percepción de la embarazada sobre el consumo de drogas ilícitas en la gestación

 

 

Graciela Lima Costa Portela^I; Lívia Moreira Barros^II; Natasha Marques Frota^II; Anna Paula Pequeno Landim^III; Joselany Áfio Caetano^IV; Francisca Lucélia Ribeiro de Farias^V

^IRN
^IIMaster's student, Universidade Federal do Ceará, Fortaleza, CE, Brazil
^IIIUndegraduate student in Nursing, Universidade de Fortaleza, Fortaleza, CE, Brazil
^IVPhD, Adjunct Professor, Universidade Federal do Ceará, Fortaleza, CE, Brazil
^VPhD, Full Professor, Universidade de Fortaleza, Fortaleza, CE, Brazil

Correspondence

 

 

---

ABSTRACT

This study aimed to identify the effects of drug use in pregnancy and its consequences for the newborn. Qualitative study accomplished in a public maternity in Fortaleza. The subjects of the research were nine postpartum. Semi-structured interviews were performed. The main drugs used were marijuana, cocaine and crack. It was identified damage in all newborns, among which stand out: congenital syphilis, jaundice, low birth weight, prematurity, respiratory distress and neonatal infection. Despite the use of drugs is a matter considered a transversal theme, discussion and exchange of experiences among professionals are rare, hindering the identification of risk factors and the implications arising in health of women and child due to drug use during gestation.

Descriptors: Drug Users; Pregnancy; Infant, Newborn.

---

RESUMEN

Se objetivó identificar las repercusiones del uso de drogas en el embarazo y las consecuencias para el recién nacido. Estudio cualitativo, realizado en una maternidad pública de Fortaleza. Los sujetos de la investigación fueron nueve puérperas. Fueron realizadas entrevistas semi-estructuradas. Las principales drogas utilizadas fueron marihuana, cocaína y crack. Se identificó daños prejudiciales en todos los recién nacidos, entres quiénes se destaca: sífilis congénita, ictericia, bajo peso al nacer, precocidad, desaliento respiratorio e infección neonatal. A pesar del uso de drogas ser un asunto considerado un tema transversal, la discusión y el cambio de experiencias entre los profesionales son poco frecuente, dificultando la identificación de los factores de riesgo y de las implicaciones ocasionadas en la salud de la mujer y del niño debido al uso de drogas durante la gestación.

Descriptores: Consumidores de Drogas; Embarazo; Recién Nacido.

---

 

 

Introduction

Studies show an increase in the use of drugs such as marijuana, tranquilizers, amphetamines, cocaine and crack. According to data published in the World Drug Report 2007 of the United Nations (UN), in Brazil, there was an increase in cocaine use by 0.4% (in 2001) to 0.7% (in 2005), being considered an important fact as well as the increased use of marijuana. Marijuana was the illicit drug showed the greatest increase in use in recent years, and its usage percentage increased from 1% in 2001 to 2.6% in 2005. The UN believes that this increase is a reflection of the ease of obtaining the drug in the country^(1-4).

Thus, illegal drugs use constitutes a major problem of public health in society, and when the risk group is pregnants this issue gains a greater impact because the exposure of these women to psychoactive substances can lead to irreversible impairment of the integrity of the mother and fetus⁽⁵⁾.

A national survey on drug use in the U.S. provides a tendency to alcohol, tobacco and illicit drugs use during pregnancy. In 1998, the use of illicit drugs was 3.1% in 1999, 4% in 2000-2001, 3.7% in 2002-2003, 4.3% in the period of 2004-2005 and 3.9% in 2006 -2007 in pregnant women^(6-7).

Some complications that the fetus may present due to exposure to drug use by the mother during pregnancy: prematurity, low birth weight, decreased head circumference, placental shift leading in some cases to abortion⁽⁸⁾.

Substances such as amphetamines, cocaine and nicotine can be transferred together with carriers of nutrients favoring the favorable competition, which reduces the delivery of nutrients to the fetus and contributes to the growth deficit⁽⁸⁾.

The screening during the prenatal consultation is the best strategy to identify drug users as well as the risk factors for consumption by pregnant women, such as: low self-esteem, financial problems, anxiety and affective problems in relationships, particularly with partner⁽⁸⁾.

Thus, early detection of risk factors related to drug use by pregnant women combined with the participation of qualified professionals enable correct targeting of measures needed to improve the quality of pregnancy for both the mother and the fetus, which may contribute to the reduction of obstetric complications ⁽⁹⁾.

Given the situational analysis of the harmful risks to both mother and child, the question arises: What impact the illicit drug use during pregnancy for the mother and for the child? Therefore, the objective of this research was to identify the effects of drug use in pregnancy and its consequences for the newborn.

An understanding of illicit drug use during pregnancy is important to approach this problem effectively since it can contribute to a critical reflection among nurses who work directly with these pregnant women through health promotion activities that are often neglected.

 

Methods

This is a descriptive study of qualitative nature performed in a public maternity of a teaching hospital located in Fortaleza, Ceará, Brazil.

Data collection occurred from April to May 2010 and the investigative process was done through semi-structured interviews with nine women who have recently given birth. Each participant was asked by verbal approach, preserving the identity which was replaced by the name of flowers.

For the selection of participants in the survey the following criteria were used: puerperal women drug users admitted to this institution and those whose children had any complications due to drug use during pregnancy, being excluded those who had no physical and emotional conditions.

The number of subjects was conditioned to the criterion of data saturation, which occurs when the information becomes repetitive or adding new data is minimal to submit to the examination procedures⁽¹⁰⁾.

The interview instrument contained socio-demographic data, drug abuse during pregnancy, adherence to prenatal, feeling of the puerperal about the newborn, knowledge of drugs use in pregnancy and health-disease situation, as well as active search in puerperal and newborn records.

For analysis of the information that emerged from the interviews was used the content analysis, in thematic modality, defined as a technique consisting of determining approximate and subjective content descriptions to highlight the objectivity, the nature and relative strengths of the stimuli to which the subject is submitted⁽¹¹⁾.

For this analysis occurs in a systematic way, three distinct phases are proposed. The first, called Pre-Analysis, aims at organizing the initial ideas leading to "development of indicators that substantiate the final interpretation", in the second phase, Exploration of the Material, the decomposition of the material collected and grouping in meaning units are performed using a specific encoding, in the third phase, called Treatment of the Results, there must be a description and subsequent interpretation of the categories presented⁽¹¹⁾.

Thus, in the first stage was held the floating reading in order to allow to establish contact with the subject's responses and know the text to verify the first impressions, which are only consolidate the last step.

In the phase of organizing and material exploration the coding of the interviews was performed, identifying the mothers for names of flowers. At this time, after several readings, words, phrases or paragraphs that presented consistent with the objectives of the study and would enable outlining the first grouped ideas were removed from the text.

In the last stage, the reunification of the meaning units, after several readings and re-readings, allowed evidence the final categories: low adherence to prenatal, puerperal attitude about motherhood, gaps in knowledge of the mothers about the effect of drug use during pregnancy and situation of health and illness of postpartum women.

This study was conducted before spontaneous signing the Statement of Consent by the puerperals, respecting the principles of Resolution 196/96 in relation to research with humans ⁽¹²⁾, after being approved by the Ethics Committee in Research of Motherhood under protocol nº 021/10.

 

Results

Nine puerperals were interviewed. The age range was between 15-28 years, with a mean age of 20.6 years. Six of the interviewees were primiparous and three multiparous. Regarding educational level, only two had completed elementary school, and seven had not completed elementary school. As for labor activity one was seamstress, one an ex-sex worker, one was homeless and the other six participants did not perform any work.

The main consequences of drug use for the NB were: jaundice, prematurity, neonatal infection, low birth weight, respiratory distress and congenital syphilis.

Six of the participants underwent serology for syphilis and two had missing information. All puerperals who underwent the VDRL had positive result and four transmitted syphilis to their unborn children.

Risk factors related to drug use during pregnancy most cited by respondents were: family problems, lack of partner, financial instability, low self-esteem and loneliness.

Through the description and documentation of the speech of puerperals were identified the following categories:

Low adherence to prenatal

The goal of prenatal care is to investigate the state of health of the mother and fetus to avoid unfavorable outcomes, however, for this to occur it is important that the pre-natal is premature and frequent beginning, but the results of the study showed that seven puerperals did not undergo prenatal and who have demonstrated a low number of consultation.

Health professionals must awaken their attention to problems like these and to the need for wider dissemination of the objectives and purposes of the program, and nursing has an important role within the program of prenatal, pointing towards the need to track illegal drug users in the beginning of gestation.

"I did not go because I was using drugs in the middle of the world" (Lily)

"... I just wanted to know if I was pregnant!" (Rose)

'' ... I told my mother that I was going to do the pre-natal and I went to use drugs "(Daisy)

"It's too bad. I stopped doing the prenatal to get high. I stopped taking care of her ... of her health. That impair too much."(Jasmine)

Rose and Daisy appeared only in one consultation at the basic care unit and when questioned what reasons led them to start the accompaniment of prenatal they responded that they only wanted to know if they were pregnant and it was a reason to be absent from home and use drugs. They recognize the harm to the health of the newborn, however they do not give importance to the fact.

This situation is worrying because even knowing the health risks due to the use of illicit drugs, the puerperals continue making use of drugs and leave aside the monitoring of prenatal. Facing this reality becomes relevant the awareness of these women and planning procedures and appropriate actions to identify risk groups and propose effective interventions to prevent these problems.

Puerperal´s attitude relative to motherhood

Family relationships are harmed due to drug abuse. This can be seen in the statements of puerperals Violet and Sunflower, which were experiencing the fifth and third pregnancy, respectively, and donated their children for not being able to assume the role of mother:

I gave my children! I do not remember where I left them ... (Violet)

I gave my children! I have no regrets about that! (Sunflower)

I started using drugs during pregnancy. I am crazy. I was having trouble with my husband and I ended up thinking that it was the solution. (Rose)

The pregnancy-puerperal period is the fase of highest incidence of mental disorders in women, who need special attention to maintain or regain wellness and to prevent difficulties for child care⁽¹³⁾.

The absence of a good family structure and an unstable relationship with the partner leads the pregnant woman to a desperate situation to the point of them donate their children. This instability, associated with drug use, shows how these women are susceptible and unprepared to take on the responsibility of motherhood.

Therefore, in addition to prenatal, the family planning should receive special attention in health units, since its control will reverberate in a possible decrease in cases of pregnancy, especially precocious pregnancy.

Gaps in knowledge of the puerperals about the effect of drug use during pregnancy

Besides the lack of preparation in relation to precocious pregnancy, there is still a lack of knowledge of the puerperals about the use of drugs and their effects during pregnancy and the consequences for the newborn, as evidenced in the statements below:

I thought it was not related, it would not harm the baby. (Orchid)

I used the whole pregnancy. Every day ... I knew it was wrong, but the addiction was too big. If I had not used, I would be at home with her. (Lily)

I did not know ... In fact, I even knew, but whatever ... (Jasmine)

From the reports it was found that the pregnant women had difficulty in stay abstinent and that the main drugs used were marijuana, cocaine and crack, and the use time more than one year in all cases.

In the case of these pregnant women drug users, professionals have greater difficulty in identifying them because information about their consumption and frequency are often not noticed in time to decrease the effects on the fetus⁽¹⁴⁾.

I've used everything! (Sunflower)

I use crack ... (Tulip)

I only used cocaine ... (Jasmine)

I used crack. Also smoked and drank beer ... (Lily)

'... I wanted to stop using cocaine and marijuana, but I could not. (Daisy)

I could get 3 days to a week without using ... (Lily)

At any time I stopped using. I started using to forget and then I saw I was pretty much addicted. I could not spend a night without using. (Jasmine)

According to the seized, the pregnant women do not correlate drug use with pregnancy, not stopping using them. It is noticed the lack of knowledge regarding their own health and the baby.

Health and disease situation of puerperals

It was found the lack of knowledge about the situation of health and disease and its modes of transmission:

... this disease that I have kills? (Tulip)

... the other doctor said I got this disease in sex (Tulip)

... I have already received discharge (Hydrangea)

During the interviews was verify that six puerperal women had syphilis that was not tracked during the prenatal and consequently transmitted to the fetus during pregnancy.

The analysis of the interviews carried allows say, once again, that the knowledge revealed by them is still quite restricted, especially with regard to prevention of diseases, pregnancy and relationship with drug use.

The perceptions of them did not change in the duration of pregnancy, fact that can be emphasized due to emotional and rational unpreparedness during a pregnancy.

 

Discussion

The use of drugs remains a major public health problem, reflecting the frightful way in the society in which we live. In pregnant women, this problem becomes more important as the exposure of these patients to drugs can lead to irreversible impairment of the integrity of both mother and fetus⁽⁵⁾.

According to the World Health Organization (WHO), programs for women's health should emphasize screening of pregnant women in areas where drug use is frequent to prevent and early detect this risk group. It is pertinent also to raise awareness of health managers about the need for continuing education for professionals, as well as further studies to identify the main risk groups for interventions to be implemented effectively.

In a study on drug use during pregnancy it is associated with factors such as: personal relationships, individual characteristics, environment, absence of stable partner, lower education, drug abuse by the father of the fetus and history of violence before and during the gestation⁽¹⁵⁾.

The importance of prenatal should be strengthened for these pregnant women, because the proper monitoring allows identification of risk situations early, preventing negative outcomes in pregnancy, in the neonatal period and the occurrence of deaths⁽¹⁶⁾.

The frequency and regularity in accompaniment of prenatal allow the development of the bond between the mother and the health care professional, which allows deepening the relationship with increased information exchange, facilitating the identification of lifestyle habits harmful to health, such as the inappropriate use of alcohol and drugs⁽¹⁷⁾.

Therefore, it is necessary to offer a integral care to women´s health during pregnancy that addresses their psychosocial needs, examining the situation in which it is embedded, destructive behaviors, their life stories and engaging in the care of pregnant women in situations of poverty, violent relationships and self-destructive behaviors such as drug use.

Another fundamental point in health care for pregnant women is the focus of parental responsibility. It is necessary that men feel responsible for the health and welfare of fetal providing change in behaviors that put their posterity at risk⁽¹⁸⁾.

The addiction tends to affect the family as a whole. The children of drug users are at increased risk for the development of future chemical dependency, mental disorders and emotional problems such as low self-esteem, social phobia, depression, anxiety and relationship difficulties⁽¹⁹⁾.

The complications present in the study were: congenital syphilis, jaundice, low birth weight, prematurity, respiratory distress and neonatal infection. These data echo the concatenation of non-adherence to prenatal, the lack of knowledge of pregnant women and the desire to stop using drugs.

Congenital syphilis was the most prevalent occurrence in the study, affecting seven newborns and is caused by hematogenous spread, via placenta, of Treponema pallidum of untreated or inadequately treated pregnant women for their unborn children. The transmission may occur at any stage of gestation and at any stage of the disease⁽²⁰⁾.

Jaundice, present in four NBs is one of the most common problems in the neonatal period. Corresponds to an increase of bilirubin in the blood and is generally benign. However, due to potential toxicity of bilirubin, the NB in risk should be monitored to prevent the development of significant hyperbilirubinemia and bilirubin encephalopathy⁽²¹⁾.

The low birth weight and prematurity are major risk factors for fetal and neonatal mortality. The effect of low birth weight affects the child growth and development during the first year of life, being also relevant for infant mortality⁽¹⁶⁾.

Respiratory distress was present in three NBs. The main risk factor for respiratory distress is prematurity, other factors are: cesarean section, male gender, diabetic women, chorioamnionitis and twin pregnancy⁽¹¹⁾.

The neonatal infection affected three NBs of the study, which determines the intensive care by multidisciplinary team to be a severe disease difficult to diagnose and can be congenital, acquired during birth or in the postnatal life⁽²²⁾.

In front of this reality is necessary to use quality care to this population through the holistic model where each patient is treated as a biopsychosocial and spiritual subject, occurring a accompaniment directed to all their needs⁽²³⁾.

Therefore, it is necessary to the preparation of professionals, especially nurses, on the phenomenon of drugs in pregnancy and its importance for a better deal with the problem, for the occurrence of health promotion of these patients from prevention measures to the use and abuse of illicit drugs

 

Final considerations

The results analysis found in this study led to the identification of a young population with low education. Most pregnant women was teenagers, a fact that indicates the urgency of planning effective actions for health promotion of this risk group. It was observed the importance of considering the lifestyle habits of pregnant women during the interview, because the collection of this information enables the knowledge of their everyday, facilitating the choice of the most effective strategies for the provision of care in assistance, aiming to provide a higher quality of life for both mother and child.

It was also found that the use of drugs during pregnancy is as a public health problem, because it was identified several harmful damage to the health of all newborns, including: congenital malformations, respiratory distress, neonatal infection, low birth weight, jaundice, acute pulmonary edema, congenital syphilis and fetal distress. It is noteworthy that the longer the period of fetal exposure to substances, the greater were the deleterious consequences.

Although drug use is an issue considered a crosscutting theme which should be addressed during all consultations in health services, discussion and exchange of experiences among professionals is infrequent, which complicates the identification of risk factors and implications arising in the health of women and child due to drug use during pregnancy.

It is believed that the results found will make available fundamental information to assist pregnant women who use drugs. It is expected that health professionals can discuss this topic and so identify and intervene in this situation. From this study, it is suggested that more research be conducted in this theme to contribute to scientific knowledge of the professionals who work directly and indirectly with this population.

 

References

1. Murphy JG, Devitt-Murphy ME. Barnett - Drink and be merry? Gender, life satisfaction, and alcohol consumption among college students. Psychol Addictive Behav. 2005 Jun;19(2):184-91.         [ Links ]

2. Stempliuk VA, Barroso LP, Andrade AG, Nicastri S, Malbergier A. Comparative study of drug use among undergraduate students at the University of São Paulo – São Paulo campus in 1996 and 2001. Rev Bras Psiquiatria. 2005 Dec;27(3):185-93.         [ Links ]

3. Boland M, Fitzpatrick P, Scallan E, Daly L, Herity B, Horgan J, et al. Trends in medical student use of tobacco, alcohol and drugs in an Irish university, 1973-2002. Drug Alcohol Depend. 2006 Apr;85:123-8.         [ Links ]

4. Lucas ACS, Parente RCP, Picanço NS, Conceição DA, Costa KRC, Magalhães IRS, et al. Uso de psicotrópicos entre universitários da área da saúde da Universidade Federal do Amazonas, Brasil. Cad Saúde Pública. 2006 Mar;22(3):663-71.         [ Links ]

5. Yamaguchi ET, Cardoso MMSC, Torres MLA, Andrade AG. Drogas de abuso e gravidez. Rev Psiquiatr Clín. 2008;35(1):44-7.         [ Links ]

6. Office of Applied Studies. Pregnancy and illicit drug use. Rockville: Department of Health and Human Services; 2001.         [ Links ]

7. Substance Abuse and Mental Health Services Administration. Results from the 2007 National Survey on Drug Use and Health: national findings. (NSDUH Series H-34, DHHS Publication No. SMA 08-4343). Rockville: Department of Health and Human Services; 2008.         [ Links ]

8. Pinheiro SN, Laprega MR, Furtado EF. Morbidade psiquiátrica e uso de álcool em gestantes usuárias do Sistema Único de Saúde. Rev Saúde Pública. mar 2005;39(4):593-8.         [ Links ]

9. Polit DF, Beck CT, Hungler BP. Fundamentos de pesquisa em enfermagem. 5ª ed. São Paulo (SP): Artmed; 2004. 38 p.         [ Links ]

10. Bardin L. Analise de conteúdo. Lisboa: Edições Setenta; 2004. 67 p.         [ Links ]

11. Ministério da Saúde (BR). Conselho Nacional de Saúde. Diretrizes e Normas Regulamentadoras de Pesquisa Envolvendo Seres Humanos. Resolução 196, de 1996. Brasília; 1996.         [ Links ]

12. Camacho RS, Cantinelli FS, Ribeiro CS, Cantilino A, Gonsales BK, Braguittoni E, et al. Transtornos psiquiátricos na gestação e no puerpério: classificação, diagnóstico e tratamento. Rev Psiquiatr Clín. mai 2006;33(2):92-102.         [ Links ]

13. Silva EA, Camargo BMV, Pavin T, Noto AR, Buscatti D, Sartori V, et al. As drogas no âmbito familiar, sob a perspectiva do cinema. Psicol Teoria Prática. jun 2008;10(1):214-22.         [ Links ]

14. Casatti, GFS. Projeto de intervenção social com gestante e/ou puérperas, usuárias de drogas ilícitas e/ou lícitas. Ensaios Ciênc. ago 2011;15(1):97-120.         [ Links ]

15. Oliveira EFB, Gama SGN, Silva CMFP. Gravidez na adolescência e outros fatores de risco para mortalidade fetal e infantil no Município do Rio de Janeiro, Brasil. Cad Saúde Pública. mar 2010;26(3):567-78.         [ Links ]

16. Moraes CL, Reichenheim ME. Rastreamento de uso de álcool por gestantes de serviços públicos de saúde do Rio de Janeiro. Rev Saúde Pública. mai 2007;41(5):695-703.         [ Links ]

17. Rodrigues DT, Nakano AMS. Violência doméstica e abuso de drogas na gestação. Rev Bras Enferm jan-fev. 2007;60(1):77-80.         [ Links ]

18. Figlie N, Fontes A, Moraes E, Paya R. Filhos de dependentes químicos com fatores de risco biopsicossociais: necessitam de um olhar especial? Rev Psiquiatr Clín. fev 2004;31(2):53-62.         [ Links ]

19. Secretaria do Estado da Saúde de São Paulo (BR). Centro de Referência e Treinamento em DST/AIDS-São Paulo, Programa Estadual de DST/AIDS. Eliminação da transmissão vertical do HIV e da sífilis no Estado de São Paulo. Rev Saúde Pública. dez 2011;45(4):812-5.         [ Links ]

20. Newman TB, Liljestrand P, Escobar GJ. Combining clinical risk factors with serum bilirubin levels to predict hyperbilirubinemia in newborns. Arch Pediatr Adolesc Med 2005 Feb;(159):113-9.         [ Links ]

21. Silva TP, Tocci HA. Efeitos obstétricos, fetais e neonatais relacionados ao uso de drogas, álcool e tabaco durante a gestação. Rev Enferm UNISA. jan 2002;(3):50-6.         [ Links ]

22. Costa TS, Vasconcelos TC, Sousa LB, Bezerra CP, Miranda FAN, Alves SGS. Percepções de adolescentes grávidas acerca do consumo de álcool durante o período gestacional. SMAD, Rev Eletr Saúde Mental Álcool Drogas.(ed. Port). [Internet]; abr-jul 2010; [acesso 13 jan 2011]. 6(1):1-15. Disponível em: http://pepsic.bvsalud.org/pdf/smad/v6n1/03.pdf        [ Links ]

 

 

Correspondence
Natasha Marques Frota
Rua Coronel Jucá, 291, Apto. 103
Bairro: Meireles
CEP: 60170-320, Fortaleza, CE, Brasil
E-mail: natashafrota_@hotmail.com

Received: Dec. 21^st 2011
Accepted: Feb. 21^st 2013