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Quitting smoking can be challenging. Though quitting without replacements or medications is ideal, replacement with gum, lozenges, or a nicotine patch is still helpful and effective. "Even though it's exposing a fetus to nicotine, it's still safer in terms of harm reduction, in terms of all the other chemicals we see in tobacco smoke," said Dr. Weaver. "The same goes for electronic cigarettes – it's still exposure to nicotine, and there are other chemicals in the electronic cigarettes. It's not a safe exposure during pregnancy." Cannabis, whether smoked or ingested through tinctures or edibles, can cause abnormal startle reflex in newborns, leading to hyperactivity. As they get older, reduced memory and verbal skills can begin to show around age four. Though opioids don't cause the same fetal anomalies that alcohol and smoking do, continuous exposure can cause NAS. If a woman recognizes dependence and stops use prior to delivery, she may not develop opioid withdrawal symptoms and can prevent NAS in her newborn. Stimulants, such as cocaine, crack, ecstasy, and bath salts, have high rate of fetal complications including spontaneous abortion, fetal defects, low birth weight, and placental abruption, which can be catastrophic if it occurs before delivery. A since-disproven theory named "Crack Baby Syndrome" attempted to link children with learning disabilities to increased likelihood of drug use. However, their home environments often accounted for many of the same features as exposure to cocaine during pregnancy. The environments were not syndromes, but contributed to a higher risk of substance use later in life, though these factors can be addressed. "If we can provide appropriate treatment for mom, that can help assist the future achievements of the child," said Dr. Weaver. Screening for Substance Use According to Dr. Weaver, all pregnant people should be screened for substance use at their first prenatal visit. "The purpose of screening is to allow for treatment of SUD, not to punish or prosecute," he said. "The purpose is not to be punitive or get child protective services or the justice system involved initially, unless there is another cause for concern related to that." recovery. HRSA is currently funding a new cycle of RCORP which will award $1 million over three years. Recipients will be announced later this fiscal year. HRSA will also add a new RCORP branch to address psychostimulants, expanding the opioid crisis to include the meth crisis as well. RCORP-NAS: Addressing Substance Use in Rural Pregnancie As defined by the CDC, the leading causes of pregnancy- associated deaths are homicide, suicide, and drug overdose. "When a new mother has delivered, you see a decrease in risk for fatal and nonfatal overdoses immediately after birth," Dr. Rousseau said. "But you see that spike again 7-12 months after birth." In rural areas, the rate of SUD-related deliveries was higher for patients from rural than from urban areas (37.7 vs 22.5 per 1,000 stays). "There is a lot of need in rural communities, and there are some very special contributing factors that need to be addressed to improve these rates," said Dr. Rousseau. Contributing factors to overdoses include having a newborn with a diagnosis of Neonatal Abstinence Syndrome (NAS), insurance loss, or termination of pregnancy-related SUD treatment after delivery, among others. To address the impact of NAS on pregnant and childbearing-able women, RCORP introduced RCORP-NAS. The program will award up to $500,000 via 30 awards over a three-year period. The goal of the program is to reduce the incidence and impact of NAS in rural communities by improving systems of care, family supports, and social determinants of health. The target population includes individuals who are pregnant or likely to become pregnant, those at risk of SUD and OUD, and their children, family, and caregivers. "SUD and OUD do not operate in isolation," said Dr. Rousseau. "We know that family ecosystems can contribute to SUD and OUD, so we really want to make sure to include children, family, and caregivers." The program also treats those in recovery or currently struggling with SUD and OUD. Award recipients work on two strategies each for prevention, treatment, and recovery strategies. Grantees choose their efforts to focus in one or two areas of the following: criminal justice, family support services, integrated care and care coordination, provider workforce, recovery capital, transportation, and telehealth. Effects of Substance Use During Pregnancy Dr. Weaver sees patients in the Innovations Addiction Treatment Clinic at the Texas Medical Center in Houston, observing the effects of various substances during and after pregnancy. Exposure to alcohol during pregnancy can cause Fetal Alcohol Syndrome (FAS) leading to heart and facial defects and developmental delays. FAS is the leading preventable cause of developmental delay. Because the amount of alcohol or duration of drinking needed to cause FAS is unknown, abstinence is encouraged as soon as pregnancy is suspected. "The safest amount of alcohol during pregnancy is none," said Dr. Weaver. "Because we don't know exactly when is the most critical time, we consider all of pregnancy to be critical in terms of exposure to alcohol causing FAS or FA effects (symptoms)." Smoking tobacco is the most common form of fetal exposure, leading to intrauterine growth complications that cause low birth weight and other problems before and during delivery. Other challenges include higher rates of spontaneous abortion, placenta previa, and increased risk of sudden infant death syndrome (SIDS). The risk of SIDS is four times greater in smoking households than in non- smoking households, and this risk continues for as long as smoking continues after pregnancy. (© emin kuliyev- stock.adobe.com) PAGE 20 August Issue 2021

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