Opiates and

Pregnancy in WI
By Shannon, Elley, Caitlyn and Sarah
Nursing Diagnosis
Compromised family coping related to situational crisis of drug abuse and pregnancy, evidence by
stated difficulty with coping, impaired adaptive behavior and problem solving skills.

Desired outcome: Identify ineffective coping skills and utilize effective coping to initiate necessary
lifestyle changes.
Why is this important to nursing
We are seeing newborns being born with birth defects related to maternal drug use during pregnancy
more and more every day. It is important to know the effects Opiates can have on these infants. It is
also important to be able to recognize the warning signs of opiate use during pregnancy so we can
stop it before the damage is already done. Wisconsin, specifically Milwaukee has one of the highest
rates of opiate use during pregnancy. The national average is 7 births out of 1000 births where opiates
were used, Wisconsin's average is 10.5 per 1000 births.
Prevalence
“Since 2002, the incidence of first time heroin use has doubled among women and among
young adults aged 18-25 years, a demographic that includes many pregnant women. 33
According to the American College of Obstetrics and Gynecology, 1% of pregnant women
report nonmedical use of opioid pain medications”. (Missouri Medicine, 2017, p3). Many
pregnant women who are addicted to opiates do not self report out of fear of judgement.
Access to
Care
Barriers to care:

● Socioeconomic status
● No health insurance
● Location with either access to health centers or hot spot
for opiate use
● Accommodation - busy schedule and not making time
for care
● Accessibility or availability - no reliable transportation
● Emotional status
● Cultural differences
● Language
Resources in Wisconsin and
Nationally
-Opioids: Wisconsin Treatment Directory -Wisconsin Addiction Recovery Helpline

-Addiction Consultation Provider Hotline -Wisconsin Society of Addicted Medicine

-Opioid Response Network -Womens’ Treatment Project - ECHO

-Resilient Wisconsin -Wisconsin Association for Perinatal Care

Primary, Secondary and Tertiary
Prevention
Primary: Programs in schools and in the community for prevention of opiate use

Secondary: Encourage clinics and hospitals to screen for drugs during prenatal period.
Providers should provide extensive teaching on possibility of addiction with prescribed
pain meds and watch patients for S&S of a formed habit.

Tertiary: Overdose prevention programs, programs for treatment during pregnancy, and
programs to prevent relapse
Morbidity and Health outcomes
● Human Immunodeficiency Virus (HIV) ● Untreated addition:
● Hepatitis C (HCV) ○ Prostitution
● Other blood borne diseases ○ Traiding sex fo drugs
○ Criminal activity
● Depression
● Violence
● 40% increase in postpartum depression
● Loss of child custody
● Legal issues for the mother
● Criminal proceedings
● Higher rates of preterm births
● Incarceration
● Low birth weights
● Other substance abuse, including tobacco,
● Reduced head circumference
marijuana and cocaine
● Neonatal withdrawal symptoms
● Poor nutrition
● Abruptio placentae
● Disrupted support systems
● Intrauterine passage of meconium
Relevant nutrition needs
During Addiction:

● Increase folate
● Vitamines C, E, A, and iron to
decrease the risk of preterm births
and intrauterine growth restriction
(IRG)
● Decrease “sweets”and increase
protein
Relevant nutrition needs
During Withdrawal:

● Regular meals & snacks that decrease temptation= decreasing the risk of binge eating
● Increase use of antioxidant and nutrient-rich vegetables and fruits to help maintain normal body functions
○ Think Superfoods
● High-protein, low-carbohydrate diets can increase your amino acid production and provide vital nutrients that
help you manage unpleasant withdrawal
● Nutrients like zinc, calcium, magnesium, omega-3 fatty acids, antioxidant, all of which can curb cravings and
improve mood swings
● Keep health snacks high in protein handy to help with cravings and stabilize your blood sugar
What community resources are
available
In September 2020, there were 665,707 prescriptions dispensed in the state of Wisconsin

September is Recovery Month-- Governor Evers

10th Street Comprehensive Treatment Center (Milwaukee)<<Acadian Healthcare>>

Addiction Services and Pharmacotherapy (ASAP)

<<West Allis>>
Prevalence

Comparison from 2016 until current

Disparities
● Early universal screenings, brief interventions
○ Short conversations, providing feedback/advice, and a referral for treatment
● Screening for substance use during initial OB visit
● Routine screening:
○ 4Ps, NIDA Quick Screen and CRAFFT
● Monitoring for chronic pain, avoiding or minimize the use of opiates for pain
management, highlight alternative pain therapies
Theorist
Sigmund Freud:

His psychoanalytic theory of the id, ego,

and superego.

● Id: Focuses on instinct and

aggressive desires.
● Ego: Focuses on the realistic aspects.
● Superego: Focuses on the moral
conscious.
Evidence based approaches to
reduce
● morbidity
Opioid overdose education and naloxone distribution programs; prescription drug
monitoring programs to reduce inappropriate opioid prescribing; Food and Drug
Administration-- approved medication for opioid use disorder (MOUD), including
methadone, buprenorphine, and naltrexone; treatment engagement and retention; and
recovery support services

● Integration with communication campaigns can

increase the impact on behavior change
Kahoot!
https://create.kahoot.it/share/health-disparities-in-wi/8e043246-c483-4a1d-8304-
25976364fa50
Work Cited
American Collegel of Obstricians and Gynocologist: https://www.acog.org/clinical/clinical-guidance/committee-
opinion/articles/2017/08/opioid-use-and-opioid-use-disorder-in-pregnancy
Hedgespeth, J. (2019). Ego, superego, and id. Salem Press Encyclopedia of Health.
Lefebvre, R. C., Chandlier, R. K., Heleme, D. W., Slater, M. D., Anakaraanoye, A. R., Beard, D., . . . Rodgers, E. (2020, Deceber).
Health communication campaigns to drive demand for evidence-based practices and reduce stigma in the HEALing
communities study. Drug and Alcohol Dependence, 217(1), 108338.
Martin, P., By, -, Martin, P., & Paul Martin is a registered nurse with a bachelor of science in nursing since 2007. Having worked as a
medical-surgical nurse for five years. (2019, June 01). 6 Prenatal Substance Dependence/Abuse Nursing Care Plans.
Retrieved November 14, 2020, from https://nurseslabs.com/6-prenatal-substance-dependence-abuse-nursing-care-plans/
National Institute on Drug Abuse. (2020, July 02). Wisconsin: Opioid-Involved Deaths and Related Harms. Retrieved November 14,
2020, from https://www.drugabuse.gov/drug-topics/opioids/opioid-summaries-by-state/wisconsin-opioid-involved-deaths-
related-har
O’Donnell, F. T., & Jackson, D. L. (2017). Opioid Use Disorder and Pregnancy. Missouri Medicine, 114(3), 181–186.
Works Cited Continued...
Tomedi, L. E., Bogen, D. L., Hanusa, B. H., Wisner, K. L., & Bodnar, L. M. (2012). A pilot study of the nutritional status of opiate-using
pregnant women on methadone maintenance therapy. Substance use & misuse, 47(3), 286–295.
https://doi.org/10.3109/10826084.2011.635324
Wisconsin Department of Health Services. (2020, October 27). Opioids: Wisconsin Treatment Directory. Retrieved from Wisconsin
Department of Health Services: https://www.dhs.wisconsin.gov/opioids/find-treatment.htm
Wisconsin Department of Hleaht Services. (2020, October 28). Wisconsin Department of Health Services. Retrieved from Opioids:
Data, Reports, Studies: https://www.dhs.wisconsin.gov/opioids/data-reports-studies.htm
Questions?