Perinatal Substance Use: Evidence for Current Practice. Karen Clemmer, MCAH Coordinator, Sonoma County
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1 Perinatal Substance Use: Evidence for Current Practice Karen Clemmer, MCAH Coordinator, Sonoma County
2 The impact of perinatal marijuana use on pregnancy outcomes & lactation Learning Objectives Influence of Adverse Childhood Experiences on behavior & health The impact of perinatal marijuana use on birth outcomes The current evidence on marijuana use during breastfeeding
3 Applying a Life Course Lens Adolescents The next generation of parents!
4 American Medical Association Position Statement
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7 Women recruited during pregnancy longitudinal study Children then assessed at ages 3yo, 6yo, & 14yo This paper discusses prenatal marijuana exposure (PME) on year olds
8 Transgenerational effect e.g. Epigenetics e.g. Life Course What if I don t smoke it, but eat it instead? Is there still a risk?
9 American Psychiatric Association Position Statement
10 The connection between infancy and adult health Applying a Life Course Lens A Brief review of ACES
11 Never before in the history of medicine have we had better insight into the factors that determine the health of an individual from infancy to adulthood, which is part of the life course perspective a way of looking at life not as disconnected stages but as integrated across time.
12 Adverse Childhood Experiences (ACE) Study Centers for Disease Control and Kaiser Permanente in San Diego, 17,300 Adults Tracked health outcomes based on childhood ACEs 75% Caucasian, 39% college graduates, 36% some college, living wage jobs with insurance; median age 57 yr. old
13 What are the Adverse Childhood Experiences? 1. Child physical abuse 2. Child sexual abuse 3. Child emotional abuse 4. Physical Neglect 5. Emotional Neglect 6. Mentally ill, depressed or suicidal person in the home 7. Drug addicted or alcoholic family member 8. Witnessing domestic violence against the mother 9. Loss of a parent to death or abandonment, including abandonment by divorce 10. Incarceration of any family member
14 Prevalence Adverse Childhood Experiences (ACEs) Study Centers for Disease Control & Prevention (CDC) Household dysfunction Substance abuse 27% Parental separation/divorce 23% Mental illness 19% Battered mother 13% Incarcerated household member 5% Abuse Psychological 11% Physical 28% Sexual 21% Neglect Emotional 15% Physical 10% Centers for Disease Control and Prevention
15 Hidden Crisis Report on ACEs Results for Sonoma County 22% have 4 or more ACEs Increased risk for depression suicide attempt drug & alcohol use heart disease, stroke, COPD diabetes Alzheimer s
16 ACE Score Increases Suicide Attempt 1 of 100 people with 0 ACEs attempt suicide 10 of 100 people with 3 ACEs attempt suicide 20 of 100 people with 7 ACEs attempt suicide
17 A Trauma Lens can help to better understand a patient s behavior. A shift in perspective from: What is wrong with this person? to What has this person been through? 17
18 Sonoma County ACEs Connection Annjané's Story
19 The impact of perinatal marijuana use on birth outcomes A review of the evidence
20 24,874 women - over a 7 year period of time
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24 The current evidence on marijuana use during breastfeeding Lactation - THC in breastmilk Parenting sleep
25 MARIJUANA POTENCY Average THC and CBD Levels in the US: Psychoactive Ingredient 2 0 NON- Psychoact ive Ingredien t THC CBD
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27 Marijuana Use During Breastfeeding THC has an affinity for lipids and accumulates in human milk. The AAP considers marijuana use a contraindication to breastfeeding. THC is fat-soluble and secreted in breast milk; with chronic heavy use levels can be 8x higher than in maternal plasma May inhibit production of prolactin which could interfere with lactation Source: American Academy of Pediatrics, 2013 Prenatal Substance Abuse
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31 In closing.
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33 Smoke Free Babies Michelle Escobar-McGarry Northern California Center for Well-Being x 19 Who to refer? How to refer? Cost?
34 Drug Free Babies Marena Koukis, Ph.D. Perinatal Placement Specialist County of Sonoma Behavioral Health Cell Who to refer? How to refer? Cost?
35 Thank you! Karen Clemmer, RN, MN, PHN County of Sonoma Maternal Child Adolescent Health Coordinator
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