II. Risk Factors: Child Abuse Associations
- Substantial increase in risk of maltreatment
- Risk of change in primary Caregiver before age 2 years
- Breast Feeding exposure to illicit substance
- Deliberate Poisoning with illicit substance
- Passive inhalation of illicit substance
- Accidental Ingestion of illicit substance
- Physical or Sexual abuse
- Household or neighborhood Violence
III. Screening
- CRAFFT Adolescent Chemical Dependency Screening
- P5 Integrated Screening
- Drug Abuse Screening Test (DAS-10)
- Single-Question Drug Abuse Screening Test (DAS-1)
- Modified Alcohol, Smoking and Substance Involvement Screening Test
IV. Complications: General
- Lack of Prenatal Care and other health care
- Fetal Growth Restriction
- Placental Abruption
- Preterm Labor
- Preterm Death
- High Risk Behavior (e.g. prostitution)
V. Management: Preterm Recommendations for Obstetric Visits
- Every 2 weeks until 30 weeks
- Every week until delivery after 30 weeks
VI. Labs: Sexually Transmitted Disease screening
- First Prenatal Visit
- Gestational age 36 weeks
- Testing
VII. Imaging: Obstetric Ultrasound
- Baseline: late first or early second trimester
- Serial Ultrasound for Intrauterine Growth Retardation
VIII. Monitoring
- Random Urine Drug Screening (obtain permit)
- Obstetric Ultrasound as above
-
Nonstress Test
- Every two weeks from 30 to 35 weeks
- Weekly after 35 weeks
- Meconium Drug Screen from fetus after delivery
IX. Management
- Child Protective Services reporting is required by most states in U.S.
- See Cocaine Abuse in Pregnancy
- See Opioid Use Disorder in Pregnancy
- See Alcohol Abuse
X. Resources
- Perinatal Harm Reduction Toolkit
- Children and Family Futures