Gebelikte Madde Kullanımı
Özet
Gebelikte madde kullanım bozuklukları (SUD), anne ve fetüs üzerinde yıkıcı etkilere sahip çok faktörlü bir halk sağlığı sorunudur. Kadınlar özellikle üreme yılları olan 18-44 yaşları arasında bu bozuklukları geliştirme açısından en yüksek risk altındadır. Gebelikte en sık kullanılan madde tütün olup bunu alkol, esrar ve diğer yasa dışı maddeler izlemektedir. Madde kullanım bozukluğu olan doğurganlık çağındaki kadınlarda istenmeyen gebelik oranı yaklaşık %80'dir. Amerikan Obstetrisyenler ve Jinekologlar Koleji (ACOG), ilk ziyarette standartlaştırılmış tarama araçlarıyla rutin tarama yapılmasını önermektedir. Tanı ve değerlendirmede idrar testleri, T-ACE gibi ampirik tarama araçları, alkol yoksunluğu için CIWA ve perinatal depresyon için EPDS ölçekleri kullanılır. Opioid kullanım bozukluğu tedavisinde nüks, fetal distres ve ölüm riskini azaltmak amacıyla metadon veya buprenorfin ile opioid agonist tedavisi tıbbi yoksunluğa tercih edilir. Emzirme, yenidoğanda görülen yenidoğan yoksunluk sendromunun (NAS) şiddetini azaltmada faydalıdır. Alkol kullanımı ise düşük, ölü doğum, konjenital anomaliler ve fetal alkol spektrum bozukluğuna yol açabilir. Bu hastalar genellikle yetersiz bakım, şiddet ve komorbid psikiyatrik hastalıklar yaşarlar. Optimal sonuçlar için disiplinler arası bir ekip yaklaşımı, hasta eğitimi ve travma bilgili ruh sağlığı hizmetleri kritik öneme sahiptir.
Substance use disorders (SUD) during pregnancy are multifactorial public health issues with devastating impacts on both mother and fetus. Women are at the highest risk of developing these disorders during their childbearing years, specifically between the ages of 18 and 44. Tobacco is the most commonly used substance during pregnancy, followed by alcohol, cannabis, and other illicit drugs. The unintended pregnancy rate among women of childbearing age with a substance use disorder is approximately 80%. The American College of Obstetricians and Gynecologists (ACOG) recommends routine screening with standardized tools at the first visit. Evaluation utilizes urine tests, empirical screening tools like T-ACE, CIWA for alcohol withdrawal, and the EPDS scale for perinatal depression. For opioid use disorder, opioid agonist therapy with methadone or buprenorphine is preferred over medically supervised withdrawal to reduce risks of relapse, fetal distress, and mortality. Breastfeeding is beneficial in reducing the severity of neonatal abstinence syndrome (NAS) in newborns. Conversely, alcohol use can cause miscarriage, stillbirth, congenital anomalies, and fetal alcohol spectrum disorders. These patients often experience inadequate care, violence, and comorbid psychiatric conditions. An interdisciplinary team approach, comprehensive patient education, and trauma-informed mental health services are critical for optimal outcomes.
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