Schwangerenbetreuung bei Drogenkonsum

Zusammenfassung

Einleitung: In Deutschland werden jährlich ca. 2 000 Kinder drogenabhängiger Mütter geboren. Eine deutlich höhere Dunkelziffer bei drogenkonsumierenden Schwangeren ist zu befürchten. Durch Mischkonsum mit vielfältiger Auswirkung auf das Kind, sowie psychosozialer und körperlicher Besonderheiten der Schwangeren, stellt die Betreuung dieser Schwangerschaften suchttherapeutisch und geburtshilflich eine Herausforderung dar.

Methode: Selektive Literaturrecherche in Pubmed, Übersichtsartikel und Originalarbeiten aus den Jahren 2001–2013, sowie Stellungnahmen deutscher und internationaler Fachverbände und Kommissionen zum Thema. Die vorliegende Arbeit möchte Gynäkologen, Geburtshelfern und Neonatologen eine Hilfestellung für die komplexe peripartale Betreuung suchtkranker Frauen geben.

Ergebnisse: Neben der besonderen psychischen Situation der Schwangeren mit gehäufter psychiatrischer Komorbidität wie Depression und Angststörung, sind gynäkologische Komplika­tionen wie vorzeitige Wehentätigkeit, intrauterine fetale Wachstumsrestriktion und maternale Infektionskrankheiten bei der Schwangerenvorsorge zu bedenken. Die pharmakologische Komplexität der konsumierten Suchtstoffe und deren mögliche Auswirkung auf den Feten muss der Schwangeren erklärt werden. Die Opiatsubstitutionstherapie ist in der Schwangerschaft das ­Mittel der Wahl zur fetomaternalen Risikoreduktion und mütterlichen Stabilisierung. Eine ­Aufklärung der Mutter über das in bis zu 90% der Neugeborenen auftretende, neonatale Abstinenzsyndrom und das Stillen in Kombination mit Nikotinabusus und/oder Infektionskrankheiten der Entbundenen ist von Bedeutung.

Diskussion: Ein professioneller und empathischer Umgang des Frauenarztes mit den betroffenen Schwangeren ist eine wichtige Voraussetzung zur Risikominimierung für Mutter und Kind. Trotz interdisziplinärer Zusammenarbeit aller Hilfesysteme und Vermeidung von Stigmatisierung ist es bei den Hochrisikopatientinnen mit polyvalentem Abusus weiterhin schwierig, alle Schwangeren einer engmaschigen gynäkologischen Vorsorge zuzuführen.

Abstract

Introduction: In Germany we find about 2 000 newborns per year with a mother misusing drugs. It is to be feared that there is a substantial amount of underreported substance abuse in pregnant women. To care for these pregnancies from an obstetric point of view as well as from an addiction treatment point of view is a challenge for all health-care professionals, due to multiple drugs being used and the special psychosocial and health issues these mothers and babies ­present.

Method: A selective search was undertaken in Pubmed, retrieving reviews and original articles from 2001–2013, with consideration of statements, recommendations and guidelines from national and international associations and committees on the topic. This review is intended to assist gynaecologists, obstetricians and paediatricians during the complex peripartum care for the drug abusing pregnant patient.

Results: When offering obstetric care for these pregnancies, several issues have to be taken into account: the special psychological situation of the pregnant drug user, with frequent occurrence of psychiatric comorbidities like depression and anxiety disorders, as well as gynaecological complications like premature labour, intrauterine growth restriction and maternal infectious diseases. The pharmacological complexity of the substances abused and the possible side-effects on the foetus have to be explained to the mother. Maintenance medication for foetomaternal risk reduction and maternal stabilisation remains the state-of-the-art treatment. Furthermore, it is important to explain the neonatal abstinence syndrome to the mother as well as the result of breast-feeding in the presence of smoking and/or infectious diseases.

Discussion: Professionalism and empathy are needed from gynaecologists in order to achieve risk reduction for mother and child in substance-using pregnancies. However, in spite of close cooperation of all health-care professionals and avoidance of stigma, it will be difficult to offer good obstetric care to the high-risk patients with poly-drug abuse.

Schlüsselwörter

Entbindung - neonatales Abstinenzsyndrom (NAS) - Risikoschwangerschaft - Schwangerenvorsorge - Drogenabusus - Opiatsubstitution

Key words

delivery - neonatal abstinence ­syndrome (NAS) - risk pregnancy - prenatal care - drug abuse - opiate maintenance therapy

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