FEAR MAKES DRUG ABUSERS AVOID CLINICS, DOCTORS SAY

Fear that their babies will be taken into care leads some pregnant drug
abusers to avoid ante-natal clinics, doctors at the National Drug Treatment
Centre have reported.

Others are too busy raising money to finance their drug habit to attend
routine ante-natal clinics, they write in an article in the Irish Medical
Journal.

The authors, Dr John O'Connor and Dr D. Sloan, advocate methadone treatment
for pregnant heroin abusers.

An attempt to detoxify and become completely drug-free during pregnancy "is
regarded as even more dangerous than continued drug use, being more
stressful for the foetus than the mother."

Previously published estimates suggest that each year more than 150 women
who are addicted to heroin - often in combination with anti-depressants and
sleeping pills - give birth in Irish hospitals, almost all in Dublin.

Heroin passes easily into the placenta, which supplies the foetus with
nourishment.

Higher than normal rates of distress, stillbirth, premature birth and
congenital defects have all been reported where pregnant women are abusing
heroin, the authors say.

When born, the babies suffer withdrawal symptoms such as convulsions,
irritability, disturbed sleep patterns and poor feeding.

Older children born to drug addicts have been found to suffer developmental
delay and hyperactivity, but it is still unclear how much of this is due to
drug use during pregnancy and how much is due to being raised in an
environment where the mother continues to use drugs, the authors write.

Such an environment, they say, "is invariably a stressful one, with
associated poverty, poor nutrition and concomitant use of cigarettes."

On average, pregnant drug abusers take a month longer than other women to
book into ante-natal clinics. This is partly because heroin abuse disrupts
the menstrual cycle and the women may not realise that they are pregnant.

Many of the women claim the ante-natal clinics are too difficult to get to,
either because of where they are located or because they presume
administrative barriers will be placed in their way.

Some "have many other demands on their time and financing their drug habit
may take precedence over routine ante-natal appointments, especially when
perceived as not conferring them with any major benefits," the authors say.

"Some women fear that their child will be taken from them into care and
present even later for their ante-natal visit."

Some are discovered to be addicted only when they begin to show withdrawal
symptoms in the labour ward.

At high risk during pregnancy are foetuses whose mothers go through cycles
of withdrawal and relapse during the pregnancy, and are multiple drug users.

The use of street drugs increases the exposure to hepatitis B or C and to HIV.

Methadone treatment, say the authors, can reduce illicit drug use and
needle sharing. "Criminal activity may also be reduced. Maternal nutrition
is usually improved."