Amphetamine use in pregnancy is increasing in the United States with a disproportionate rise occurring in rural counties. Amphetamine-affected births (mostly attributed to methamphetamine) doubled -- from 1.2 per 1,000 hospitalizations in 2008-2009 to 2.4 per 1,000 delivery hospitalizations by 2014-2015 (Admon LK 2019).
Methamphetamines in Pregnancy (Jones C. 2018)
Consequences of In Utero Exposures:
- Preterm labor
- Intrauterine growth retardation
- Cardiac and cardiovascular abnormalities
- Cranial abnormalities
- Brain abnormalities
Consequences to child of In Utero Exposures:
- Behavior problems
- Emotional dysregulation
- Social deficits
- Increased risk of neglect and abuse
- Deficits in attention, memory, and motivation
- Depression and anxiety
- Aggression and delinquent behaviors
It is estimated that 9 percent of American children live with at least one adult who is a substance abuser. More than 1,100 children were injured at, killed at, or removed from methamphetamine laboratory sites from 2007 through September 2008.
The basic needs of children, including nutrition, supervision, and nurturing, often go unmet due to parental substance abuse, resulting in neglect. Maltreated children of substance abusing parents are more likely to have poorer physical, intellectual, social, and emotional outcomes. Children who have been abused or neglected are more likely to abuse substances as adults, and adults with substance use disorders are more likely to abuse or neglect their own children. A study by Brecht (2004), found that 33% of methamphetamine users had been sexually abused before the age of 15 and a similar percentage reported childhood physical abuse.
The Child Abuse Prevention and Treatment Act (CAPTA) is Federal legislation that requires the notification of Child Protective Services (CPS) if abuse or neglect are suspected. CAPTA defines child abuse as "Any recent act or failure to act on the part of a parent or caretaker, which results in death, serious physical or emotional harm, sexual abuse, or exploitation, or an act or failure to act which presents an imminent risk of serious harm".
As of 2003, to be eligible for Federal funding under CAPTA, States must also require the notification of Child Protective Services of “infants born and identified as being affected by illegal substance abuse or withdrawal symptoms resulting from prenatal drug exposure.” CAPTA does not require reporting of legal substances like tobacco or alcohol exposure but it does not preclude their reporting. Health care workers must become familiar with their State laws to be compliant.
The 2018 Monitoring the Future (MTF) survey of adolescent drug use and attitudes reported that about 1 percent of 8th, 10th, and 12th graders had used methamphetamine within the past year. Families may need help to identify teenage emotional, behavioral or physical changes which are outside the norm. Signs which might indicate methamphetamine use or another serious condition could include:
Nurses familiar with local drug use patterns are well positioned to identify early signs of drug use and to direct families toward appropriate professional intervention. Nurses should remember that CAPTA applies to any child which has not attained the age of 18 years and pertains to any condition which presents an imminent serious risk of harm, sexual abuse or explotation. For more information regarding Child Abuse and Neglect Mandatory Reporting please visit the Child Welfare Information Gateway at http://www.childwelfare.gov/systemwide/laws_policies/state/
Admon LK, Bart G, Kozhimannil KB, Richardson CR, Dalton VK, Winkelman TNA (2019) Amphetamine- and Opioid-Affected Births: Incidence, Outcomes, and Costs, United States, 2004–2015. American Journal of Public Health Association January, 2019.
Jones C. (2018) Drug Endangered Children: What You Need to Know. Child Health Specialty Clinics, University of Iowa Stead Family Children's Hospital.
U.S. Department of Health and Human Services Administration for Children and Families Administration on Children, Youth and Families Children’s Bureau. Targeted Grants to Increase the Well-Being of, and to Improve the Permanency Outcomes for, Children Affected by Methamphetamine or Other Substance Abuse: Fourth Annual Report to Congress