Gebelikte ve Emzirme Döneminde Alkol ve Madde Kullanım Bozuklukları
Özet
Gebelik ve emzirme döneminde alkol ile madde kullanım bozuklukları; bireysel, ailevi ve toplumsal düzeyde ciddi sağlık sorunlarına ve yeti yitimine yol açan önemli bir halk sağlığı problemidir. Kadınlarda bu bozuklukların gelişim riski özellikle 18-29 yaş aralığında zirveye ulaşmaktadır. Hamilelik sürecinde tütün, alkol, esrar, opioid ve kokain gibi çeşitli maddelerin kullanımı; düşük doğum ağırlığı, erken doğum, plasenta dekolmanı, ölü doğum, konjenital malformasyonlar ve Fetal Alkol Spektrum Bozukluğu (FASB) ile doğrudan ilişkilendirilmiştir. Ayrıca kronik intrauterin madde maruziyeti, doğum sonrasında yenidoğanda merkezi sinir sistemi ve otonom sistemi etkileyen Yenidoğan Yoksunluk Sendromu'na (YYS) neden olabilmektedir. Emzirme döneminde ise nikotin, alkol ve esrar gibi maddeler süte yüksek oranda geçerek bebekte uyku bozukluklarına, kusmaya, sedasyona ve motor gelişim geriliğine yol açarken; kokain gibi uyarıcılar yüksek toksisite riski nedeniyle emzirmeye kesin kontrendikasyon oluşturur. Bu bozuklukların tedavisinde farmakolojik yaklaşımların gebelikteki güvenilirliği ve etkinliği sınırlı veya çelişkili olduğundan, motivasyonel görüşmeler ve bilişsel davranışçı terapileri içeren kısa psikososyal ve davranışsal müdahaleler temel tedavi stratejisini oluşturmaktadır. DSÖ, klinisyenlerin gebelikte ilk fırsatta alkol ve madde kullanımını taramasını ve biyo-psiko-sosyal yaklaşımla tedavi süreçlerini yönetmesini önermektedir.
Alcohol and substance use disorders during pregnancy and lactation are significant public health problems that lead to serious health issues and disability at individual, familial, and societal levels. The risk of developing these disorders in women peaks especially between the ages of 18 and 29. The use of various substances such as tobacco, alcohol, cannabis, opioids, and cocaine during pregnancy has been directly associated with low birth weight, preterm birth, placental abruption, stillbirth, congenital malformations, and Fetal Alcohol Spectrum Disorder (FASD). Furthermore, chronic intrauterine substance exposure can cause Neonatal Abstinence Syndrome (NAS) in the newborn after birth, affecting the central nervous system and autonomous system. During lactation, substances like nicotine, alcohol, and cannabis pass into breast milk at high rates, causing sleep disturbances, vomiting, sedation, and motor developmental delay in the infant, whereas stimulants like cocaine constitute an absolute contraindication to breastfeeding due to the high risk of toxicity. Since the reliability and efficacy of pharmacological approaches in treatment during pregnancy are limited or contradictory, brief psychosocial and behavioral interventions, including motivational interviewing and cognitive behavioral therapies, form the core treatment strategy. The WHO recommends that clinicians screen for alcohol and substance use in pregnant women at the earliest opportunity and manage treatment processes through a bio-psycho-social approach.
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