33
Addiction and Infectious Diseases ADDICTION SERVICE In 2020, 36 women linked with the Drug Liaison Midwife (DLM) and attended the service, 28 of whom gave birth in 2020. Nine additional women who linked with the DLM were non-opioid dependent but using other drugs, chose to remain on other obstetric teams. Six women declined follow up with the DLM service after phone and/or faceto-face consultation. The majority of these women gave a history of cannabis use. Eighteen women were already linked to an opioid substitution treatment (OST) programme and prescribed methadone. In addition, five women presented who were abusing heroin and/or other drugs and not in treatment. They were started on an OST outpatient programme during their pregnancies. One woman declined this programme. One woman completed methadone detox before pregnancy and attended our service for support during pregnancy. The DLM was linked in with 28 women who self-reported use of cocaine, alcohol, unprescribed benzodiazepine and/ or cannabis in pregnancy and were not opiate dependent. Seven women were admitted to residential drug stabilisation treatment programmes within the Community Addiction Service. Fifteen opiate dependent women delivered 16 liveborn babies. Six women delivered seven babies at less than 37 weeks’ gestation. Fourteen babies were admitted to NICU/ SCBU (one of whom was transferred to another hospital). They had a mean length of stay of 15 days (range 1 to 94 days). Four babies needed pharmacological treatment for neonatal abstinence syndrome (NAS). These babies had a mean length of stay in the NICU/SCBU of 42 days (range 11 to 94 days). Two of the 16 non-opioid dependent women delivered at less than 37 weeks’ gestation. Five babies were admitted to the NICU/SCBU. They had mean length of stay of 12 days (range one to 31 days). None of these babies required pharmacological treatment for NAS.
There continued to be a decrease in the number of women prescribed OST who presented to the CWIUH. However, within this cohort there was polydrug use including heroin, benzodiazepine abuse, cocaine particularly crack, and cannabis. Almost 50% (12/45) of women linked to the DLM were staying in homeless accommodation. The senior medical social worker (MSW) meets with all women who attend the CWIUH with current drug or alcohol addictions. This facilitates a focused and specialised service for these women. The senior MSW is present at the weekly antenatal clinic. This promotes the role of the senior MSW within the multidisciplinary team (MDT) and increases women’s accessibility to the MSW service. The senior MSW provides ongoing interdisciplinary and interagency education and training on working with women experiencing a current addiction and highlights trends of social complexities experienced by women in addiction which in turn informs practice. INFECTIOUS DISEASES (HEPATITIS B AND C, HIV, GENITAL HSV AND TREPONEMA PALLIDUM) In 2020, 285 women attended the infectious diseases service at the CWIUH, the majority of whom were provided with full antenatal care and postnatal follow up. In addition, a number of antenatal and gynaecology patients attended for consultation and follow up regarding positive sexually transmitted infection (STI) screening. Fourteen women who booked for antenatal care in 2020 tested positive for hepatitis B virus, two of whom were newly diagnosed on antenatal screening. Seven women were born in Eastern Europe, four in Africa, two in Asia and one in Europe. Eight additional women who showed evidence of resolved infection attended the service. One woman had an intrauterine fetal death. Thirteen antenatal women tested positive for hepatitis C, with one new diagnosis of reinfection (having previously been PCR [polymerase chain reaction] negative). Of the 13, one woman was PCR positive and 12 were PCR negative, the majority of whom had been successfully treated. Eleven women were born in Ireland, one was born in Eastern Europe and one was born in South East Asia. One Irish born woman became reinfected and she was linked in with the Department of Hepatology, St James’s Hospital for treatment. The decline in the number of women who are hepatitis C PCR positive attending, is directly attributable to the recent successful roll out of the National Hepatitis C Treatment Programme in Ireland.
