Addiction and Infectious Diseases

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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.

Coombe Women & Infants University Hospital Annual Report 2020

Sixteen antenatal women tested positive for HIV (human immunodeficiency virus infection), with no new diagnoses. Nine women originated from Africa, four from Ireland and the remaining three from Europe and South America. Three women were coinfected with genital herpes and one woman was coinfected with hepatitis C. One woman miscarried. Three women had preterm births at 24, 26 and 30 weeks’ gestation (one of whom died). One baby died from terminal congenital cardiac disease at 12 days of age.

Ninety-one antenatal women with a history of or outbreak in pregnancy of genital herpes simplex virus (HSV) were cared for. Thirty-three women had a positive PCR test or were antibody positive for HSV-1. Forty-one women had a positive PCR test or were antibody positive for HSV-2. Samples from 17 women could not be typed.

Eleven women were confirmed positive for Treponema pallidum. Four of these women required treatment in pregnancy as new diagnoses. Two of the women originated from Eastern Europe, one from Ireland and one from India. The remaining women had been appropriately treated in the past. Seventy-eight antenatal women required follow up and/or repeat testing due to indeterminate serology which was attributed to cross-reactivity in pregnancy.

No mother-to-child transmission of an infectious disease occurred in 2020.

The diagnosis and management of an infectious disease in pregnancy challenges the healthcare provider with a myriad of complexities in the provision of antenatal and follow up care. The clinic is specifically designed to ensure individualised education and care-planning, specialised counselling as well as disclosure and support services. Women are provided with a specific pathway into specialist ongoing care, ensuring treatment and monitoring thereby often preventing disease progression, mother-to-child transmission and significantly reducing future healthcare costs in this high risk cohort.

A shared care approach is taken for a number of our high risk women. Under the managed clinical care network, they can now attend the Midland Regional Hospital Portlaoise (MRHP) and GP services for part of their care. Women also attend for shared care with maternity services in the Midland Regional Hospital Mullingar, Portiuncula University Hospital and Wexford General Hospital. Specialist services were also provided for additional women with high risk pregnancies e.g. loss in pregnancy, serodiscordant couples, current STI and Tuberculosis. Couples continued to be seen in our conception clinic, which provides fertility investigations for both seropositive and serodiscordant couples attempting to optimise conception, while safeguarding the risk of transmission of HIV.

Prof. Fiona Mulcahy and Sinead Murphy, CNS retired in 2020. Sinead relocated to the Mid-West and is setting up a GUIDE service there.

Dr. Aisling Loy and Emma Flynn joined the GUIDE team. Orla Cunningham was accepted onto the inaugural MSc Midwifery Advanced Practice in TCD and continues to work towards being recognised as an Advanced Midwife Practitioner.