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(2) AUD treatment initiation and engagement
Î Recommendation VII.30: Engagement in treatment for AUD is
particularly important for pregnant patients with alcohol withdrawal
given the risk of Spectrum Disorder (FASD) including Fetal Alcohol
Syndrome (FAS).
(3) Pharmacotherapy
Î Recommendation VII.31: Before giving any medications to pregnant
patients, ensure that patients understand the risks and benefits of the
medication, both for the patient and the developing fetus.
Î Recommendation VII.32: Benzodiazepines and barbiturates are the
medications of choice in treatment of pregnant patients with alcohol
withdrawal. While there is a risk of teratogenicity during the first
trimester, the risks appear small, and they are balanced in view of the
risk for fetal alcohol spectrum disorder and consequences to mother
and fetus should severe maternal alcohol withdrawal develop.
Î Recommendation VII.33: Due to the high teratogenic risk, valproic
acid is not recommended for pregnant patients.
Î Recommendation VII.34: For patients at risk for pre-term delivery
or in the late third trimester, use of a short-acting benzodiazepine is
recommended. This minimizes the risk for neonatal benzodiazepine
intoxication given shorter onset and duration of action.
(4) Newborn considerations
Î Recommendation VII.35: In cases of alcohol withdrawal treated
close to delivery, assess the newborn for benzodiazepine intoxication,
sedative withdrawal, and Spectrum Disorder (FASD) including Fetal
Alcohol Syndrome (FAS).
Î Recommendation VII.36: Inform pregnant patients of all wraparound
services that will assist them in addressing newborn needs, including
food, shelter, pediatric clinics for inoculations, as well as programs
that will help with developmental or physical issues that the newborn
may experience as a result of in-utero substance exposure.
Î Recommendation VII.37: Licensed clinical staff have an obligation to
understand and follow their state laws regarding definitions of child
abuse and neglect, reporting requirements, and plans for safe care of
newborns with in-utero alcohol exposure.
