MANAGEMENT OF SUBSTANCE-ABUSING PREGNANT- WOMEN AND THEIR OFFSPRING

Children of substance abuse mothers have an increased risk of severe p athological disorders such as perinatal diseases (prematurity, intraut erine growth retardation, infections) with their neurological and resp iratory complications and sequelae, and transmission of drug addiction related infections, ie human immunodeficiency virus, hepatitis B and C virus, syphilis. Many of these children present a drug withdrawal sy ndrome characterized by restlessness and jetteriness during the neonat al period. This is frequently followed by a post withdrawal period of several weeks duration with crying, excitement, sleep and feeding diff iculties. Although these drug withdrawal manifestations have no incide nce on the vital prognosis, it severely impairs the mother-infant inte raction. Despite these disorders it appears that the outcome of these children is mainly related to their familial environment which is expo sed to many risk factors: mother-child separation, violence, delinquen cy, precariousness, unhealthy housing, prostitution, drug dependency, parental death or imprisonment... Early medico-psycho-social intervent ion starting during pregnancy and a prolonged support for several year s are the only way to improve their spontaneously poor outcome.