For most medical situations, effective medical treatment and the correct diagnosis are vital to the patient's quality of life and survival. A barrier to the correct diagnosis and the right medical treatment is the failure of the patient to do as required by following the healthcare provider's recommendations. Patient nonadherence, also called noncompliance, can be of different forms; what the patients are advised by the healthcare provider to control certain conditions is often completely ignored, forgotten, carried out incorrectly or even completely misunderstood. For instance, after having potential health risks known by the healthcare provider concerning pregnant patients, the healthcare providers usually recommend some changes in the behavior based on the lifestyle choices such as environmental exposures, dietary habits, alcohol consumption, and drug use. Even after being offered the most effective recommendations, some patients struggle with such recommendations on how to tackle their lifestyle following pregnancy that would lead to health risks to both the fetus and the mother.
Signs and Symptoms
Chronic alcohol exposure has a significant impact on the mother. During the first trimester of the pregnancy, alcohol exposure leads to decreased placental perfusion and reduced oxygen supply later in pregnancy to fetal vasculature (Lo et al., 2017). Alcohol exposure has an effective representation of placental vasoconstriction that leads to increased placental-fetal vascular resistance. As a result, there is an impaired supply of oxygen transported to the fetus. Placental development is then highly disrupted. Foreign substances such as alcohol, interfere with the functions of the placenta on different levels. The functions that have been interfered with due to the disruption, includes the release of hormones and enzymes, cell signaling, cellular growth, and the transfer of waste products and nutrients (Tai et al., 2017). Maternal alcohol ingestion leads to fetal injury, specifically, impairing brain and somatic growth through different ways such as fetal toxicity and indirect placental injury.
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The healthcare provider can detect early signs of alcohol use during the pregnancy period through ultrasound. Early detection is vital to know about "fetal alcohol spectrum disorders (FASDs)" during the second trimester of the pregnancy. If the healthcare provider knows about the patient's drinking behavior, they can do the ultrasound tests to check for such FASDs signs such as growth delays and heart defects. Maternal drinking is considered to be associated with elements of placenta accreta (Ohira et al., 2019). Also, maternal drinking has significant impacts on the placenta abruption and placenta previa.
Having preterm labor before the expiration of 37 weeks is a symptom associated with alcohol use by the pregnant patient. There could be a change in the patient's vaginal discharge such as blood and sometimes water or even more discharge from the vagina than is often expected. Due to the preterm labor, the patient could be experiencing low backaches, painful contractions, and sometimes belly cramps.
Impact of Nonadherence to the Fetus and Patient
In addition to the various alterations to the fetal growth and placental function, the development of the fetus' brain is affected when exposed to alcohol consumption during the first trimester. To be more specific, the brain development has a significantly smaller biparietal diameter and also smaller brain weight (Denny, Acero, Naimi & Kim, 2019). The patient can experience a miscarriage before the pregnancy reaches its 20th week. Birth defects are also experienced such as the fetus' heart and hearing issues. Also, the fetus is of low weight and is shorter than peers, has a small head due to reduced brain development. Some of the cognitive issues are such as low IQ, language and speech delays, learning disabilities, attention difficulties and poor memory for the fetus. Stillbirth is also highly likely for the patient having consumed alcohol over some period before birth.
Treatment and Management Strategies for Patients
First, inpatient programs are important as some last 30-90 days. Patients are needed to live within the premises during the program. The program has a combination could have a combination of support groups, group therapy, individual therapy, and 24/7 medical supervision. Based on the type of facility, the programs for the inpatients may provide various amenities such as management services and also postpartum support. Other treatment centers that provide diagnosis treatment, can tackle concurrent mental issues such as disorders, thoughts, anxiety and patient's moods. Secondly, there are outpatient programs that help provide pregnant women with home-living flexibility while she is offered care. In more cases, the outpatient programs are not as expensive as the inpatient programs. The patients in the outpatient programs would have to attend some therapy for multiple hours every week.
In addition to the case management and therapy, healthcare providers can have medication prescribed to the patents to provide aid to alcohol withdrawal issues. Some of the prescriptions include naltrexone- which is used during the period of pregnancy with no harmful effects. Secondly, disulfiram is used to elevate the acetaldehyde levels but may harm the fetus.
Conclusion
It is notable that if there is noncompliance with the patient, then more frequent visits and close monitoring is necessary. The pregnant women should neither be blamed nor judged by the healthcare provider for their drinking habits, but it becomes vital for the healthcare provider to have the best motive for the patient. The pregnant patient should be advised on the impacts drinking has on her pregnancy and fetal development.
References
Denny, C. H., Acero, C. S., Naimi, T. S., & Kim, S. Y. (2019). Consumption of alcohol beverages and binge drinking among pregnant women aged 18–44 years—United States, 2015–2017. Morbidity and Mortality Weekly Report, 68(16), 365.
Lo, J. O., Schabel, M. C., Roberts, V. H., Wang, X., Lewandowski, K. S., Grant, K. A. ... & Kroenke, C. D. (2017). First trimester alcohol exposure alters placental perfusion and fetal oxygen availability affecting fetal growth and development in a non-human primate model. American journal of obstetrics and gynecology, 216(3), 302-e1.
Ohira, S., Motoki, N., Shibazaki, T., Misawa, Y., Inaba, Y., Kanai, M. ... & Nomiyama, T. (2019). Alcohol Consumption During pregnancy and Risk of placental Abnormality: the Japan environment and Children’s study. Scientific reports, 9(1), 1-8.
Tai, M., Piskorski, A., Kao, J. C., Hess, L. A., M de la Monte, S., & Gündoğan, F. (2017). Placental morphology in fetal alcohol spectrum disorders. Alcohol and Alcoholism , 52 (2), 138-144.
https://drugabuse.com/alcohol/drinking-while-pregnant/
