Gunilla Larsson

The influence of amphetamine addiction on pregnancy and the newborn infant.

ABSTRACT. influence of amphetamine addiction on pregnancy and the newborn infant has been studied retrospectively in 23 cases. Six of the mothers claimed to have discontinued their abuse in early pregnancy, while the remaining 17 mothers continued throughout. In comparison with the average number of visits by pregnant Swedish women to maternal health centres, the 17 women who continued their abuse made significantly fewer visits, although there was a wide variation. Complications related to pregnancy and delivery were few, however. One child with a myelomeningocele was stillborn. Six children were preterm and three were small for gestational age. Two full‐term children were extremely drowsy and in need of tube feeding, symptoms that might be due to the maternal abuse. Eight of the ten mothers, who had previous children placed in foster homes by the Social Welfare Department, left the hospital with their newborn infant in their care as well as all the eleven primiparae.

Prevention of fetal alcohol effects. An antenatal program for early detection of pregnancies at risk.

Abstract. The increased consumption of alcoholic beverages by young people must be viewed with great concern, particularly as regards prospective parents. A study was therefore started at four Maternal Health Clinics to develop methods for the early detection of maternal alcohol abuse and for treatment of the women concerned. The study involved 464 consecutive pregnant women. A systematic drinking anamnesis was obtained from all patients. Attention was also paid to additional indicators of maternal alcohol abuse. Four per cent of the women were classified as alcohol abusers, and a further 7% as excessive drinkers. The majority of the mothers reduced their drinking altogether or stopped after receiving information about alcohol. The alcoholic women, on the other hand, needed intensive counselling. Most women welcomed the opportunity to obtain an accurate assessment of the risks of alcohol consumption during pregnancy. One infant was given a diagnosis of fetal alcohol syndrome at birth and another neonate had a partial fetal alcohol syndrome. The antenatal staff identified significantly more women with excessive alcohol consumption, compared with the situation the year prior to starting the program. Family guidance provided by a multi‐disciplinary team in pregnancy may result in lifelong benefits to both the mother and her child.

Psychiatric morbidity and personality characteristics of battered women

Forty‐nine battered women attending a surgical emergency department were studied with regard to prior and current psychiatric morbidity, substance abuse and personality characteristics, and were compared with a control group. More battered women than controls had consulted a psychiatrist and half of them were classified as heavy consumers of alcohol. One third of the assaulted women were found to be depressed, compared to 6% of the controls. The groups also differed in respect of muscular tension, aches and pain, and autonomic distrubances, the battered women having more pronounced symptoms. It is important for psychiatrists to recognize the symptoms that battered women often exhibit. With better early diagnoses, these women could be offered more appropriate psychosocial therapy.

Aetiological and precipiating factors in wife battering. A psychosocial study of battered wives

ABSTRACT— Forty‐nine women who attended a surgical emergency department after being battered are the subjects of this prospective study. The childhood and adolescence of the women had been marked by abuse and violence in the parental home. Most of the women had suffered prolonged, repeated battering. Fifty‐one per cent of the women and 88% of their male assailants were considered to be heavy consumers of alcohol and in over half of the cases of battering both the man and the women had been drinking. In most cases the womens own children were present when the mother was beaten. One third of the women stated that they were highly dependent on the man in question emotionally. It is concluded that social heredity, heavy consumption of alcohol and emotional dependence on the male assailant are major reasons for the womans inability to break away from a relationship characterized by repeated battering.

THE AMPHETAMINE ADDICTED MOTHER AND HER CHILD

During the past few decades, drug addiction has been recognized In Sweden as a growing social problem of great importance (5). Women in the childbearing age group constitute a significant fraction of the addicted population. Maternal addiction during pregnancy is associated with medical and social complications and has therefore been viewed with deep concern. The Swedish drug scene has so far been rather distiwtive, since it is dominated by amphetamine abuse (53). Among medical and social professionals there has been a growing apprehension that chiidren of amphetamine-addicted mothers in Sweden are children at risk. The present study was started in 1976 to determine the consequences for these children following maternal amphetamine addiction. During the past decade, severs1 studies have reported a variety of medical and social effects on pregnancy, delivery and the newborn baby following maternal heroin addiction (19, 57, 69, 74). The few published follow-up studies on infants born to heroin-dependent mothers mainly originate from the USA, with its specific socio-economic structure. I t is reported that fetal heroin exposure can affect growth and behaviour as well as the perceptual and learning processes (43, 72). In a Danish study based on 19 children born to mothers addicted to a variety of drugs, including amphetamine and heroin, the somatic growth as well as gross and fine motor development appeared to be normal (59). In contrast to the vast documentation of the effects of maternal heroin addiction, there are few corresponding studies describing the consequences of maternal amphetamine abuse during pregnancy (41, 44, 69). In particular, there are no follow-up studies on these infants and few data on the long-term prognosis for the children. Moreover, the experience gained by the various authorities in Sweden concerning drug abuse during pregnancy have not been reported. Children raised by drug-addicted parents, however, appear to face an increased risk of neglect and abuse (9, 38, 40). Because of parental incapacity, some of these children are placed in foster homes (15, 43, 59). There is little information about the extent to which social measures, other than the revocation of parental custody, have been taken in relation to these families. Of course the criteria for taking legal measures varies in different countries. Under the Swedish Child Welfare Act, the social welfare agencies have the responsibility of ensuring the safety and wellbeing of children. The legal measures which the welfare agencies may take to eliminate unsatisfactory conditions are primarily of a preventive nature. If these prove ineffective, the parental right to custody of the child may be revoked. The law provides a wide range of individual interpretation as there is no definition of the childs needs or of a minimum standard for the environment. There is a need for an analysis of maternal social risk factors which might be of special importance in the decision-making process concerning the custody of infants born to drug-addicted mothers. The process of drug addiction has been described in a conceptual model including three stages ( I ) . Even the termination of addiction -the deaddiction process-has also been divided into three phases (20). In one Swedish study, drug addicts tended to abandon their drug career either before 2 years or after 6 years of addiction (20). There does not appear to be any difference between the populations of heroin and amphetamine addicts as regards relapse frequency in comparable stages of the drug career. The conceptual model might

Prognosis of children admitted to institutional care during infancy

The present study has investigated the prognosis of infants admitted to institutional care. The follow-up was made after five and ten years. Three groups of children were studied: those who were in adoptive homes, foster homes and biological homes, respectively, at the time of the investigation. Approximately 50% of the total population was treated in hospital after the neonatal period. More children in foster and biological homes were hospitalized because of trauma. At 4 years of age the psychomotor development was considered normal in 77% of the adopted children compared to approximately 55% in the other two groups. Furthermore, the children in foster and biological homes demonstrated a higher rate of psychological or behavioral disturbances. The children who were in foster homes had experienced more separations and 39% of them had been subjected to 6 or more placements. The experiences of institutional care per se in infancy do not predispose the child to health and behavioral problems. The determining factor for optimal development seems to be permanency of care and parenting capability.

Violence in the family: morbidity and medical consumption

Morbidity in homes, where family violence occurred, was investigated. Approximately 90% of the women and 60% of the men had been treated in hospital during a five-year period. Treatment in surgical department was most common. More women than men had symptoms indicating psychosomatic or indefinite aetiologies. One fifth of the women reported injuries due to physical violence. The medically certified illness for both men and women was about three times higher than in the general population. The children had twice as many admissions to hospital than controls. The diagnoses of the children were more frequently socially related. An early diagnosis of the family conditions and preventive measures are needed to safeguard against repeated battery and counteract social handicap.

Institutional care of infants in Sweden: Criteria for admission in 1970, 1975 and 1980☆

The purpose of the present study was to analyze the criteria used for admission of infants to institutional care in the metropolitan area of Stockholm in 1970, 1975 and 1980. The study included 337 infants. Their records from the institutional care have been studied. A significant decrease was observed from 1970 to 1980 on the following grounds for admission: teen-age mother, adoption, unsatisfactory housing situation, hospitalization of the mother. The following criteria for admission showed a significant increase: maternal alcohol and/or drug abuse as well as psychiatric disorders. It is concluded that there has been a dramatic change in the criteria used for admission of infants to institutional care from 1970 to 1980. Voluntary admissions of infants for maternal health reasons or social problems of a temporary nature have apparently been supplanted by non-voluntary admissions owing to maternal addiction and psychiatric insufficiency.

Battered women--their susceptibility to treatment

During an eight-month period a trial was made of a special therapeutic programme focused on the diagnosis and treatment of battered women who sought treatment for physical injuries at a surgical emergency department. Forty-nine women agreed to undergo the treatment programme, the aim of which was to provide social and psychological support. The women were treated as inpatients at the department of surgery. After their discharge from the hospital, contact on an out-patient basis was difficult to maintain. Nearly half of the women dropped out during the first month and only 22 women (45%) completed the programme. The causes of the high drop-out rate were analysed considering the womens backgrounds of repeated battering, high alcohol consumption and psychiatric morbidity. It is concluded that battered women need long-term and individualized support and that more attention should be focused on the possibility of carrying out the suggested treatment. Prolonged ambulatory treatment within the frame of medical care does not, however, seem to be the right method for helping and supporting battered women.

Services to Families with Children. A Study of Community Work in Uppsala

This article describes some of the results of a study of services to families and children in a suburban district, Sweden. Services included in the study were: maternal and child health care, child psychiatry, services for handicapped children, school health care, day care services, community social services and family counselling services. The baseline studies comprised analyses of official goals expressed in legislation and recommendations, interviews with local politicians and administrators, record studies, studies of working time distribution and questionnaires to field professionals and families. The results indicate that services with traditional goals and well-defined tasks (e.g. health supervision) were more satisfied with their goal attainment, less inclined to collaborate with other services, and more occupied with direct client work than services with non-traditional goals and vaguely defined tasks (e.g. strengthening democracy).