Hey everyone, welcome back to Exam 4. I’m Olivia Parker, and today we’re diving into some really important nursing concepts—starting with substance use in pregnancy and how it affects both mom and baby. This is one of those topics that, honestly, can feel overwhelming, but I promise we’ll break it down together.So, let’s start with the big picture. There are a bunch of substances that can impact pregnancy—alcohol, opioids, nicotine, marijuana, caffeine, even prescription drugs if they’re misused. Each one has its own set of risks, but the common thread is that the fetus just can’t metabolize these substances like an adult can. That means the effects can last way longer for the baby than for the mom.Take alcohol, for example. It’s a teratogen, which basically means it’s toxic to developing babies. There’s no safe amount during pregnancy. We see things like fetal alcohol spectrum disorders—so, structural anomalies, neurocognitive disabilities, and even facial features like a thin upper lip or small head circumference. And it’s actually the leading cause of nongenetic intellectual disability in the U.S. That’s wild, right?Opioids are another big one. They cross the placenta super quickly, and babies can be born with something called neonatal abstinence syndrome, or NAS. That’s when newborns go through withdrawal—so, you’ll see irritability, high-pitched crying, tremors, feeding problems, and sometimes even seizures. It’s heartbreaking, honestly. I remember caring for a newborn with NAS whose mom had struggled with opioid dependence. We used the 5 A’s approach—Ask, Advise, Assess, Assist, Arrange. So, we asked about her substance use, advised her on treatment options, assessed her motivation, assisted with resources, and arranged follow-ups. For the baby, comfort measures were key: swaddling, low lighting, gentle handling, and frequent small feedings. It’s all about minimizing stimulation and supporting both mom and baby.Nicotine is another big culprit. Smoking during pregnancy increases the risk for preterm labor, low birth weight, and even sudden infant death syndrome. And then there’s marijuana—most widely used illicit drug in pregnancy. It can cause preterm delivery and babies might have altered responses to stimuli or a high-pitched cry. Even caffeine, if it’s over 200 mg a day, can lead to growth restriction or anemia.Now, identifying substance use isn’t always straightforward. There are risk factors—like low self-esteem, poor support, psychiatric history, or socioeconomic barriers. And a lot of women are afraid to disclose their use because of stigma or fear of being reported. Screening tools like CAGE or AUDIT can help, but they’re not perfect, especially for low-level use. So, as nurses, we have to be sensitive, nonjudgmental, and really focus on building trust.I might be rambling a bit, but the main thing is—our role is to support, educate, and advocate. Whether it’s providing comfort measures for a baby with NAS or connecting a mom to resources, every little bit helps. Okay, let’s shift gears and talk about family planning and infertility, because that’s another area where nurses make a huge impact.Alright, so family planning. This is more than just picking a birth control method—it’s about helping people make informed choices that fit their lives, values, and health needs. There are so many options: behavioral methods like abstinence or fertility awareness, barrier methods like condoms and diaphragms, hormonal options like pills, patches, rings, and IUDs, and then permanent methods like vasectomy or tubal ligation. When you’re helping someone choose, you have to consider things like age, marital status, future pregnancy plans, religious beliefs, cost, and how easy it is to use. And, of course, whether it protects against STIs.Preconception care is another big piece. The goal is to optimize health before pregnancy even happens—so, things like taking folic acid, managing chronic conditions like diabetes, making sure vaccinations are up to date, and reviewing any medications that could be risky. Glycemic control is huge for people with diabetes, because high blood sugar can increase the risk of birth defects. And, honestly, just encouraging a healthy lifestyle—good nutrition, exercise, quitting smoking, all that good stuff.Now, infertility. It’s defined as not being able to conceive after a year of regular, unprotected sex. It affects about 15% of couples, and it’s not just a “female problem”—male factors are involved in a lot of cases. There are so many emotions tied up in this—frustration, grief, sometimes even shame, depending on cultural or religious beliefs. Some cultures see infertility as a violation of norms, and that can really affect how couples approach treatment. As nurses, we have to be sensitive to those beliefs and help people navigate their options.Diagnostics can get pretty technical—there’s hormone testing, semen analysis, imaging like hysterosalpingograms to check the uterus and tubes, and sometimes laparoscopy. Treatments range from medications to induce ovulation, to assisted reproductive technologies like IVF or ICSI. I remember working with a couple who were just starting infertility testing. They were overwhelmed, and honestly, kind of embarrassed. My job was to walk them through what to expect, connect them with emotional support resources, and just be there to listen. Sometimes, that’s the most important thing we can do.Nursing interventions here are all about education, psychological support, and cultural sensitivity. We encourage healthy habits—like quitting smoking, taking folic acid, managing stress—and we help couples find support groups or counseling if they need it. It’s a team effort, and every couple’s journey is different.Okay, let’s keep going and talk about menstrual dysfunction—because, wow, there’s a lot to cover there, too.Menstrual dysfunction is one of those things that can really impact quality of life, but a lot of people just kind of suffer in silence. So, let’s break down the main types. There’s amenorrhea, which is the absence of periods—either primary, where someone’s never had a period by age 14 or 16 depending on development, or secondary, where periods stop for three cycles or more in someone who used to have regular periods. Then there’s dysmenorrhea, which is just a fancy word for painful periods. Primary dysmenorrhea is usually from increased prostaglandins, while secondary is often due to something like endometriosis.Abnormal uterine bleeding, or AUB, is another big one. That’s when bleeding is prolonged, excessive, or irregular, and not due to any obvious structural cause. It’s most common at the beginning and end of reproductive years, and it’s usually related to hormone disturbances. Then we have PMS and its more severe cousin, PMDD—these involve a whole range of symptoms, from mood swings and irritability to bloating and cravings. And finally, endometriosis, where tissue similar to the uterine lining grows outside the uterus, causing pain and sometimes infertility.Assessment is all about a thorough history—menstrual patterns, pain, associated symptoms, and any underlying conditions. Sometimes we need labs or imaging, depending on what we find. For management, it’s a mix of lifestyle changes, medications, and supportive care. For example, with dysmenorrhea, comfort measures like heat therapy, increasing water and fiber intake, and stress reduction can make a big difference. I had a patient with severe dysmenorrhea who was missing school every month. We worked together on using a heating pad, practicing relaxation techniques, and making some dietary changes. Over time, her symptoms improved, and she felt more in control.For AUB, treatment might involve hormonal therapy or, in some cases, surgical options like D&C or endometrial ablation. PMS and PMDD often respond to lifestyle changes—exercise, balanced diet, reducing caffeine and alcohol, and sometimes medications like SSRIs or oral contraceptives. And with endometriosis, management can include pain meds, hormone therapy, or surgery, plus lots of education and support.I know that was a lot, but hopefully it helps make these topics a little less intimidating. Remember, as nurses, our job is to assess, educate, and support—whether it’s substance use in pregnancy, family planning, or menstrual health. Thanks for hanging out with me today, and keep an eye out for more episodes where we’ll keep breaking down the essentials. You’ve got this!

Episodes

Essential Nursing Knowledge on Substance Use, Reproduction, and Menstrual Dysfunction