FACTORS AND CONSEQUENCES OF PRENATAL DRUG EXPOSURE: a multiphase mixed methods study in a maternal-neonatal population in Alagoas.
Maternal and Child Health. Substance-Related Disorders. Culturally Competent Care. Health Profile. Polymorphism, Genetic.
The uncontrolled use of drugs by the world population has become a public health problem. When used during pregnancy, it can have consequences for the mother, fetus or newborn. In this context, the present study aimed to investigate the factors and outcomes of prenatal exposure to drugs, in the first hours of life, in a maternal neonatal population in a region of Alagoas. This is an ethnoepidemiological, clinical and genetic investigation, with a mixed methods approach by concomitant triangulation, which brings results from four studies that composed a multiphase main research project. Data collection took place between January 2019 and March 2020, in maternity hospitals in Arapiraca, whose population of interest was mothers and their newborns. The study was developed in four phases, with parallel extension actions whose focus was the translation of knowledge. The qualitative approach of the main project was carried out from an ethnographic study and discussions in the light of Leininger's Theory. The quantitative approach occurred through clinical, epidemiological and genetic studies, where it was possible to apply the KDD process through the WEKA tool. Other quantitative data analyzes were performed using SNPStats, BioEstat and G*Power software. In a multiphase combination, the interface of the qualitative and quantitative elements took place in an objective structure of the main project, at an interactive level, with equal emphasis, in addition to having used within the larger project priority quantitative studies followed by supplementary qualitative studies. Among the main results it was possible to identify that most mothers, more than 60%, were young, brown skin, married women, with low education and income, in social vulnerability. Caffeine, alcohol and tobacco were the most consumed drugs, in 73% of mothers, with a strong family influence. The interrelationship sociocultural of technological, religious and philosophical, kinship and social, cultural values, belief and lifeways, political and legal, economic, and educational factors, was observed when analyzing the characteristics of postpartum women. Neonates manifested neurobehavioral alterations or Neonatal Withdrawal Syndrome in 29.5% of cases. In addition, newborns who presented below-expected neurobehavioral assessment results were more likely to present changes mainly in the dimensions of tone and type of tone, behavior, reflex, movement and abnormal signs, compared to newborns who presented satisfactory results. In the search for the etiopathogenesis of neurobehavioral dysfunctions, the genetic study performed did not show a significant difference when evaluating the genotypic and allelic frequencies of -819C/T (IL-10) and -308G/A (TNFA) polymorphisms in the groups of neonates in the study. By from this study, it was possible to understand the sociocultural aspects that involve maternal-neonatal exposure to drugs, indicate the most relevant neonatal clinical markers to be evaluated, such as myoclonic spasms and ventral suspension, in addition to presenting different, expressive and complementary elements that can support further studies and contribute to qualified maternal-neonatal care. As a characteristic of a multiphase project, the study demonstrates the need to continue advancing towards general objective.