Alcohol Withdrawal Management and Relapse Prevention in Pregnancy

Abstract

Objectives: The aim of this is to provide a clinical example of acute alcohol withdrawal management and alcohol use disorder (AUD) relapse prevention, followed by a systematic review of the existing literature that provides clinicians with suggestions regarding treatment of this common clinical scenario. Methods: A case report was prepared with respect to the medical management of a patient that had been seen by our team. We searched “PubMed” and “The UBC Library Online Collections” using the search limits of subject terms for “alcohol withdrawal,” and “pregnancy,” and all fields for “management,” NOT “opioid.” We also reviewed medications frequently used in treating AUD as per the existing literature. Results: One case report met our search criteria. We also reviewed the recently published guidelines by the American Psychiatric Association. Several medications used in acute alcohol withdrawal and relapse prevention are known teratogens. However, several medications appear to be compatible with pregnancy and were found to be Category C and their use may outweigh the risks. Conclusions: There is a paucity of synthesized literature pertaining to alcohol withdrawal treatment and pregnancy. Given the relatively high prevalence of AUD in the population, further investigation is warranted. The current data supports a thorough consideration of the risks of medications against the known teratogenicity of alcohol. We suggest only brief use of benzodiazepines to manage the acute withdrawal from alcohol. Gabapentin, naltrexone, or acamprosate could be considered for AUD relapse prevention. Objectifs: L’objectif est de fournir un exemple clinique de gestion du sevrage alcoolique aigu et de prévention des rechutes liées à l’usage de l’alcool, suivi d’un examen systématique de la littérature existante fournissant aux cliniciens des suggestions concernant le traitement de ce scénario clinique courant. Méthodes: Un rapport de cas a été préparé concernant la gestion médicale d’un patient vu par notre équipe. Nous avons effectué une recherche dans «PubMed» et «Les collections en ligne de la bibliothèque de l’UBC» en limitant la recherche des termes utilisés pour «sevrage alcoolique» et «grossesse» et tous les champs pour «gestion», excluant «opioïdes». Nous avons également passé en revue les médicaments fréquemment utilisés dans le traitement des troubles liés à la consommation d’alcool, conformément à la littérature existante. Résultats: Une analyse de cas répondait à nos critères de recherche. Nous avons également examiné les lignes directrices récemment publiées par l’American Psychiatric Association. Plusieurs médicaments utilisés dans le sevrage alcoolique aigu et la prévention des rechutes sont connus comme agents tératogènes. Cependant, plusieurs médicaments semblent être compatibles avec la grossesse et se sont avérés être de la catégorie C et les effets bénéfiques l’emportaient sur les risques. Conclusion: Il existe peu d’études synthétisées sur le traitement de sevrage alcoolique en lien avec la grossesse. Compte tenu de la prévalence relativement élevée de troubles liées à la consommation d’alcool dans la population, des investigations supplémentaires sont nécessaires. Les données actuelles justifient un examen approfondi des risques des médicaments contre la tératogénicité connue de l’alcool. Nous suggérons de n’utiliser que brièvement les benzodiazépines pour gérer le sevrage aigu de l’alcool. La gabapentine, la naltrexone ou l’acamprosate pourraient être envisagés pour la prévention des rechutes liées à l’alcoolisme.

Treatment of Gamma Hydroxybutyrate Withdrawal in a Pregnant Female: A Case Report

“…Acute and severe GHB withdrawal likely places pregnant people at higher risk of adverse obstetrical outcomes, and inpatient management of this process is warranted. 1,3,5,11,12 However, the lack of guidelines for this population make clinical decision-making challenging. The literature for the general population recommends benzodiazepines as the first-line approach to alcohol withdrawal syndrome.…”

“…Acute and severe GHB withdrawal likely places pregnant people at higher risk of adverse obstetrical outcomes, and inpatient management of this process is warranted 1,3,5,11,12 . However, the lack of guidelines for this population make clinical decision-making challenging.…”

“…Because data on fetal effects of acute GHB withdrawal are limited, we drew on the available literature for acute alcohol withdrawal in pregnancy. Adverse perinatal outcomes including placental abruption, preterm labor, and fetal distress are associated with acute alcohol withdrawal 12 . In the only known case study of GHB withdrawal management during pregnancy, 5 a patient in the third trimester presented with seizure caused by severe withdrawal.…”

“…Adverse perinatal outcomes including placental abruption, preterm labor, and fetal distress are associated with acute alcohol withdrawal. 12 In the only known case study of GHB withdrawal management during pregnancy, 5 a patient in the third trimester presented with seizure caused by severe withdrawal. Symptoms rapidly progressed to delirium with dangerous and erratic behavior.…”