Addiction Among Pregnant Women
Evaluating an Individual’s Treatment Needs
Addiction Among Pregnant Women
During pregnancy, addiction treatment can mean the difference between having a healthy child and losing a baby or giving birth to an infant with serious developmental problems. Although many pregnant women and teens fear the repercussions of having their drug or alcohol use exposed, the fact remains that recovering from substance abuse is much safer than giving birth while actively addicted. Drugs and alcohol can cause serious complications with pregnancy, as well as harm to the physical and cognitive development of the fetus. In addition, a life of drug use and addiction exposes pregnant women and girls to violence, crime, legal persecution, and communicable disease.
Yet in spite of the risks of substance abuse during pregnancy, national statistics indicate that many pregnant women continue to drink heavily or take drugs. The 2013 National Survey on Drug Use and Health (NSDUH) reports the following statistics on substance abuse in pregnant women:
- Approximately 5.4 percent of pregnant females age 15-44 were actively using illicit drugs at the time of the survey, compared with 11.4 percent of non-pregnant females.
- Pregnant teens age 15-17 were more likely to abuse drugs than older teens and women (14.6 percent versus 3.2 percent) who were pregnant.
- About 9.4 percent of pregnant women reported that they were active users of alcohol.
- Approximately 2.3 percent of pregnant women reported binge drinking, or consuming five or more alcoholic beverages in one sitting, while 0.4 percent reported that they were current heavy drinkers.
Fortunately, a significant number of pregnant women are actively seeking help for addiction. According to the Treatment Episode Data Set (TEDS) Report of 2013, 4.4 percent of the women age 15-44 who sought treatment for drug or alcohol addiction in that year were pregnant. Among pregnant treatment admissions, the percentage seeking treatment for alcohol abuse fell from 46.6 percent to 34.8 percent between 2000 and 2010. However, the number of pregnant females in treatment for drug abuse rose from 51.1 percent to 63.8 percent in that same time frame.
Effects of Substance Abuse on Mother and Baby
Throughout the development of a fetus, vital nutrients and oxygen are filtered from mother to infant through the placenta, a layer of tissue and blood vessels that lines the uterus. Together with the umbilical cord, the placenta acts as a lifeline for the growing fetus. However, the harmful compounds contained in alcohol, marijuana, cocaine, heroin, and other drugs can also cross the placenta and affect the baby. In addition, these compounds can harm the placenta itself, interrupting the exchange of nutrients and the elimination of waste materials.
Alcohol and drugs can have a devastating effect on the course of a pregnancy and the development of the fetus. The Merck Manual notes that women who drink alcohol while they are pregnant are nearly 50 percent more likely to have a miscarriage and substantially more likely to give birth to a baby with low birth weight.
The complications caused by drug and alcohol use do not end after childbirth. Neonatal abstinence syndrome, or NAS, occurs when an infant is born addicted to drugs, especially opioids. Within 24-72 hours after birth, newborns can experience severe withdrawal symptoms as their brain and nervous systems adjust to the absence of chemicals.
As they grow older, babies born exposed to drugs or alcohol before birth are more vulnerable to developmental delays, learning problems, and behavioral disorders. They may also have a higher risk of premature death from sudden infant death syndrome (SIDS) and other causes.
Quitting drugs and alcohol significantly reduces the risk of the following complications of pregnancy:
- Placental abruption, or the separation of the placenta from the uterus
- Premature labor
These withdrawal symptoms include:
- Muscle spasms
- Feeding difficulties
- Sleeping problems
- Rapid breathing
Treatment can reduce the risk of serious birth defects and problems with development, including:
- Low fetal birth weight
- Fetal alcohol syndrome (FAS)
- Neurological defects
- Deformities of the face, such as cleft palate
- Deformities of the skull, such as an abnormally small head
- Neonatal abstinence syndrome (NAS)
- Sudden infant death syndrome (SIDS)
Within 24-72 hours after birth, newborns can experience severe withdrawal symptoms as their brain and nervous systems adjust to the absence of chemicals.
Common Drugs of Abuse and Their Effects on Fetal Health
Any chemical substance, whether legally prescribed by a doctor or used illegally for recreational purposes, can have a direct effect on the growth and health of the fetus. Listed below are some of the most commonly abused drugs among pregnant women, and their effects on fetal health:
Alcohol exposure during pregnancy is the number one cause of birth defects, according to the Merck Manual. Alcohol abuse can lead to fetal alcohol syndrome, or FAS, a condition that can cause neurological deficits, low birth weight, facial deformities, small head circumference in infants, along with cognitive and behavioral problems in toddlers and older children. Alcoholism also greatly increases the risk of miscarriage and stillbirth during pregnancy and delivery.
The effects of tetrahydrocannabinol, the active chemical in marijuana, on fetal health are still being studied. Although there is no clear evidence of the effects of marijuana on pregnant women or their babies, heavy marijuana use during pregnancy may lead to developmental delays or behavioral problems in infants and children. The National Institute on Drug Abuse states that infants exposed to marijuana before birth have higher levels of learning disabilities, attention disorders, and memory problems later in childhood.
Cocaine is an illegal central nervous stimulant that can produce addiction in a mother and her unborn baby. Cocaine abuse can cause complications with pregnancy, such as placental abruption, premature labor, and miscarriage, as well as fetal growth restriction and small head circumference in newborns. Infants born addicted to cocaine show symptoms of neonatal abstinence syndrome, including tremors, high-pitched cries, vomiting, or seizures. Cocaine exposure in the womb may also lead to a higher risk of learning disabilities and developmental problems later in childhood.
This illicit opioid is a central nervous system depressant, which poses a serious risk of addiction and overdose to pregnant women. Pregnant women who abuse heroin intravenously (“shooting up”) are exposed to communicable diseases through shared needles. Heroin abuse in a pregnant woman can lead to opioid dependency in her unborn baby, resulting in withdrawal syndrome after birth. Heroin may also contribute to low birth weight, fetal growth restriction, and birth defects.
- Meth, ecstasy, and other club drugs:
Meth (short for methamphetamine), ecstasy, and other psychoactive stimulants are popular in the club scene. These drugs can have serious side effects on pregnant women, including rapid heart rate, high blood pressure, appetite loss, sleeping problems, nausea, and vomiting. According to March of Dimes, club drugs can also increase the risk of low birth weight, birth defects, and neonatal abstinence syndrome.
- Prescription drugs:
Opioid pain relievers, sedatives, and sleep aids may be prescribed to pregnant women to help them cope with the discomfort of pregnancy. However, the effects of these drugs on fetal development may not be fully known. According to the Journal of Obstetrics and Gynecology, infants born to opioid-addicted mothers have higher rates of neural tube defects, or defects of the brain and spinal cord. Mothers who abuse opioid pain medications, such as Vicodin, Percocet, or Norco, may give birth to opioid-dependent babies, who are at high risk of neonatal withdrawal syndrome.
Alcohol and Infant Death: Is There a Connection?
Alcohol abuse during pregnancy could have fatal consequences for newborns. A study published in Pediatrics found a strong association between maternal alcohol abuse and infant mortality. Babies born to women who abused alcohol during pregnancy or during the first year after pregnancy had a 50 percent higher risk of death than babies born to nonalcoholic mothers, the journal reported, and at least 16.4 percent of cases of SIDS were associated with maternal alcohol abuse.
Substance Abuse and Depression during Pregnancy
The emotional, physical, and financial stress caused by pregnancy can trigger episodes of depression or anxiety in women, even if they have not previously been diagnosed with a mental illness. The American College of Obstetricians and Gynecologists (ACOG) estimates that between 14 and 23 percent of pregnant women experience antepartum depression, or depression before childbirth. Because some of the primary symptoms of depression, such as episodes of sadness, mood swings, low energy levels, and sleep disturbances, mimic the symptoms of pregnancy, it can be difficult to diagnose depression in pregnant patients. However, identifying depression during pregnancy is vitally important, as this serious mental condition can lead to the following:
- Low motivation to seek prenatal care
- An increased risk of pregnancy complications
- Lower fetal birth weight
- A higher rate of drug or alcohol abuse
- An increased risk of suicidal thoughts and suicide attempts
- An increased risk of postpartum depression
- Difficulty bonding with the baby after birth
In pregnant women, as in any other group, mental illness and substance abuse often exist simultaneously. Pregnant women who are depressed may turn to alcohol or drugs in order to relieve feelings of hopelessness, despair, or sadness. But the use of central nervous system depressants like alcohol or tranquilizing medications can ultimately make depressive symptoms worse.
Pregnant women whose symptoms are mild to moderate often respond well to individual or group therapy without needing antidepressants. For women with more severe depressive symptoms, antidepressant medication may be necessary to ensure the mother’s health and reduce the chances of harm to the baby. Although the use of antidepressants poses some level of risk to the developing fetus, the health benefits of pharmaceutical treatment for mother and baby often outweigh those dangers. Mayo Clinic notes that most popular antidepressant medications, such as the selective serotonin reuptake inhibitors (SSRIs), are generally safe for pregnant women and developing babies, especially when compared to the negative impact of maternal depression.
Obstacles to Rehab and Recovery
Even if they are aware of the risks of using drugs and alcohol during pregnancy, many women avoid treatment because they are afraid of the consequences of being caught using drugs or drinking. They may be concerned about custody issues involving other children or the legal ramifications of illicit drug use during pregnancy. They may also worry about being judged or criticized for their addictive behaviors by clinicians or peers who view addiction as a lifestyle choice rather than a disease.
The American College of Obstetricians and Gynecologists (ACOG) has spoken out against the criminalization of drug use during pregnancy when it is believed that substance abuse can cause fetal harm. ACOG opposes this attitude for the following reasons:
- The threat of incarceration or mandatory institutionalization discourages women from seeking help for drug addiction.
- Legal measures to punish women for substance abuse in pregnancy have been unsuccessful at reducing the rate of drug or alcohol abuse in pregnant women.
- Laws mandating obstetricians to report substance abuse in their patients violate the confidentiality of the patient-physician relationship.
- Measures to penalize addicted women with the loss of custody, loss of housing, or involuntary commitment treat addiction as a failure of character rather than a chronic, progressive disease.
Although some states have initiated laws to treat substance abuse as a form of child abuse, there are still many medical professionals and treatment facilities that provide confidential, compassionate care to help pregnant women recover from addiction and to maximize their chances of having a healthy pregnancy.
Therapies for Substance Abuse in Pregnancy
Getting help for substance abuse can benefit both a mother and her unborn baby in numerous ways. In addition to reducing the risk of miscarriage and birth defects, a comprehensive rehab program can help to restore the mother’s physical and psychological health. During alcohol or drug detox, the body is cleared of chemical intoxicants. Women suffering from poor nutrition and insufficient hydration can receive the nutrients and fluids they need to sustain a healthy pregnancy.
In addition to recovery activities and therapies, pregnant women in rehab have access to a psychosocial support system that consists of doctors, nurses, therapists, and social workers. Pregnant women need access to affordable prenatal services, as well as referrals to obstetricians, nutritionists, and pediatricians. After birth, they may need assistance with housing, transportation, childcare, and occupational counseling.
Women suffering from poor nutrition and insufficient hydration can receive the nutrients and fluids they need to sustain a healthy pregnancy.
Once they are clinically stable, pregnant clients can receive the therapeutic services needed to abstain from drugs and alcohol before and after childbirth, such as:
- Alcohol or drug detox
- Individual therapy
- Peer support groups
- Family counseling
- Medication-assisted treatment
- Experiential therapies
- Case management
Opioid Treatment in Pregnancy: Which Choice Is Best?
Pregnant women who are addicted to heroin or prescription opioids have a choice of two medications to help them stay drug-free and avoid withdrawal symptoms: methadone or buprenorphine. Both of these opiate-replacement drugs have been approved by the U.S. Food and Drug Administration for use during pregnancy, and both have had good results at helping women complete rehab with minimal complications or withdrawal symptoms. Methadone is an older medication, available since the 1960s, while buprenorphine (sold as Suboxone or Subutex) was approved for use in 2002. Pregnant women who take methadone must do so through a structured medication assistance program, administered by a specialized clinic or rehab center. Buprenorphine can be dispensed by any physician or healthcare facility certified in its use.
Although both drugs are very effective, Suboxone offers more flexibility to the client and may be easier to obtain. Clinical research shows that Suboxone may also produce fewer withdrawal symptoms in newborns. A 2010 study called Maternal Opioid Treatment: Human Experimental Research (MOTHER) compared the effects of methadone and Suboxone in a group of pregnant women and infants. In this clinical trial, buprenorphine was found to improve outcomes for newborns, with fewer cases of neonatal abstinence syndrome. Although both methadone and buprenorphine are considered safe for pregnant women and can significantly reduce the risk of NAS in infants, babies born to mothers using buprenorphine/Suboxone had shorter hospital stays and fewer post-birth complications.
Staying Drug-Free after Pregnancy
Although many women are able to stay sober or drug-free while they’re pregnant, relapse can occur after the baby is born, especially among women who haven’t had the support of a professional rehab program. After the baby is born, continued support from an aftercare program can ensure the health and wellbeing of mother and baby.
The components of an aftercare program for pregnant women and new mothers include:
- Counseling sessions with a therapist
- Medication management
- Transitional housing in a sober living environment
- Participation in community support groups or 12-Step programs
- Participation in alumni groups with peers who have finished rehab
- Referrals to services for pregnant women and mothers, such as postnatal care, childcare, affordable housing, transportation, and educational or occupational counseling
Residential treatment in a specialized rehab program may be the most effective approach to promoting long-term abstinence in pregnant women and mothers. The Journal of Substance Abuse published a study of 305 women enrolled in a residential treatment program dedicated to the needs of pregnant and parenting women. The participants’ level of functioning was assessed before and after treatment.
The study found that the majority of women showed improvement in the following areas:
- Reduced substance use
- Improved employment records
- Fewer legal conflicts
- Fewer mental health symptoms
- A more positive attitude toward parenting
- Fewer high-risk behaviors
This study, and others like it, confirm that connecting women with the services they need to have healthy pregnancies and healthy children is a top priority for families and communities. Professional rehab programs offer ongoing support for women who have taken on the challenging task of parenting while working to overcome the disease of addiction.
Residential treatment in a specialized rehab program may be the most effective approach to promoting long-term abstinence in pregnant women and mothers.
- American Pregnancy Helpline: Pregnancy and Illegal Drug Use: This free, confidential telephone hotline provides information and support for young women and teens seeking answers to their questions about pregnancy, childbirth, substance abuse, and recovery.
- Twelve Steps to a Healthy Pregnancy: This website covers all aspects of maternal and perinatal health in a concise and approachable manner, from prenatal care to nutrition, exercise, safe medication use, and mental health care during pregnancy.
- March of Dimes: Street Drugs and Pregnancy: This charitable organization, which is dedicated to fighting premature birth and birth defects, offers a comprehensive discussion of the effects of illegal drugs on fetal growth and infant development, along with resources for individuals seeking education or support services.
- Merck Manual Consumer Version: Drug Use During Pregnancy: A comprehensive, detailed listing of legal medications and illicit drugs, and their effects on pregnancy and fetal development.
- Mother To Baby: is an educational service dedicated to providing information about the effects of medications, illegal drugs, and other substances on fetal health and development. This informative website is sponsored by the Organization of Teratology Information Specialists (OTIS), which specializes in the study of fetal development and birth defects.
- National Perinatal Association: Advocacy for pregnant women and their families, as well as education for healthcare professionals and the public on healthy pregnancy, are the primary goals of this nationwide organization. Its website offers links to educational services, advocacy resources, and information about support groups for pregnant women and their families across the country.