Detox During Pregnancy
Substance abuse negatively impacts lives beyond that of the user. This is especially the case when a woman addicted to drugs or alcohol becomes pregnant. The detrimental prenatal and postnatal effects of drugs and alcohol on infants are well-documented. Women who continue to abuse drugs during pregnancy greatly increase the risk of giving birth to an infant with serious birth defects, the likelihood that he or she will be born addicted to drugs, and lifelong challenges for the child due to drug exposure in utero.
Pregnancy Substance Abuse Demographics
Rates of substance abuse during pregnancy in the U.S. have remained relatively stable since the early 1990s1. According to the 2013 U.S. National Survey on Drug Use and Health, 5.4% of all pregnant women reported current illicit drug use while 9.4% reported alcohol use.2 In multiple surveys prior to 2001, 20% of all women reported consuming some alcohol during pregnancy. Rates of alcohol use during pregnancy have decreased in the last 15 years due in part to increased public education and awareness regarding the detrimental effects on the infant.3
The actual number of children who have been exposed to drugs in utero may be higher because pregnant women often underreport substance use for reasons including fear of reprisals, such as losing their baby to child protective services.2,4 The majority of pregnant women who use illegal substances during pregnancy also use legal drugs, which also can negatively impact the fetus.2
The introduction of long-acting oxycodone in the mid-1990s and the significant increase in opiate prescriptions has contributed to a growing trend of prescription opiate misuse. Opioids are now the most common reason why pregnant women seek treatment for illicit substances. Recent research indicates pregnant women also seek treatment for the following drugs.1
- Marijuana (20%)
- Methamphetamines (15.6%)
- Cocaine (7.4%)
- Tranquilizers and sedatives (1.2%)
- Hallucinogens and PCP (0.6%)
The Effects of Substance Abuse on Children
Since nearly all psychoactive drugs enter the circulation of the developing fetus, maternal use of these drugs has the potential to disrupt normal development of the infant’s brain. The degree to which these drugs influence fetal development depends on factors including the chemical properties of the drug, dose, timing and duration of exposure. Not all of the effects are immediately apparent, and in fact, many cognitive issues do not manifest until adolescence. To fully understand the effects of prenatal drug exposure, it is essential to follow up with drug-exposed children into their teen years.4
- Heroin withdrawal is not fatal to healthy adults, however, fetal death is a risk in pregnant women who are not treated for opioid addiction because infants can experience acute opioid abstinence syndrome. The condition affects 50% to 80% of all opioid-exposed infants, and is characterized by gastrointestinal, respiratory, autonomic and central nervous system (CNS) problems.4
- In three of four case studies, there was an association between pregnant women who used codeine in the first trimester and infants born with congenital heart defects.4
- In utero exposure to alcohol can lead to fetal alcohol spectrum disorder (FASD), which is the leading, nonhereditary cause of intellectual disability in the Western world.2 Experts estimate that the full range of FASDs in the U.S. and some Western European countries may affect as many as five in 100 schoolchildren.5 Symptoms include growth retardation, facial deformities and intellectual disabilities associated with CNS dysfunction.
Screening for substance abuse is a part of complete obstetric care and should be done with cooperation of pregnant woman. Prior to pregnancy and early in the first trimester, all women should be routinely asked about their use of alcohol and drugs, including prescription opioids and other medications used for nonmedical reasons. Healthcare providers must maintain an unbiased approach and reassure women that the information will be kept confidential. Maintaining a caring and nonjudgmental approach is key to obtaining the most complete disclosure regarding substances used.4
The most common methods to assess prenatal drug exposure are self-reporting by the mother and urine toxicology screens. Maternal urine toxicology screening can detect drugs including cocaine, amphetamines, marihuana, barbiturates and opiates. However, this method only detects recent drug use and yields no data on the quantity or frequency of drug use. Alcohol can also be detected by urine toxicology screenings, but only within 24 hours of intake.4
While there is extensive research, albeit ever-changing, on the repercussions of substance abuse in fetuses and infants, there is considerably less information on detox for women who are pregnant. The prevalence of substance abuse during pregnancy requires that all practicing obstetrician-gynecologists be informed about its implications and work with addiction specialists as part of a multidisciplinary team on appropriate management strategies including detox and rehab.4
In a survey of 946 pregnant opioid-using women entering treatment in the U.S., 86% reported a history of at least one unintended pregnancy. Women who reported recent use of illicit drugs other than cannabis were almost three and a half times more likely than other women to report an unintended pregnancy. Teens who used alcohol, cannabis or other drugs were at greater risk of participating in risky sexual behavior and its consequences, such as sexually transmitted infections and unintended pregnancy.6
Researchers theorize that female substance abusers likely face obstacles in accessing reproductive healthcare services. One solution would be the integration of contraceptive services into drug health clinics, which would enable women to more easily address their various health needs in a familiar and less-threatening environment.6
Detox Research Findings
Methadone is the routine substitution therapy for heroin-addicted pregnant women. Pregnant women on methadone therapy have better prenatal care compared to women who do not receive therapy. Women who receive treatment have babies with higher birth weights, as well as fewer obstetric complications, preterm births and neonatal morbidity. Despite these benefits, it is common for infants of methadone-exposed pregnant women to experience complications. These include decreased fetal heart rate, a higher risk of mortality in the first year of life, sudden infant death syndrome and Long QT syndrome, a heart rhythm disorder that can cause serious irregular heart arrhythmias.7
The Maternal Opioid Treatment: Human Experimental Research (MOTHER) trial was undertaken to understand the complex issues involved in treating opioid-dependent pregnant women. This encompassed the safety and impact of medications used for detox in pregnant women and fetuses.8 The trial included 131 pregnant women who were addicted to opioids including heroin or prescription pain medication, with low rates of other illicit drug use.9
The MOTHER trial concluded that compared to methadone, buprenorphine was acceptable for managing opioid dependence during pregnancy. While there were no statistical differences in the maternal outcome between buprenorphine and methadone, buprenorphine resulted in less severe cases of neonatal abstinence syndrome.1
Make the Right Decision About Ending Drug Use: It’s Never Too Late
Motherhood presents challenges and great joy. Abusing drugs during pregnancy is unhealthy for the mother and unborn child. Living drug free enables women to be better prepared for personal and parental success. If you are pregnant and struggling with drug addiction, talk about it with your physician and make the decision sooner rather than later to undergo detox. This will not only provide your child with a healthier start in life, but can also prevent potentially dangerous drug-related maternal health complications. It is possible to detox while pregnant, however, it must be done under the care of a multidisciplinary team with specialized skills due to the inherent risks to both mother and child.
- Jumah NA. Rural, Pregnant, and Opioid Dependent: A Systematic Review. Subst Abuse. 2016 Jun 20;10(Suppl 1):35-41. doi: 10.4137/SART.S34547. eCollection 2016.
- Konijnenberg C1. Methodological Issues in Assessing the Impact of Prenatal Drug Exposure. Subst Abuse. 2015 Nov 8;9(Suppl 2):39-44. doi: 10.4137/SART.S23544. eCollection 2015.
- Bhuvaneswar CG, Chang G, Epstein LA, Stern TA. Alcohol Use During Pregnancy: Prevalence and Impact. Prim Care Companion J Clin Psychiatry. 2007;9(6):455-460.
- Opioid Abuse, Dependence, and Addiction in Pregnancy. American College of Obstetricians and Gynecologists website. http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/Opioid-Abuse-Dependence-and-Addiction-in-Pregnancy Published May 2012. Updated July 27, 2016.
- Fetal Alcohol Spectrum Disorders (FASDs). Centers for Disease Control and Prevention website. http://www.cdc.gov/ncbddd/fasd/data.html Updated November 17, 2015. Accessed July 27, 2016.
- Black KI, Day CA. Improving Access to Long-Acting Contraceptive Methods and Reducing Unplanned Pregnancy Among Women with Substance Use Disorders. Subst Abuse. 2016;10(Suppl 1):27-33. doi:10.4137/SART.S34555.
- Alinejad S, Kazemi T, Zamani N, Hoffman RS, Mehrpour O. A systematic review of the cardiotoxicity of methadone. EXCLI J. 2015;14:577-600. doi:10.17179/excli2015-553.
- Jones HE, Fischer G, Heil SH, et al. Maternal Opioid Treatment: Human Experimental Research (MOTHER) – Approach, Issues, and Lessons Learned. Addiction. 2012 Nov;107 Suppl 1:28-35. doi: 10.1111/j.1360-0443.2012.04036.x.
- Choosing Treatment for Pregnant Women Addicted to Opioids. Partnership for Drug-Free Kids website. http://www.drugfree.org/news-service/choosing-treatment-for-pregnant-women-addicted-to-opioids/ Published May 11, 2012. Accessed July 27, 2016.