Drug Use During Pregnancy
Substance abuse can negatively impact lives beyond that of the user. This is especially the case when a woman addicted to drugs or alcohol becomes pregnant. The 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, addicted to drugs, and with lifelong challenges for the due to drug exposure in utero.
Pregnancy Substance Abuse Demographics
Rates of substance abuse during pregnancy in the U.S. have remained 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. Also 9.4% reported alcohol use.2 In surveys, 20% of all women reported consuming some alcohol during pregnancy. Rates of alcohol use during pregnancy have decreased in the last 15 years. This is 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 than reported. Pregnant women often underreport substance use for reasons including fear of judgment from others or punishments. They do not want to risk losing their baby to child protective services.2,4 The majority of pregnant women who use illegal substances may also use legal drugs such as alcohol. This can impact the fetus leading to fetal alcohol syndrome which is discussed below.2
The introduction of long-acting oxycodone in the mid-1990s has contributed to a growing trend of prescription opioid misuse. Opioid use is currently 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
Psychoactive drugs enter the circulation of the developing fetus. Maternal use of these drugs can 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
- Timing of exposure
- Duration of exposure
The effects are not immediately apparent, and many cognitive issues do not manifest until adolescence. To 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. When a pregnant woman continues to use opioids, the infant can experience acute opioid abstinence syndrome. This includes symptoms of gastrointestinal, respiratory, autonomic and central nervous system (CNS) problems. This condition affects 50% to 80% of all opioid-exposed infants.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). This is the leading, nonhereditary cause of intellectual disability in the Western world.2 Experts estimate that the full range of FASDs may affect as many as five in 100 schoolchildren. Fetal alcohol syndrome can cause a baby to be born with:
- Growth problems
- Nervous system abnormalities
- Intellectual disabilities
- Facial deformities
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. This should include prescription opioids and other medications used. Healthcare providers must reassure women that the information will be kept confidential. Maintaining a nonjudgmental approach is key to obtaining the most accurate information.4
The most common methods to assess prenatal drug exposure are:
- Self-reporting by the mother
- Urine toxicology screens
Maternal urine toxicology screening can detect drugs including:
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
The prevalence of substance abuse during pregnancy requires a treatment team. All practicing obstetrician-gynecologists must be informed about its implications. They should work with addiction specialists as part of a multidisciplinary team on appropriate management strategies including detox and rehab.4
In a U.S. survey of 946 pregnant opioid-using women entering treatment, 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 to report an unintended pregnancy. Teens who used drugs were at greater risk of participating in risky sexual behavior and its consequences. These may include sexually transmitted infections and unintended pregnancy.6
Researchers theorize that female substance abusers likely face obstacles in reproductive healthcare services. One solution would be the integration of contraceptive services into drug health clinics. This 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 than those who do not receive therapy. Women who receive treatment have babies with higher birth weights, fewer birth complications. It is common for infants of methadone-exposed pregnant women to experience complications. Some of these complications include:
- Decreased fetal heart rate
- Higher risk of mortality in the first year of life
- Sudden infant death syndrome
- Long QT syndrome, a heart rhythm disorder that can cause serious irregular heart arrhythmias7
Make the Right Decision About Ending Drug Use: It’s Never Too Late
Motherhood presents both challenges and great joys. Abusing drugs during pregnancy is unhealthy for the mother and unborn child. Living drug free helps women be better prepared for personal and parental success. If you are pregnant and struggling with drug addiction, talk about it with your physician. Make the decision to undergo detox sooner rather than later. This will not only provide your child with a healthier start in life. It can also prevent dangerous drug-related health complications. It is possible to detox while pregnant. For safety, 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. https://www.ncbi.nlm.nih.gov/pubmed/27375357 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. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4640424/ 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. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2139915/ 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. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4869602/ 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. https://www.ncbi.nlm.nih.gov/pubmed/26869865 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. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4497510/ 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.