Pregnancy among substance use disorder (SUD) sufferers is a tragic and common reality. According to the National Institute on Drug Abuse (NIDA), a baby is born suffering from opioid withdrawal every twenty-five minutes in the United States. There has been a fivefold increase in the number of babies suffering from neonatal abstinence syndrome over the past twenty years—so a problem that should be on the decline is getting far worse. Recognizing and addressing the factors that contribute to SUD among pregnant women, and the barriers they face when they endeavor to receive care, is critical in developing proactive solutions to this dangerous and pervasive public health issue.
The Scope of the Problem
The rate of co-occurring pregnancy and SUD is far more common than many may realize or care to admit. Data from the Yale School of Medicine indicates that smoking, drinking, and marijuana use are the leading substance use behaviors among this population; however, the use of multiple illicit substances and co-occurring mental health issues that drive substance abuse are also significant factors.
The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that:
- Nearly six percent of pregnant women use illicit drugs.
- More than eight percent of pregnant women drink alcohol.
- Nearly 16 percent of pregnant women smoke cigarettes.
The World Health Organization (WHO) reports that cannabis is the drug most prevalent in prenatal substance abuse, followed by stimulants and opioids. One recent collaborative studybetween multiple universities, including Yale and the University of Pennsylvania, revealed rates of prenatal polysubstance use (more than one substance) of more than 50 percent.
Dangers of Prenatal Substance Abuse
Using substances while pregnant dramatically increases the risk of acute and long-term health risks for both the mother and child. Risks to the fetus include but are not limited to:
- Blotchy skin coloring
- Diarrhea and vomiting
- Abnormal sucking reflex
- Fever and flu-like symptoms
- Hyperactive reflexes
- Irritability and restlessness
- Poor feeding ability
- Rapid breathing
- Seizures and trembling
- Sleeping problems
- Slow weight gain
- Excessive sweating
The most severe effects can include birth defects, low birth weight, premature birth, small head circumference, and sudden infant death syndrome (SIDS). Fetuses whose mothers abuse drugs are also at incredibly high risk for neonatal abstinence syndrome (NAS),a condition that is manifested through a variety of physical and psychological withdrawal symptoms.
Mothers are at heightened risk of effects and withdrawal symptoms commonly associated with drug and alcohol abuse; however, the involvement of a child may lead to significantly higher rates of psychological conditions like postpartum depression, anxiety, trauma, and others.
Substance Use after the Baby Is Born
One recent study from Duke University disclosed that rates of postpartum depression–related drinking were as high as 49 percent and rates of postpartum drug use were as high as 8.5 percent. The unfortunate reality is that childbirth is not always enough to help new mothers achieve and maintain sobriety, and use of tobacco, alcohol, and illicit drugs can persist long after the infant is born, creating even greater health risks for both mother and child. For example, new mothers who breastfeed while continuing to engage in substance use are almost certain to pass some of those substances on to their babies through breast milk during the feeding process.
Psychological Issues Associated with Co-Occurring Pregnancy and SUD
No mother wants to expose their child to drug or alcohol abuse. It’s important to remember that addiction is chronic medical disease (the same as heart disease, hypertension, or any other), and it requires effective, comprehensive, and compassionate care. Despite the clinical community’s recognition of addiction as a legitimate medical illness, the cultural perception of the disease is still that it’s a moral failing that should be met with scorn and dismissal. These perceptions are often compounded for pregnant women afflicted with SUD. The shame and ridicule they face as a result of their situation can lead to or exacerbate psychological conditions like depression, anxiety, and PTSD.
These toxic perceptions also inform genuine care practices and accessibility for pregnant SUD sufferers who try to enter treatment and can discourage many from seeking help altogether. A recent report from George Washington University’s Jacobs Institute for Women’s Health disclosed that only 44 percent (6,212 of 14,152) of treatment facilities offered programs specifically for adult women, and only 20 percent (2,795) offered programs for pregnant or postpartum women. The SUD treatment needs of women very often differ from men; the needs of pregnant or postpartum (one year or less from last childbirth) women can be even more distinct.
Treating SUD in Pregnant Women
Each patient’s substance use treatment needs are unique and should be customized according to their medical requirements, substance use history, and eligibility for specialized medications and modalities; however, there are a few universal elements of treatment that are crucial for long-term abstinence and sobriety, including:
- medically supervised detox. It’s critical that pregnant women have doctors manage their withdrawal management for their sake as well as their child’s. Medical detox provides patients with a safe, sterile, discreet, compassionate, and supportive environment as well as a team of medical experts that can intervene in the event of a medical emergency, the likelihood of which can be higher for pregnant patients.
- behavioral rehab. While the exact nature and design of the individual rehab process can be more customized, it is still highly recommended that pregnant SUD sufferers undergo rehab to address the root causes of their substance use, psychological factors that have emerged through their co-occurring pregnancy and SUD, and the fallout that has occurred as a result of their prolonged and untreated drug or alcohol use. Rehab should also provide an aftercare plan that can help patients avoid relapse.
After their immediate course of treatment, it is recommended that patients receive ongoing psychiatric therapy that builds on the progress they made in rehab. Pregnant patients have to exercise more caution when endeavoring to use maintenance drugs like methadone, buprenorphine, or naltrexone, as well as alcohol medications like Acamprosate and Disulfiram. SAMHSA has endorsed methadone use for pregnant opioid use disorder patients but advises caution regarding pregnant women using Acamprosate and Disulfiram. Individual patients are urged to speak with their physicians about their eligibility for these drugs.
Don’t Be Afraid to Ask for Help
If you or a loved one are experiencing simultaneous pregnancy and SUD, don’t let the fear of shame or stigma get in the way of you getting the help you need for you or your child. There are more compassionate and effective treatment resources than ever out there for pregnant women. Treatment options may be available through Medicaid, employer-based health insurance, and other state-funded programs. You’re stronger than addiction. Get the help you need today.
- drugabuse.gov -Dramatic Increases in Maternal Opioid Use and Neonatal Abstinence Syndrome
- ncbi.nlm.nih.gov – Substance use during pregnancy
- samhsa.gov -National Survey on Drug Use and Health:
Summary of National Findings
- unodc.org – World Drug Report
- ncbi.nlm.nih.gov – Perinatal Substance Use: A Prospective Evaluation of Abstinence and Relapse
- stanfordchildrens.org – Neonatal Abstinence Syndrome
- ncbi.nlm.nih.gov – Postpartum Substance Use and Depressive Symptoms: A Review
- publichealth.gwu.edu – Pregnant women and Substance use
- store.samhsa.gov – Methadone Treatment For Pregnant Women