pregnancy and abuse

According to the most recent national survey, an estimated 24.6 million Americans are considered current illicit drug users, which means that they used drugs within 30 days of the survey being conducted.[1] Continued and regular drug or alcohol abuse can lead to changes in the brain and a psychological and physical dependence may form. This dependency to drugs or alcohol does not magically disappear when a woman becomes pregnant, even when the mother-to-be recognizes that continuing to abuse illicit substances puts the fetus at risk.

Data from a 2010 national survey found that over 60 percent of the women between ages 18 and 44 who use alcohol do not have children living at home and are not pregnant. While rates of alcohol use among pregnant women declined during the three trimesters of pregnancy, many women do consume alcohol during pregnancy. The same survey of women who drink alcohol showed that among those who were pregnant, 19 percent used alcohol in the first trimester, 7.8 percent in the second, and 6.2 percent drank alcohol in the third trimester.[2] Another 4.4 percent of pregnant women reported using some form of illicit drugs within the month prior to the national survey as well.[3]

Any use of alcohol or drugs during pregnancy may have devastating effects on the unborn baby. Between 800,000 and one million fetuses are estimated to be exposed to either illegal or legal mind-altering substances, which includes alcohol, each year.[4]

Risks of Substance Abuse During Pregnancy

Abusing drugs resulted in 2.5 million visits to emergency departments in 2011.[5] Illicit drugs, controlled substances, and alcohol have mind-altering effects and can result in a plethora of negative consequences and potential risk factors. Drug overdose is the leading cause of injury death in America, and 44 people die every day in the United States from fatal prescription opioid overdoses.[6]

Pregnant women and their unborn babies may have unique risks associated with abusing drugs or alcohol as these substances can cross the placenta and affect the baby. Potential risks for abusing specific types of mind-altering substances during pregnancy include: <Put the following into a drop-down menu for different substance types.>

Alcohol +

  • Low birth weight
  • Spontaneous miscarriage
  • Preterm delivery
  • Placenta abruption
  • Stillbirth
  • Fetal alcohol syndrome (FAS), which is the number one cause of preventable mental retardation and may result in irreversible behavioral, cognitive, and physical disabilities[7]
  • Liver damage or disease in the mother
  • Onset of cardiovascular disease in the mother
  • Increased injuries to both mother and unborn baby due to lowered inhibitions, decreased motor functions, and amplified risk-taking behaviors while intoxicated

Marijuana +

  • Miscarriage
  • Low birth weight
  • Behavioral or intellectual delays and/or learning problems
  • Premature birth
  • Irregular heart rate in the mother
  • Cognitive impairment for chronic abusers may lead to an irreversible loss of eight IQ points[8]
  • Mood swings and increased risk-taking by the mother may lead to accidents or injury
  • Memory lapses in adult users

Cocaine +

  • Malnutrition in the mother, which can have adverse effects on the fetus as well
  • Contraction of infectious diseases from using unclean needles, which may pass to the unborn baby
  • Miscarriage
  • Low birth weights
  • Preterm labor
  • Placental abruption
  • Stillbirth
  • Restricted growth of infant
  • Potential learning disabilities in child
  • Damage to newborn’s brain, genitals or kidneys, causing defects in these regions
  • Withdrawal symptoms in infant, including difficulties feeding and sleeping as well as muscle spasms and drug dependency

Heroin and opioid narcotics +

  • Pulmonary complications may result in respiratory distress and development of illnesses like pneumonia
  • Injection drug users may contract infectious diseases and pass them to unborn baby in utero
  • Developmental delays in baby
  • Low birth weight
  • Preterm labor
  • Passage of intrauterine meconium
  • Placental abruption
  • Spontaneous abortion
  • Intracranial hemorrhage, or bleeding, in baby’s brain
  • Low blood sugar in baby
  • Respiratory difficulties in baby
  • Onset of neonatal abstinence syndrome (NAS) when the baby is born addicted to opioids, which can be fatal if not treated and generally requires hospitalization and medication; NAS symptoms include slow weight gain, irritability, excessive crying, seizures, fever, respiratory problems, trouble feeding, vomiting, diarrhea and tremors

Methamphetamine +

  • Premature labor
  • Low birth weight
  • Placental abruption
  • Abnormalities in brain or heart of baby
  • Lethargy in infant
  • Baby may be born dependent and suffer withdrawal symptoms including muscle spasms, trouble sleeping, tremors and difficulties feeding
  • Potential psychosis in mothers who are chronic abusers that may lead to fetal harm
  • Weight loss and dental problems in addicted mothers

Hallucinogens like PCP and LSD +

  • Violent and erratic behavior in users that can result in increased risk-taking and self-harming behaviors that can negatively affect the fetus
  • Birth defects in baby
  • Low birth weight
  • Brain damage in baby
  • Poor muscle control by infant
  • Babies may be born dependent and suffer withdrawal symptoms like tremors and lethargy

Benzodiazepines +

  • Impaired cognition in chronic users
  • Disrupted sleep patterns in the mother, which also can be unhealthy for the fetus
  • Development of cleft palate or lip in infant
  • Low muscle tone in baby
  • Withdrawal symptoms in newborn, including agitation, trouble feeding and sleeping and tremors

Laws Surrounding Infant Exposure to Drugs or Alcohol

Safe Substance Abuse Treatment for Expectant Mothers

Treatment during pregnancy and beyond has proved effective, especially when women remain in treatment for a longer amount of time.[14] Length of time in treatment improves abstinence rates, job retention, and overall positive attitudes toward parenting while decreasing time spent in the criminal justice system.[15] Specialized programs may be most effective when they include some form of childcare or direct involvement with child protective services.

The Affordable Care Act seeks to increase coverage and access to treatment for mental health and substance abuse services to those who previously may not have been able to receive proper care due to a lack of insurance coverage or other criteria.[16] Most infants born to substance-abusing mothers will not suffer catastrophic consequences, and neonatal substance abuse treatment programs can prevent future behavioral or cognitive delays in the child and prevent infant mortality.[17]

Detox is often the initial stage of a drug treatment program, and it may utilize medications to avoid difficult or even life-threatening withdrawal symptoms and manage intense drug cravings. The use of medications during pregnancy should be carefully monitored, however, as the use of some drugs may have negative consequences on an unborn baby. For instance, methadone is often used during opioid detox as a replacement to short-acting and potentially more harmful drugs such as heroin. Methadone still passes through the placenta, and infants may still present symptoms of NAS when the mother is on methadone.

A study in 2012 found that one baby was born every hour to a mother addicted to an opioid drug; there were approximately 13,500 affected babies that year.[18] Current research indicates that buprenorphine is a safer alternative to methadone replacement therapy and that babies will need less time in the hospital and fewer medications when the mother is taking buprenorphine as opposed to methadone.[19] Buprenorphine is a partial opioid agonist with a ceiling effect that does not produce the same high as other opioid drugs. It is also commonly combined with naloxone, which is a partial opioid antagonist that acts as an opioid blocker and effective aversion medication. It is also generally considered safe for pregnant women and their unborn babies.[20] Women with substance abuse issues related to opioids may be offered alternative pain management during labor and delivery as well.

Substance Abuse Services for Pregnant Women and New Mothers


Nutrition services are also beneficial for pregnant and postpartum women and their children. Addicts generally do not take much care in personal hygiene, regular sleep patterns, or a healthy diet, so improving the physical self during substance abuse treatment can also increase mental clarity and enhance motivation to remain abstinent. Alternative, or holistic, methods may also heighten the connection between mind and body and help women regain self-confidence. Learning the concept of mindfulness through yoga or meditation may improve a person’s overall general well-being as well as providing peace of mind. Pregnant women should consult their doctors prior to starting any exercise regime, including a yoga practice.

Mental illness, which so commonly occurs alongside substance abuse, can also be successfully treated during pregnancy in a substance abuse treatment program catering to co-occurring disorders. Educational sessions detailing the consequence of substance abuse to oneself, one’s baby, and others as well as education about impending or new motherhood is also beneficial during drug and alcohol treatment programs.

Addiction can leave people feeling isolated and lonely, and peer support and empathy from others in similar situations and circumstances are helpful during recovery. Groups and programs for pregnant women and women with young children exist to form a supportive community for these recovering women. Continuing support for women in recovery after delivery is imperative to a drug treatment program’s success and should encompass a range of services, including relapse prevention techniques, parenting classes, skills training, mental health evaluations and continued counseling or therapy sessions.

Black Bear Lodge can provide the solace and peaceful environment necessary to recover from drug or alcohol abuse or dependency during pregnancy and beyond. Calls are confidential, and our admissions coordinators are on hand 24 hours a day, seven days a week, to answer any questions you may have regarding the levels of care and programs offered. Contact Black Bear Lodge today.

Citations

[1] (Sept. 2014). “Results from the 2013 National Survey on Drug Use and Health (NSDUH): Summary of National Findings.” Substance Abuse and Mental Health Services Administration (SAMHSA). Accessed July 10, 2015.

[2](May 2009). “Substance Abuse Among Women During Pregnancy and Following Childbirth.” The National Survey on Drug Use and Health (NSDUH) Report. Accessed July 10, 2015.

[3] Committee on Health Care for Underserved Women and the American Society of Addiction Medicine (May 2012). “Opioid Abuse, Dependence and Addiction in Pregnancy.” American College of Obstetricians and Gynecologists (ACOG) Women’s Health Care Physicians. Accessed July 10, 2015.

[4] Lester, B., Twomey, J. (2008). “Treatment of Substance Abuse During Pregnancy.” Women’s Health. Accessed July 10, 2015.

[5] (May 2013). “Drug Abuse Warning Network (DAWN) 2011: National Estimates of Drug-Related Emergency Department Visits.” Substance Abuse and Mental Health Services Administration (SAMHSA). Accessed July 2011, 2015.

[6] (April 2015). “Prescription Drug Overdose Data.” Centers for Disease Control and Prevention (CDC). Accessed July 11, 2015.

[7] (n.d.). “Treatment of Pregnant Women with a Substance Abuse Disorder.” New York State Office of Alcoholism & Substance Abuse Services (OASAS). Accessed July 11, 2015.

[8] (June 2015). “DrugFacts: Marijuana.” National Institute on Drug Abuse (NIDA). Accessed July 11, 2015.

[9] (Oct. 2014). “Parental Substance Use and the Child Welfare System.” Child Welfare Information Gateway. Accessed July 10, 2015.

[10] Committee on Health Care for Underserved Women and the American Society of Addiction Medicine (July 2011). “Substance Abuse Reporting in Pregnancy: the Role of the Obstetrician-Gynecologist.” American College of Obstetricians and Gynecologists (ACOG) Women’s Health Care Physicians. Accessed July 11, 2015.

[11] Dunn. (n.d.). “House Bill 227.” General Assembly of the State of Tennessee. Accessed July 11, 2015.

[12] Chokshi, N. (May 2014). “Criminalizing Harmful Substance Abuse During Pregnancy: Is There a Problem With That?” Washington Post. Accessed July 11, 2015.

[13] (July 2015). “State Policies in Brief: Substance Abuse During Pregnancy.” Guttmacher Institute. Accessed July 11, 2015.

[14] Lester, B., Twomey, J. (2008). “Treatment of Substance Abuse During Pregnancy.” Women’s Health. Accessed July 11, 2015.

[15] Ibid.

[16] (Dec. 2013). “The Affordable Care Act and Women’s Health.” U.S. Department of Health and Human Services. Accessed July 11, 2015.

[17] Thorp, J. M.D., Wilson, J. M.D. (2008). “Substance Abuse in Pregnancy.” Global Library of Women’s Medicine. Accessed July 11, 2015.

[18] Zezima, K. (July 2014). “The Obama Administration Does Not Approve of a Law Making it a Crime to Use Drugs While Pregnant.” Washington Post. Accessed July 11, 2015.

[19] (Nov. 2014). “How Does Heroin Use Affect Pregnant Women?” National Institute on Drug Abuse (NIDA). Accessed July 11, 2015.

[20] Ibid.

[21] (May 2009). “Substance Abuse Among Women During Pregnancy and Following Childbirth.” The National Survey on Drug Use and Health (NSDUH) Report. Accessed July 11, 2015.

[22] Ibid.

[23] (2009). “Substance Abuse Treatment. Addressing the Specific Needs of Women.” Center for Substance Abuse Treatment. Accessed July 11, 2015.