Seeking Addiction Treatment During Pregnancy

Seeking Addiction Treatment During Pregnancy

Statistics on Substance Use During Pregnancy

Substance use during pregnancy is a significant concern, affecting both maternal and fetal health. According to a 2013 national survey in the United States, the rates of substance use among pregnant women were as follows:

Source: NCBI

Further data from the National Institute on Drug Abuse (NIDA) indicates that almost 10 percent of pregnant women in the United States have smoked cigarettes in the past month. Smoking during pregnancy increases the risk for certain birth defects, premature birth, miscarriage, and low birth weight, and is estimated to cause more than 1,000 infant deaths each year.

In another study, it was found that 5.9% of pregnant women in the United States use illicit drugs, 8.5% drink alcohol, and 15.9% smoke cigarettes. This results in over 380,000 offspring exposed to illicit substances, over 550,000 exposed to alcohol, and over one million exposed to tobacco in utero.

Risks of Using Addictive Substances While Pregnant

Using addictive substances during pregnancy poses significant risks to both the mother and the developing fetus. The potential consequences of substance use during pregnancy include:

• Cigarettes: Smoking during pregnancy is associated with an increased risk of birth defects, premature birth, miscarriage, and low birth weight. It is also linked to more than 1,000 infant deaths annually.
• Alcohol: Alcohol use during pregnancy can lead to Fetal Alcohol Spectrum Disorders (FASDs), which can cause physical, behavioral, and intellectual disabilities in the child.
• Illicit Substances: The use of illicit drugs such as opioids, methamphetamine, and heroin can result in Neonatal Abstinence Syndrome (NAS), where the newborn experiences withdrawal symptoms. Other risks include low birth weight, developmental delays, and stillbirth.

Understanding these statistics and risks underscores the importance of seeking addiction treatment during pregnancy. By addressing substance use issues, pregnant women can significantly improve their health outcomes and those of their unborn children.

Effects of Specific Substances

Opioids and Pregnancy

The use of opioids, including prescription painkillers, heroin, and methadone, during pregnancy is linked to various health risks for both the mother and the baby [3]. Opioid use in pregnancy is correlated with a greater risk of low birthweight, respiratory problems, third-trimester bleeding, toxemia, and mortality. Maternal opiate use is also associated with an increased risk of neonatal abstinence syndrome (NAS), affecting 45 to 94% of infants exposed to opioids in utero [2].

Benzodiazepines and Pregnancy

Benzodiazepines, often prescribed for anxiety and sleep disorders, can have adverse effects during pregnancy. Usage is linked to preterm birth, low birthweight, and neonatal withdrawal symptoms. Long-term use may lead to dependence in both the mother and the newborn.

Tobacco and Pregnancy

Smoking tobacco during pregnancy is a leading cause of preventable adverse pregnancy outcomes. It is associated with preterm birth, low birthweight, and developmental issues in infants. Additionally, smoking increases the risk of sudden infant death syndrome (SIDS).

Alcohol and Pregnancy

Alcohol consumption during pregnancy can lead to fetal alcohol spectrum disorders (FASD), characterized by physical, behavioral, and learning problems. There is no safe amount of alcohol during pregnancy, and its use can result in miscarriage, stillbirth, and a range of lifelong disabilities for the child.

Cannabis and Pregnancy

Cannabis use during pregnancy is linked to low birthweight, preterm birth, and developmental issues in children. Studies suggest that prenatal cannabis exposure can affect brain development, leading to cognitive and behavioral problems in the child.

Methamphetamine and Pregnancy

Methamphetamine use during pregnancy can result in severe complications such as placental abruption, preterm birth, and fetal growth restriction. The stimulant effects of methamphetamine can also lead to increased maternal blood pressure and heart rate, posing further risks to both mother and baby.

Heroin and Pregnancy

Heroin use during pregnancy can result in neonatal abstinence syndrome (NAS), a condition where the baby experiences withdrawal symptoms after birth. NAS occurs when heroin passes through the placenta to the fetus during pregnancy, causing the baby to become dependent on opioids. Treatment with methadone and buprenorphine during pregnancy can reduce the severity of NAS.

Impact on Maternal and Fetal Health

Maternal Health Consequences

Substance use during pregnancy can have severe effects on maternal health. Pregnant women who use opioids face a greater risk of complications such as low birthweight, respiratory issues, third-trimester bleeding, toxemia, and even mortality [2]. These health issues can complicate the pregnancy and increase the chances of adverse outcomes for both the mother and the baby.

Fetal Health Consequences

The health of the fetus is significantly impacted by maternal substance use. Exposure to opioids in utero is associated with an increased risk of neonatal abstinence syndrome (NAS), affecting 45 to 94% of infants exposed to opioids. Other risks include developmental delays, low birthweight, and respiratory problems. These conditions can have long-term effects on the child's health and development.

Neonatal Abstinence Syndrome (NAS)

Neonatal Abstinence Syndrome (NAS), also known as Neonatal Opioid Withdrawal Syndrome (NOWS), is a condition that affects newborns exposed to opioids while in the womb. Symptoms of NAS can include irritability, tremors, feeding difficulties, and respiratory distress. The severity of NAS can vary, but it is generally more manageable when the mother receives treatment during pregnancy.

Figures courtesy NCBI

Treatment with methadone or buprenorphine during pregnancy has been shown to reduce the severity of NAS. While NAS still occurs in babies whose mothers received these treatments, it is less severe compared to those without any treatment. Research indicates that addressing maternal substance use with appropriate medical interventions can lead to better outcomes for both mother and child.

Treatment Options for Pregnant Women

Methadone Maintenance Therapy

Methadone maintenance therapy (MMT) is considered the standard care for pregnant women with opioid use disorders. Methadone helps prevent relapse, reduces risky behaviors, improves compliance with prenatal care, and leads to better neonatal outcomes [2]. Methadone has been used since the 1970s and officially recognized as standard care since 1998. It offers higher treatment retention rates compared to other therapies [5].

Buprenorphine Treatment

Buprenorphine has emerged as an alternative to methadone for treating opioid use disorder in pregnant women. This medication shows benefits such as reduced treatment for neonatal abstinence syndrome (NAS) and shorter hospital stays for infants compared to methadone. Studies indicate that buprenorphine may be a better option for some pregnant women due to its lower risk of severe NAS.

Medication-Assisted Treatment (MAT)

Medication-assisted treatment (MAT) combines medications like methadone or buprenorphine with counseling and behavioral therapies. MAT is effective in treating opioid use disorders and can help pregnant women safely manage their addiction while reducing the risk to the fetus. By stabilizing the mother's condition, MAT improves prenatal care compliance and reduces the incidence of NAS in newborns.

Benefits of Abstinence and MAT

Abstinence and MAT offer significant benefits for both the mother and the fetus. While methadone and buprenorphine do not eliminate the risk of NAS, they reduce its severity. Research shows minimal to no long-term neurodevelopmental adverse outcomes in infants exposed to these treatments. Reducing maternal methadone dose to avoid NAS is not recommended, as it may lead to increased illicit drug use, posing greater risks to the fetus.

Each treatment option offers unique benefits and should be considered based on the individual needs of the pregnant woman seeking addiction treatment.

Barriers to Accessing Treatment

Lack of Antenatal Care

Pregnant women with substance use disorders are significantly less likely to receive antenatal care compared to their non-using counterparts. This discrepancy can be attributed to several factors, including underlying medical and psychiatric comorbidities, poor coping skills, and difficulties related to transportation and childcare.

Challenges in accessing antenatal care:

• Medical and psychiatric comorbidities
• Transport and childcare difficulties
• Poor coping skills
• Intimate partner violence
• Incarceration
• Poor provider communication
• Negative health belief factors

Social and Economic Factors

Social and economic factors play a substantial role in hindering pregnant women from seeking addiction treatment. Economic instability often limits access to healthcare services, including addiction treatment programs. Furthermore, a negative psychosocial environment, characterized by poor nutrition and lack of social support, exacerbates these barriers.

Key social and economic barriers:

• Economic instability
• Poor nutrition
• Lack of social support
• Negative psychosocial environment

Stigmatization and Legal Concerns

Stigmatization and fear of legal consequences are significant barriers that prevent pregnant women from seeking addiction treatment. The societal stigma associated with substance use during pregnancy often leads to feelings of shame and guilt, which can discourage women from seeking the help they need. Additionally, fear of legal repercussions, such as the potential for losing custody of their child, further deters women from accessing essential treatment services.

Factors contributing to stigmatization and legal concerns:

• Societal stigma
• Fear of legal consequences
• Potential custody loss

Understanding and addressing these barriers is crucial for ensuring that pregnant women can access the addiction treatment they need without fear or hesitation.

Substance Use Effects on Pregnancy

Substance use during pregnancy can have profound impacts on both maternal and fetal health. This section explores how various substances can cross the placenta, their specific effects, and the negative outcomes associated with their use.

Cross-Placental Impact

Many addictive substances can cross the placenta, impacting fetal development and brain growth. This transfer occurs because the placenta, while acting as a filter for some harmful substances, cannot completely protect the fetus from all external agents. This means that when a pregnant woman uses substances, her fetus is often directly exposed to these chemicals, which can interfere with normal development.

Specific Effects of Different Substances

Alcohol

Alcohol is a well-established teratogen, leading to fetal alcohol spectrum disorders (FASD) and other negative outcomes. Exposure to alcohol during pregnancy can cause a range of physical, behavioral, and cognitive disabilities.

Nicotine

Nicotine exposure is associated with orofacial clefting and a range of congenital anomalies. Pregnant women who smoke are at a higher risk of premature birth, low birth weight, and sudden infant death syndrome (SIDS).

Cannabis

Cannabis use is linked to smaller head circumferences, learning and cognitive problems, and adverse pregnancy outcomes [6]. This can affect the child's brain development and lead to long-term cognitive and behavioral issues.

Opioids

Opioid use increases the risk of neonatal abstinence syndrome (NAS) and other negative outcomes. NAS is a condition where the newborn experiences withdrawal symptoms due to exposure to opioids in utero.

Negative Pregnancy and Child Outcomes

The use of addictive substances during pregnancy can result in a range of negative outcomes for both the mother and the child. These outcomes can vary based on the type and amount of substance used, as well as the timing during pregnancy when exposure occurs.

Maternal Health Consequences

Substance use can exacerbate existing health issues in pregnant women and lead to complications such as high blood pressure, preeclampsia, and gestational diabetes. These conditions can increase the risk of adverse outcomes for both the mother and the fetus.

Fetal Health Consequences

The fetus can suffer from slowed growth, congenital anomalies, and developmental delays. Exposure to substances can also lead to long-term health issues such as learning disabilities, behavioral problems, and chronic health conditions.

Neonatal Abstinence Syndrome (NAS)

One of the most significant consequences of opioid use during pregnancy is NAS. Newborns with NAS experience withdrawal symptoms such as tremors, irritability, poor feeding, and respiratory problems. This condition requires specialized care and can have long-term effects on the child's health and development.

References

[1]: https://nida.nih.gov/publications/research-reports/substance-use-in-women/substance-use-while-pregnant-breastfeeding

‍[2]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4870985/

‍[3]: https://recoveryfirst.org/drug-abuse/treatment-for-pregnant-woman/

‍[4]: https://www.ncbi.nlm.nih.gov/books/NBK542330/

‍[5]: https://nida.nih.gov/publications/research-reports/medications-to-treat-opioid-addiction/what-treatment-available-pregnant-mothers-their-babies

‍[6]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6038015/