Drug Treatment Programs for Pregnant Women
Substance abuse in pregnancy can have severe consequences on the health of the mother and the child. Unfortunately, this is still not such a rare phenomenon. According to a 2012 survey, 5.9% of pregnant women in the U.S. use illicit drugs, 8.5% drink alcohol, and 15.9% smoke cigarettes.1
Substance Abuse in Pregnancy
Women are generally at the highest risk for developing a substance use disorder during their reproductive years (18–44), especially ages 18–29.2 It is therefore not surprising that there are quite a few cases of addiction disorders among pregnant women.
Statistics show that the most frequently used substance in pregnancy is tobacco, followed by alcohol, cannabis, and other illicit substances. Moreover, the epidemic of opioid prescription misuse is also visible in the population of pregnant women, with a recent increase in the number of cases of opiate abuse in pregnancy.2
Implications for Treatment Programs for Pregnant Women
It is highly recommended that pregnant women who want to quit their addiction seek professional help. In certain cases, trying to break the addiction without medical help may cause serious distress for the baby.3 This is why drug treatment programs for pregnant women are carefully designed to cater to their particular needs.
On the other hand, research that explored the characteristics of addiction and treatment-seeking in pregnant women established that getting help is not always easy.4 There is a pronounced necessity for drug treatment programs for pregnant women that are more accessible so that more women from all areas would be able to receive treatment appropriate for their condition.5
What Are the Risks of Substance Abuse in Pregnancy?
Substance abuse in pregnancy can be very harmful because the substances that the mother uses reach the fetus via the placenta and the umbilical cord. This increases the risk of pre-term labor, miscarriage, or stillbirth. Moreover, the adverse consequences of addiction in pregnancy may not emerge immediately. There is a growing body of evidence of long-term effects of substance abuse such as respiratory diseases or behavioral issues in children.1
These are the health risks per substance type:
- Alcohol: Miscarriage, stillbirth, infant mortality, fetal growth restriction, congenital anomalies.2
- Tobacco: Miscarriage, ectopic pregnancy, placental insufficiency, low birth weight, fetal growth restriction, preterm delivery, childhood respiratory disease, and behavioral issues.1
- Marijuana: Fetal growth restriction, as well as withdrawal symptoms in the baby.1
- Opioids: Maternal death, fetal growth restriction, preterm labor, stillbirth, birth defects, neonatal abstinence syndrome (when the baby becomes dependent on the substances used by the mother during pregnancy).6
- Cocaine: miscarriage, preterm labor, placental abruption, congenital anomalies, poor feeding, lethargy.1
Furthermore, research data suggest that the babies of mothers who both drank and smoked beyond their first trimester of pregnancy have 12 times more chance of dying from the sudden infant death syndrome (SIDS) compared to those who were unexposed or exposed only in the first trimester.7
In addition to direct health risks, theNational Institute on Drug Abuse also warns about the following indirect risks that are closely linked to substance abuse in pregnancy:8
- Malnutrition and poor prenatal care
- Increased risk for maternal infection (such as HIV or hepatitis)
- Dangers from drug seeking (such as violence and incarceration)
How Drug Treatment Programs for Pregnant WomenWork
Although the effects of substance abuse in pregnancy can be severe, there is encouraging evidence that treatment programs for pregnant addicts can result in improved birth outcomes including delivery of drug-free infants and babies with better birth weights.9
The Addiction Treatment Process
As any other addiction treatment, this one also involves a period of detoxification, when a substance is eliminated from the body. It is important that this process is medically supervised in order to mitigate withdrawal symptoms that can harm the baby. In cases of opioid addiction, methadone and buprenorphine have been shown to be safe and effective in drug treatment programs for pregnant women.8
As it may be the case with any substance use disorder, a pregnant woman may have co-occurring psychological disorders, such as depression or anxiety. These need to be treated so that the person would resolve the issues that have led to substance abuse. There are various forms of counseling, behavioral therapy, family therapy programs and counseling, support groups, and so on.
Frequently Asked Questions
- When it comes to logistics, treatment centers offer both inpatient and outpatient drug treatment programs for pregnant women. Some inpatient programs offer care and housing even after the baby is born. All these programs normally involve obstetric care, regular checkups, and put a lot of emphasis on healthy habits, primarily nutrition and sleep. It is also recommended that programs include an educational component about preparation for giving birth and postpartum needs.9An important aspect of effective treatment programs for pregnant addicts is relapse prevention. Data suggest that while many women abstain from substance abuse in pregnancy, there is a rather high rate of relapse in the months following delivery. This is the period of high childcare needs and dependence on the mother.2
It is also important to mention that there are different types of programs available, including specialized alcohol treatment options for women. Some centers also offer support for families of people dealing with addiction.
- There are several factors that can prevent pregnant women from receiving treatment, the most prominent being the following ones:4
- The fear of social stigma often prevents women from reporting their issues and seeking help.
- The fear of legal consequences can be quite strong. Some US states classify maternal drug use as child abuse, thus criminalizing it and introducing punitive measures.
- Lack of accessible facilities that would accept pregnant women since not all addiction treatment facilities do so.
- Another important concern related to addiction during pregnancy is whether breastfeeding is safe.Although it is known that the substances that the mother consumes pass into her breastmilk, there is no conclusive evidence of the dangerous concentration of substances and their effects on children. Women who are active drug users are advised against breastfeeding, but this is not necessarily the case with those in drug treatment programs for pregnant women.
For example, there is a consensus that breastfeeding is to be encouraged and supported for women on methadone therapy.10 It has been shown that in the short term, breastfeeding can lessen the severity of neonatal abstinence syndrome in the infant and result in fewer pharmacological interventions.
The general recommendation is that the decision on breastfeeding should be based on drug use and substance abuse treatment histories, other maternal medication needs, infant health status, and plans for further treatment.11
1. Keegan J., Parva M., Finnegan M., Gerson A. & Belden M. (2010). Addiction in Pregnancy. J Addict Dis, 29(2),175-91.
2. Forray A. (2016). Substance use during pregnancy.F1000 Faculty Rev-887.
3. National Institute on Drug Abuse. Drug Use Hurts Unborn Babies.
4. Stone R. (2015). Pregnant women and substance use: fear, stigma, and barriers to care. Health & Justice, 3, 2.
5. Haug, N., Duffy, M. & Mccaul, M. (2014). Substance Abuse Treatment Services for Pregnant Women: Psychosocial and Behavioral Approaches. Obstetrics and Gynecology Clinics of North America, 41(2).
6. Centers for Disease Control and Prevention. (2020).About Opioid Use During Pregnancy.
7. National Institutes of Health. (2020). Combined prenatal smoking and drinking greatly increases SIDS risk.
8. National Institute on Drug Abuse. (2017). Treating Opioid Use Disorder During Pregnancy.
9. Substance Abuse and Mental Health Service Administration. (2017). Family-Centered Treatment for Women with Substance Use Disorders – History, Key Elements, and Challenges.
10. Jansson, L. M., Choo, R., Velez, M. L., Harrow, C., Schroeder, J. R., Shakleya, D. M., & Huestis, M. A. (2008). Methadone maintenance and breastfeeding in the neonatal period. Pediatrics, 121(1), 106-14.
11. Indiana Perinatal Quality Improvement Collaborative. (2019). Breastfeeding and Substance Use: Evidence-based Practices Guidance Document.