Detoxing while Pregnant

On average between 2012 and 2013, almost 5.5 percent of pregnant women between the ages of 15 and 44 were considered to be current illicit drug users, according to the National Survey on Drug Use and Health (NSDUH).
The Centers for Disease Control and Prevention (CDC) publishes that as many as 1 out of 10 pregnant women report alcohol use.

Drinking alcohol or using drugs while pregnant can harm not only the mother, but also the unborn child as these substances cross the placenta to the baby to some degree. The National Institute on Drug Abuse (NIDA) publishes that substance abuse can double or even triple the risk for stillbirth, depending on the substance abused. Fetal alcohol syndrome (FAS), other birth defects, miscarriage, premature birth, low birth weight, neurological defects, and babies born with a dependence on opioids (neonatal abstinence syndrome, or NAS) are all potential consequences of continued drug or alcohol abuse during pregnancy.

The safest and smoothest way to stop using addictive substances is through medical detox, and it’s essential for pregnant women. Detox is the removal of toxins from the body through an outpatient or residential program, usually lasting a few days to a week. Medical detox is more comprehensive, comes with 24-hour professional supervision, and may use medications to alleviate withdrawal side effects and drug cravings. The use of medications should be even more carefully monitored in pregnant women than in the general population, as some prescription drugs can create complications without proper medical knowledge, care, and continual supervision.

Detox during pregnancy should be closely supervised by highly trained professionals, as withdrawal symptoms may be especially harmful to the fetus. Therefore, if a pregnant woman is physically dependent on a substance, medical oversight during detox is considered the safest course of action for both the mother and the unborn baby.

Potential Complications of Withdrawal during Pregnancy

pregnancy and detoxDifferent substances of abuse will have variable withdrawal symptoms and potential issues that may arise. In addition to the type of drug used, the method of abuse (smoking, swallowing, snorting, or injecting), length of time abusing it, amount abused each time, biological and genetic contributors, and environmental factors can all influence how dependent on the substance the person may be. This level of dependency impacts the duration and potential severity of withdrawal. Generally speaking, the more dependent a person is on a substance, the more possible risk factors and complications may occur during withdrawal.

It’s not recommended to stop certain mind-altering substances that are considered to be addictive, whether illicit or prescription, “cold turkey.” This sudden stoppage can cause the brain to try and restore balance, and lead to both physical and psychological withdrawal symptoms. There are potential concerns and symptoms to be aware of when the individual detoxing is pregnant, outlined below according to specific substances of abuse.

  • Heroin and prescription opioids (OxyContin, Vicodin, morphine, fentanyl): Opioid withdrawal syndrome is often compared to a really bad case of the flu and includes muscle and joint pain, sweating and chills, insomnia, restlessness, tremors, increased heart rate and blood pressure, yawning, tearing, runny nose, nausea and vomiting, and diarrhea. Sudden opioid withdrawal for unborn babies can cause respiratory depression, which can lead to the fetus not getting enough oxygen and may be fatal, MinnPost reports. Psychologically opioid withdrawal can induce anxiety and depression, which may be heightened by the stress of pregnancy and hormones.
  • Cocaine and other stimulant drugs (methamphetamine and ADHD medications like Adderall and Ritalin): Stimulant withdrawal is most significant emotionally, as these drugs can create extreme euphoria when abused by altering brain chemistry involved in pleasure and reward. When they are then removed, severe depression, difficulties feeling happy, intense drug cravings, and even suicidal thoughts or tendencies may be common, which again may be exacerbated by pregnancy.
  • Alcohol: Suddenly stopping alcohol use after a dependency has formed can be life-threatening, causing hallucinations, seizures, confusion, and delirium (called delirium tremens, or DTs). DTs can lead to death of both mother and fetus. Alcohol withdrawal, in its more moderate form, can also have significant emotional and physical side effects, including anxiety, headaches, dizziness, impaired memory, slowed cognitive functions, stomach pain, nausea and vomiting, diarrhea, depression, hypertension, tachycardia, sweats, fatigue, irritability, insomnia, and muscle weakness.
  • Benzodiazepines (Ativan, Klonopin, Valium, Xanax): These prescription anti-anxiety and sedative drugs depress the functions of the central nervous system. A dependency can be formed in a matter of weeks even with legitimate medical use, according to the labeling information on Xanax (alprazolam) published by the U.S. Food and Drug Administration, or FDA. Once a dependency is in place, sudden removal of these drugs can cause the brain to rebound. Anxiety, insomnia, depression, irritability, restlessness, seizures, and increased heart rate, blood pressure, and body temperature are all potential side effects of benzodiazepine withdrawal that can be life-threatening to both the fetus and the mother.

Security and Safety Provided by Medical Oversight during Detox

Medical detox, especially in programs specifically tailored to the needs and circumstances surrounding pregnant women, is often considered the safest and most comfortable way to stop taking drugs.
It may be tempting to simply stop any and all drug use immediately upon discovering a pregnancy; however, this can be especially distressing to the fetus and to the mother. Instead, a medical detox program can help the expectant mother to discontinue drug use safely and also manage any potential withdrawal symptoms.

Medical detox can be provided in an outpatient or inpatient program, depending on what is needed or deemed necessary, but generally inpatient detox is recommended for pregnant women. The risk for seizures during benzodiazepine and alcohol withdrawal is particularly concerning to both the mother and fetus. Dehydration and depletion of essential vitamins and minerals can be side effects of alcohol dependence that need to be closely monitored during detox, as they can be harmful to both mother and baby. Medical detox can provide around-the-clock monitoring of vital signs and mental health to ensure safety and security as well as keep individuals from self-harm.

Medications are often useful during detox even when the person is pregnant, as the possible side effects of the drugs may be less significant than the symptoms of withdrawal or continued drug use. Medical professionals can help individuals weigh their options. Co-occurring mental health or medical issues also need to be considered and managed during detox. Adjunct medications like antidepressants may be necessary, for instance, and a mental health or medical provider can choose one with the fewest potential complications.

Cocaine detox during pregnancy, for example, is primarily supportive, although mood-stabilizing medications may be helpful, the Primary Care Companion to the Journal of Clinical Psychiatry reports. Alcohol withdrawal, due to the potential for seizures, may require the use of short-acting benzodiazepines during detox. As pregnant women metabolize these drugs at faster rates than others, they may be given more often, as much as once an hour, for a period of five days or so during an inpatient detox program. Clonidine, a blood pressure medication used off-label for the treatment of alcohol and benzodiazepine withdrawal may also be helpful during detox, and it is thought to be safe for use during pregnancy.

During opioid withdrawal, methadone substitution and maintenance have traditionally been accepted for use during pregnancy. Methadone doses may be split in order for the drug to remain effective in the system in response to a pregnant woman’s increased metabolism. Methadone still carries a risk for dependence and NAS, however, and other options may be more desirable. Buprenorphine, a long-acting partial opioid agonist, has shown promise in recent studies published by the American Congress of Obstetricians and Gynecologists (ACOG) for possibly being a better candidate to help pregnant women to detox from opioid drugs. Partial opioids fill the opioid receptors to prevent or vastly reduce withdrawal symptoms, and they can be given in lower doses less often and without the euphoric “high.” Opioid detox is optimally performed in the second trimester when possible, ACOG recommends, although the damage of continued illicit drug use as the alternative may mean that detox should be started sooner.

A comprehensive approach that provides both specialized and supportive care, and that helps a woman to safely detox from drugs, often with the aid of medications, is the optimal approach for detox while pregnant.

After the baby is born, postpartum pain and the emotional strain of labor, delivery, and new motherhood may be soothed through transition to a substance abuse treatment program and/or an addiction specialist, the journal Obstetrical & Gynecological Survey publishes. Specialized programs cater to this population by addressing potential triggers to relapse and helping new mothers to start fresh and remain healthy.

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