Pregnancy can be a wondrous time of life—a time when women become more focused on their own health to support the health of their unborn baby. They may start to become more conscious of what they’re putting into their bodies and how that may affect the child they’re carrying.
However, if the mother is addicted to drugs or alcohol, she may have many questions. Is help available and truly safe? What will it entail? Is it possible to get free from the grip of the addicting substance without harming the baby? How does one learn to live sober?
Help is available for pregnant women who struggle with substance abuse. More rehabilitation programs have begun to incorporate services for women who are pregnant. However, only about a quarter of rehab programs nationwide offer resources for pregnant women.
Dangers and Risks of Abusing Substances during Pregnancy
Many factors play into the risks associated with consuming drugs or alcohol while pregnant. These include the specific drug(s) being abused, how often the substance is used, and at what point in the pregnancy the substance was introduced.
In general, risks to the unborn fetus from substance abuse include:1,2
- Placental abruption.
- Premature birth.
- Developmental defects.
- Low birth weight.
- Small head size.
- Sudden infant death syndrome (SIDS).
- Postnatal withdrawal syndrome.
Further, some babies born to mothers who have abused alcohol or certain drugs may develop additional health issues, such as:3,4,5
- Heart defects: Drinking alcohol and taking certain drugs during pregnancy can result in heart defects, particularly septal defects (a hole in the heart). The majority of infants born with heart defects die within the first year of life.
- Infections, including hepatitis C and HIV: These viruses are often transmitted by people who share needles during injection drug use. Viruses can then be passed on to the unborn baby during pregnancy or at birth.
- Neonatal abstinence syndrome (NAS): This syndrome can occur when a baby is born to a mother addicted to a substance (most commonly, opioids) and develops withdrawal symptoms after birth.
- Fetal alcohol spectrum disorders (FASDs): These disorders are associated with a range of cognitive and developmental difficulties and usually last for life.
In addition, there are other substance-related developmental consequences that could become significant issues later in life, including behavior/learning deficits and slower growth rates in some children.2
Alcohol is a known teratogen (an agent that can lead to congenital abnormalities). Alcohol can cause developmental defects and health problems in a baby if the mother uses it at any time during her pregnancy. The central nervous system is particularly sensitive to teratogens.6
Alcohol abuse during pregnancy is the leading preventable cause of developmental disabilities, learning disabilities, and birth defects in the United States, according to the National Organization on Fetal Alcohol Syndrome, with alcohol ranking above cocaine, heroin, and marijuana in producing serious effects in the fetus.7
In addition, women who use drugs are more likely to receive delayed, limited, or no prenatal care at all, potentially leading to other complications for the growing fetus.8
The sooner a woman can find help and quit using drugs, the better chance her baby has at being born full-term without complications.
How Many Pregnant Women Abuse Substances?
According to the Centers for Disease Control and Prevention, between 2011 and 2013, 1 in 10 pregnant women reported alcohol use and 1 in 33 reported binge drinking (defined as consuming 4 or more drinks on one occasion) in the past 30 days. According to the study, drinking prevalence was highest among pregnant women 35-44 years of age who were college educated and not married.9
Between 2011 and 2013, 1 in 10 pregnant women reported alcohol use and 1 in 33 reported binge drinking.
In addition, according to a national survey from 2012:2
- 9% of pregnant women used illegal drugs.
- 5% drank alcohol.
- 9% smoked cigarettes.
That amounts to over 380,000 infants exposed to illicit substances, over 550,000 exposed to alcohol, and over 1 million exposed to tobacco in the womb.2
Detox for Pregnant Women
It’s imperative that a pregnant woman be under a doctor’s care to detox from alcohol and/or drugs during pregnancy, both for her safety and the health of her unborn child. Detox methods ultimately depend on the substance that has been used, the level of abuse, and the mother’s health and psychiatric history. Pregnant women—particularly those addicted to alcohol—should seek treatment in an inpatient setting due to the risk of miscarriage during detox. Those addicted to sedatives and opioids should also consider an inpatient setting with 24-hour medical care.10,11
In some instances, such as opioid addiction, substitute medications like methadone may be used during detox. The use of methadone, combined with prenatal care and complete care, can enhance outcomes for mothers and their infants. That said, newborns exposed to methadone may still need treatment for withdrawal symptoms. Some studies indicate that replacement therapy with buprenorphine (which is also available as Suboxone, a combination product with naloxone) may be associated with less acute infant withdrawal than methadone.12
In the case of alcohol detoxification, the process may include the use of other prescribed medications when deemed necessary. However, these should be used with caution, as typical medications used in alcohol detox, such as benzodiazepines, may themselves be associated with certain fetal/neonatal risks such as oral clefts or floppy-infant syndrome. There is little research on other medications often used to augment the treatment of alcohol dependence, such as disulfiram (Antabuse), naltrexone, acamprosate, topiramate, baclofen, and ondansetron.13
During the detox period, other recovery resources may be incorporated to help pregnant women learn to live drug-free lives. While detox and medical stabilization are critical, they do not constitute drug addiction treatment on their own. Detox should be followed by comprehensive therapy to address the causes that led to substance abuse.
More Topics Covering Pregnancy
If you’re a pregnant woman looking for help, consider a rehab center that is well-versed in treating women who are pregnant. Pregnancy necessitates specialized treatment during both detox and addiction treatment. Not all facilities are equipped to help women who are pregnant, so it’s important to confirm this area of expertise before enrolling in a particular program.
In a 2017 study by the Substance Abuse and Mental Health Services Administration (SAMHSA), 22.4% of rehab facilities offered specialized care for pregnant or postpartum women.14 In addition, studies suggest that women abusing substances are more likely to have medical and mental health problems, as well as a history of physical or sexual abuse, and therefore require dedicated treatment to address these issues as well.15
According to SAMHSA, a model program for pregnant women should include:16
- Pregnancy and parenting education.
- Staff with medical, mental health, and addiction treatment backgrounds.
- Continuity with counselors.
- Health and psychiatric services.
- Child care services.
- Transportation services.
- Housing services.
Treatment can make a difference. One study found that substance abuse therapy for pregnant women led to increased fetal growth, which lowered the chance of negative neonatal outcomes.17 In addition, methadone treatment can lower the risk of relapse, boost adherence with prenatal care, and lead to better outcomes for the newborn.2
Risks and Complications of Treatment
As discussed above, there are some risks in going through detox while pregnant, such as miscarriage and infant withdrawal symptoms from opioid replacement medications such as methadone and buprenorphine.
However, babies that are born to women on methadone are generally as healthy as other infants. The long-term effects of methadone on children are unknown, but these babies are much healthier than those born to mothers using heroin.18
Additionally, women who are on methadone and are not HIV-positive may breastfeed. The advantages of breastfeeding outweigh the risks of a small amount of methadone entering breast milk. But any decisions about breastfeeding should be discussed with your doctor.18
Help for Pregnant Women
Comprehensive addiction treatment for pregnant women may include the following:
- Medical detox, if needed
- A specialized treatment plan designed by professionals from various specialties
- Pregnancy education and counseling
- Parenting training
- Individual, group, and family therapy
- Assessment and therapy for co-occurring disorders
- 12-Step programming
- Prenatal care
- Life skills workshops
- Aftercare planning
Therapeutic approaches that have been shown to be effective in treating pregnant women with substances use disorders include contingency management, motivational interviewing, and cognitive behavioral therapy.2
- Contingency management uses rewards, such as vouchers, to reinforce positive behaviors such as abstaining from drug use.2
- Motivational interviewing helps pregnant women work through any hesitations they have about beginning rehab and adjusting their behaviors.2
- Cognitive behavioral therapy helps women gain insight into the situations that lead them to use substances; break old patterns of thinking, feeling, and behaving; and replace those habits with new ones.2
For women seeking help, there is often a fear of judgment. Many are afraid they will be arrested, forced to have an abortion, asked to leave a prenatal care program, and reported to child protective services.11
These are all legitimate concerns that can be addressed with an intake specialist at a treatment center. If the rehab center is geared toward working with pregnant women, staff members will understand these concerns and be able to alleviate anxiety about taking the next step toward a healthier lifestyle.
In evaluating options, it’s important to consider what would happen if one does not get help. The risks to an unborn fetus are high, not to mention the consequences to the mother if substance abuse continues. Addiction only grows without intervention, as do the harsh realities that accompany addiction.
New life is a time for celebration as is each day of sobriety. Pregnant women can enjoy this fresh journey in life with newfound sobriety and continued recovery. Help is available. Comprehensive care, along with a nurturing and supportive environment, offer the baby and mother the best chances for full recovery.
. National Institute on Drug Abuse. (2018). Substance Use While Pregnant and Breastfeeding.
. Forray, A. (2016). Substance use during pregnancy. F1000 Research, 5: F1000 Faculty Rev-887.
. American Pregnancy Association. (2018). Congenital Heart Defects.
. March of Dimes. (2016). Street Drugs and Pregnancy.
. March of Dimes. (2016). Alcohol During Pregnancy.
. Children’s Hospital of Wisconsin. Teratogens.
. National Organization on Fetal Alcohol Syndrome. Key Facts on Alcohol and Pregnancy.
. Roberts, S. Strategies for engaging pregnant women who use alcohol and/or drugs in prenatal care. Contra Costa Health Services.
. Centers for Disease Control and Prevention. (2018). Fetal Alcohol Spectrum Disorders (FASDs): Data & Statistics.
. Federal Bureau of Prisons. (2018). Detoxification of Clinically Dependent Inmates.
. Bishop, B. et al. (2017). Pregnant Women and Substance Use. Jacobs Institute of Women’s Health.
. National Institute on Drug Abuse. (2018). What are the unique needs of pregnant women with substance use disorders?
. Heberlein, A., Leggio, L., Stichtenoth, D., and Thomas, H. (2016). The Treatment of Alcohol and Opioid Dependence in Pregnant Women. Current Opinion in Psychiatry, 25(6), 559-564.
. Substance Abuse and Mental Health Services Administration. (2017). 2017 State Profile—United States and Other Jurisdictions, National Survey of Substance Abuse Treatment Services (N-SSATS).
. Tuchman, E. (2010). Women and Addiction: The Importance of Gender Issues in Substance Abuse Research. Journal of Addictive Diseases, 29(2), 127-138.
. Forman, R., and Nagy, P. (2006). Substance Abuse: Clinical Issues in Intensive Outpatient Treatment. Substance Abuse and Mental Health Services Administration.
. Little, B.B. et al. (2003). Treatment of substance abuse during pregnancy and infant outcome. American Journal of Perinatology, 20(5), 255-262.
. Substance Abuse and Mental Health Services Administration. (2014). Methadone Treatment for Pregnant Women.