However, if the mother is addicted to a substance, they 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 rehab programs have begun to incorporate services for women who are pregnant. However, only about a quarter of programs nationwide offer these services.
Many factors play into the risks associated with using substances while pregnant. These include the specific substance(s) being used, how much 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
Further, some babies born to mothers who have abused alcohol or certain drugs may develop additional health issues, such as:3,4,5
In addition, there are other substance-related developmental changes 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 stop using substances, the better chance her baby has at being born full-term without complications.
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
That amounts to over 380,000 babies exposed to illegal substances, over 550,000 exposed to alcohol, and over 1 million exposed to tobacco in the womb.2
First and foremost, 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 safety 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, replacement medications like methadone may be used during detox. The use of methadone, combined with prenatal care and comprehensive treatment, can improve outcomes for mothers and their babies. 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 severe 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.
If you’re a pregnant woman looking for help, choose a center that is well-versed in treating women who are pregnant. Pregnancy necessitates specialized treatment during both detox and addiction treatment. Not all centers 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 survey by the Substance Abuse and Mental Health Services Administration (SAMHSA), 22.4% of treatment 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 specialized treatment to address these issues as well.15
According to SAMHSA, a model program for pregnant women should include:16
Treatment can make a difference. One study found that substance abuse treatment for pregnant women led to increased fetal growth, which reduced the risk of negative neonatal outcomes.17 In addition, methadone treatment can lower the risk of relapse, increase compliance with prenatal care, and lead to better outcomes for the newborn.2
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 babies. The long-term effects of methadone on babies are unknown, but these babies are much healthier than babies born to mothers using heroin.18
Additionally, women who are on methadone and are not HIV-positive may breastfeed. The benefits 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
Comprehensive addiction treatment for pregnant women may include the following:
Therapeutic approaches that have been found to be effective in treating pregnant women with substances use disorders include contingency management, motivational interviewing, and cognitive behavioral therapy.2
For women seeking help, there is frequently 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 life.
In weighing 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 encouraging 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.