Addiction and PregnancyA Guide for Mothers

Pregnancy should be an exciting and empowering time in a woman’s life. Unfortunately, addiction and mental health problems can compromise a woman’s safety and well-being. There’s hope for recovery, though. Help is available for pregnant women who are suffering from addiction.

Addiction is a progressive, chronic disease characterized by compulsive behavior, harmful side effects and relapse. Like other diseases, addiction presents serious risks for pregnant women and their babies. Drug addiction is one of the most dangerous types of addiction.

Co-occurring mental health disorders, which commonly accompany addiction, also present unique health care challenges. Eating disorders, depression and other co-occurring disorders can cause physical changes that disrupt the development of the prenatal child.

Every substance a woman consumes while pregnant can be transferred to her baby. Alcohol, tobacco and other drugs can pass through the placenta — the organ that provides nutrition and oxygen to the baby — and cause serious problems.

Thus, women who are pregnant or who are planning to become pregnant should avoid substances of abuse, and talk to their health care provider about a healthy diet and lifestyle. Those who are unable to quit using alcohol or other drugs should seek treatment immediately. Women in recovery from addiction should talk to a physician about their health before trying to become pregnant.

Estimated Annual Average Number of Pregnant Women Who Used Illicit Drugs in the U.S., 2013 and 2014:

Estimated Annual Average Number of Pregnant Women Who Used Illicit Drugs in the U.S., 2013 and 2014

Treatment for pregnant mothers who suffer from addiction can help them recover and protect their children from the dangers of drugs and other types of addiction. Without proper treatment, the health consequences can be serious.

In 2003, an estimated 5,000 babies were born dependent on drugs in the United States. That number grew to 27,000 diagnosed cases in 2013.

Risks of Drug Use During Pregnancy

Women who are pregnant must make several lifestyle changes to increase the chances of a healthy pregnancy. They should avoid foods, beverages and activities that may put them or their babies at risk. They should take prenatal supplements, get plenty of rest and exercise lightly. Even when women take every precautionary measure, they may still be at risk for complications.

Various types of addiction and co-occurring disorders drastically increase the chance of complications during pregnancy.

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Health professionals don’t fully understand the roles addiction and mental health disorders play during pregnancy, but according to the National Institute on Drug Abuse, numerous studies indicate they can increase the chances of several serious complications.

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Miscarriage and Stillbirth

A miscarriage refers to the death of a prenatal child before the 24th week of pregnancy. Between 10 and 15 percent of all pregnancies end in miscarriage. Miscarriages can be caused by a variety of health conditions, including chromosome problems, infections, various diseases, alcohol or drug abuse and eating disorders. A stillbirth occurs when a baby is born with no sign of life after the 24th week and is most commonly caused by placental abnormalities, but smoking and the use of drugs and alcohol can contribute to stillbirth.

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Placenta Abruption

Placental abruption occurs when the placenta separates from the uterine wall before labor. It is rarely triggered by direct causes such as a fall, an automobile accident or an impact to the abdomen. It is more commonly caused by smoking cigarettes, consuming alcohol or abusing other drugs. The condition is seldom deadly, but it can lead to developmental problems.

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Premature Labor and Birth

An infant is considered premature when it is born before the 37th week of pregnancy or about three weeks earlier than the due date. Premature labor is usually caused by health problems such as diabetes, heart disease, kidney disease or drug addiction.

Premature infants have difficulty breathing, maintaining a consistent body temperature and eating or drinking. Their organs are underdeveloped, and they usually require intensive medical support for weeks or months.

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Fetal Alcohol Spectrum Disorders

Fetal alcohol spectrum disorders are a group of disorders that are caused by alcohol consumption during pregnancy. When a pregnant woman drinks alcohol, the alcohol travels through the umbilical cord to the baby. There is no known safe amount of alcohol that a woman can drink during pregnancy, and alcohol can cause FASDs at any time during pregnancy.

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Neonatal Abstinence Syndrome

Neonatal abstinence syndrome refers to a number of complications affecting infants born to mothers who are addicted to opioids. The drugs pass through the placenta, and the baby becomes dependent on them. The infant suffers withdrawal when it doesn’t receive the drugs after birth.

Symptoms of NAS include:

  • Blotchy skin color
  • Diarrhea
  • Fever
  • Rapid breathing
  • Seizure
  • Sweating
  • Trembling
  • Vomiting

The results of a study in the Journal of Perinatology showed that an estimated 21,732 babies were diagnosed with NAS in 2012, an increase of 2.4 percent from 2009.

NAS can also cause premature labor, low weight and small body size. Infants with NAS must be gradually detoxed using medication. Babies born to addictive drugs such as nicotine, amphetamines or cocaine can suffer long-term health problems, but there isn’t any indication that they suffer from NAS.


Other Birth Defects

Addiction can cause a variety of other birth defects, including:

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    Sudden infant death syndrome

    SIDS refers to the unexpected and sudden death of a baby less than one year old. Although autopsies do not show any explainable cause of death, babies born to mothers who abused drugs during pregnancy die of SIDS at higher rates than those born to women who did not use drugs during pregnancy.

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    Small head circumference

    Microcephaly, commonly referred to as small head circumference, usually means an infant’s brain is not developing correctly. The skull grows as the brain grows, so a small head circumference at birth usually means the brain did not grow properly in the womb.

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    Low birth weight

    A baby weighing less than five pounds and eight ounces at birth is considered low weight. About eight percent of babies are born with low birth weight, and some are still considered healthy. Others suffer breathing problems, heart problems, intestinal problems, vision problems or bleeding in the brain. Low birth weight may lead to future health problems such as diabetes, heart disease, high blood pressure or obesity.

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    Development and behavioral problems

    Alcohol and other drugs taken during pregnancy can damage a baby’s central nervous system. The damage can lead to future behavioral issues and poor academic performance.

An estimated 21,732 babies were diagnosed with NAS in 2012, an increase of 2.4 percent from 2009.

How Drugs Affect a Prenatal Child

Drug addiction is one of the most dangerous forms of addiction for a mother and her baby. Illicit drugs can cause dangerous side effects — fever, tremors, hallucinations, breathing problems or rapid heartbeat — that can be dangerous to a mother and the prenatal child. Various illicit drugs affect a baby in different ways.

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Alcohol

Drinking alcohol during pregnancy can lead to fetal alcohol spectrum disorders. FASDs cannot be cured, but early intervention can help a child’s future development.

Risks to the mother

  • High blood pressure
  • Bone loss
  • Liver damage
  • Kidney damage
  • Weakened immune system
  • Increased risk of cancer
  • Premature birth

Risks to the baby

  • Alcohol-related birth defects: include problems with kidneys, bones, hearing and the heart.
  • Alcohol-related neurodevelopmental disorder: includes problems with behavior, learning, judgment, attention and impulse control. People with ARND may also suffer from other birth defects.
  • Fetal Alcohol Syndrome: includes abnormal facial features, nervous system issues and growth or development problems. Infants with FAS often suffer from birth defects and neurodevelopmental disorders.
  • Fetal death: the most extreme consequence of drinking while pregnant.
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Tobacco

Carbon monoxide and nicotine are the two most dangerous chemicals in tobacco. Research cited by the National Institute on Drug Abuse indicates that nicotine passes through the placenta and accumulates in high concentrations in the baby. An estimated 910 infants died because their mothers smoked during pregnancy from 1997 to 2001. Studies indicate that the more tobacco a pregnant woman smokes, the greater the chance and severity of health problems for her child.

Risks to the mother

  • Increased heart rate
  • Increased blood pressure
  • Sweating
  • Nausea
  • Diarrhea
  • Lung damage
  • Increased risk of cancer

Risks to the baby

  • Low birth weight
  • Stunted growth
  • Learning problems
  • Behavioral problems
  • Increased risk for addiction
  • SIDS
  • Ectopic pregnancy
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Marijuana

The THC, in addition to other chemicals, in marijuana passes through the placenta and to the baby. Women who consume marijuana often consume other drugs of abuse, including alcohol and tobacco, which makes it difficult for researchers to determine the specific effects of marijuana on a prenatal child. However, studies indicate consuming marijuana while pregnant increases the chances of several health problems.

Risks to the mother

  • Rapid heart rate
  • Lung problems
  • Memory problems
  • Anxiety
  • Depression
  • Insomnia

Risks to the baby

  • Premature birth
  • Low birth weight
  • Stillbirth
  • Development problems
  • Behavioral problems
  • Withdrawal symptoms
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Cocaine

Cocaine can force the uterus to contract, which can lead to blood loss and premature labor. Babies born to women who smoked crack during pregnancy — often referred to as crack babies — were expected to suffer devastating developmental side effects. However, according to NIDA, studies indicate the effects are more subtle. These children tend to suffer from learning disabilities, problems with memory and attention problems.

Risks to the mother

  • Weight loss
  • Heart attack
  • Stroke
  • Respiratory failure
  • Infections from shared needles
  • Increased pressure

Risks to the baby

  • Placental abruption
  • Low birth weight
  • Small head circumference
  • Premature birth
  • Development problems
  • Behavioral problems
  • Miscarriage
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Opioids

Babies born to mothers who use heroin and other opioids such as oxycodone, hydrocodone or codeine while pregnant are almost always born with NAS and experience high rates of SIDS. Women should not quit taking opioids cold turkey, however, because it can lead to severe withdrawal for the mother and the baby and cause premature labor.

Health care professionals will usually slowly decrease a woman’s dose of opioids or use methadone or morphine during detox, but infants can still be born dependent on methadone or morphine. Health providers closely monitor the health of the baby during detox.

Risks to the mother

  • Respiratory failure
  • Heart and lung infection
  • Infections from shared needles
  • Kidney disease
  • Liver disease
  • Coma

Risks to the baby

  • Placental abruption
  • Low birth weight
  • Premature birth
  • Stillbirth
  • SIDS
  • NAS
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Crystal Meth and Other Amphetamines

Research on the effects of amphetamines during pregnancy is limited. The drugs are found on the street in the form of methamphetamine and crystal meth or in prescription drugs and some over-the-counter medications. Early studies indicate women who use amphetamines during pregnancy suffer several health problems at high rates.

Risks to the mother

  • Weight loss
  • Fever
  • Rapid heart rate
  • Rapid breathing
  • Seizure
  • Hyperthermia

Risks to the baby

  • Placental abruption
  • Low birth weight
  • Small head circumference
  • Premature birth
  • Miscarriage
  • Heart defects
  • Brain abnormalities
  • Behavioral problems
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Inhalants

Inhalants can cause significant damage to the health of a mother and her baby during pregnancy. Because people who abuse inhalants also abuse other substances, very few studies can conclusively link specific chemicals to a specific birth defect. Still, animal studies have linked inhalant abuse to several birth defects, and anecdotal evidence suggests infants born to mothers who use inhalants suffer a multitude of health problems.

Risks to the mother

  • Slurred speech
  • Dizziness
  • Unconsciousness
  • Nervous system damage
  • Liver damage
  • Kidney damage

Risks to the baby

  • Low birth weight
  • Skeletal abnormalities
  • Delayed brain development
  • Weight gain
You’re going to have a troubled kid oftentimes because the brain was stimulated with all of these chemicals and now it’s not.

Dr. Kevin Wandler, Chief Medical Officer, Advanced Recovery Systems

Co-Occurring Disorders

People suffering from addiction often suffer from co-occurring mental health disorders. These disorders are so common that many rehabilitation facilities are capable of treating addiction and co-occurring disorders simultaneously.

Pregnant women who suffer from addiction should be screened for co-occurring disorders to receive the most effective treatment. Studies cited in the British Columbia Medical Journal suggest that women are more vulnerable to mental health disorders during pregnancy. The research on psychiatric disorders during pregnancy is limited, but some studies have found risks associated with certain mental health problems.

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Depression

Between 13 and 17 percent of women suffer from depression during pregnancy. Most major health risks are indirect. They include increased risks of poor nutrition, failure to participate in proper prenatal care, suicidal thoughts and thoughts of harming the prenatal child. One study also found babies born to depressed mothers suffered early development problems.

Postpartum Depression

Postpartum depression is different from normal mood swings or feelings of sadness that women often feel in the first days or weeks after childbirth. Postpartum depression is caused by physical changes, hormonal imbalance or emotional issues associated with childbirth. Substance abuse and other mental health problems can amplify feelings of depression.

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Panic Disorder

Research on panic disorders among pregnant women is limited, but one study indicated high levels of anxiety could cause decreased blood flow to the prenatal child, which could hinder brain development.

Eating Disorders

Almost five percent of women who become pregnant suffer from an eating disorder. There is some indication that symptoms of eating disorders may decrease during pregnancy, but the consequences are serious for the mother and the baby. Eating disorders are linked to miscarriage, low birth weight, breathing problems, dehydration, gestational diabetes and premature birth.

4.4% of women who sought treatment for addiction in 2010 were pregnant.

Treatment & Rehab Options for Pregnant Mothers

Women suffering from addiction or co-occurring mental health disorders should seek help from health care providers. Health professionals will assess each woman’s situation and develop a treatment plan based on her stage of pregnancy, her addiction, any co-occurring disorders and a variety of other factors.

Alcohol

Education can be an extremely effective treatment for women who choose to drink while pregnant. Many people do not fully understand the consequences of drinking while pregnant. Women suffering from alcohol addiction need specialized treatment.

Pregnant women should be closely monitored during detox to prevent seizures or other symptoms of withdrawal. Detox should be followed by evidence-based therapy and referral to support-group meetings like Alcoholics Anonymous. Meetings tailored to pregnant women may be more effective.

Tobacco

Nicotine replacement therapy and other medication-assisted therapy should be used with extreme caution during pregnancy. Pregnant women should seek behavioral therapy and counseling first. Contingency management therapy has a high success rate with pregnant women. Medication should be used only with the supervision of a health professional.

Marijuana

Addiction to marijuana can be treated with detox and therapy. Withdrawal symptoms from marijuana addiction typically include anxiety, depression or trouble sleeping. Cognitive behavioral therapy, motivational enhancement therapy and contingency management therapy have been effective treatments.

Cocaine, Methamphetamine and Other Stimulants

Individuals addicted to cocaine, methamphetamine and other stimulants usually respond similarly to various treatment options. Pregnant women seeking help for stimulant addiction should be treated with supervised detox and contingency management, cognitive behavioral therapy or the matrix model.

Opioids

Women should not try to overcome addiction to heroin, prescription painkillers or other opioids without medical assistance. Withdrawal can be fatal to the baby, depending on the severity of addiction.

Methadone can help reduce withdrawal symptoms for the mother and the baby during detox. Infants born to mothers on methadone maintenance tend to have higher birth weights than those born to opioid-addicted mothers without treatment. An infant can be born with NAS if its mother is receiving methadone treatment.

Other medications such as buprenorphine have not been approved for use in pregnant women, but early studies cited by the U.S. National Library of Medicine indicate they may be effective. Behavioral therapy and access to resources such as housing, employment opportunities and food increase the chances of positive health care outcomes.

Co-Occurring Disorders

Behavioral therapy and counseling are usually the first treatment options for pregnant women suffering from mental health problems like depression, anxiety or eating disorders. Some antidepressants or anti-anxiety medications may be dangerous to the baby, so women should always talk with their doctors before starting one of those medications. Women should also tell their doctors if they are already taking any medications because quitting abruptly can be dangerous.

Pregnant women who suffer from an eating disorder should establish regular appointments with a prenatal health professional to monitor the health of the baby. They may want to consider seeing a dietitian or nutritionist. Counseling and therapy are the safest treatments for a woman suffering from an eating disorder, but therapists may prescribe medication if a woman is also suffering from severe depression or anxiety.

Specialized addiction treatment centers and rehabilitation facilities treat women who are pregnant and provide a safe environment in which they can recover from addiction. Women should continue to attend therapy appointments or support group meetings after giving birth to increase the chances of long-term recovery.

In 2010, 4.8 percent of women who were admitted to addiction treatment programs were pregnant.

A variety of treatment options are available for drug-addicted pregnant women, but some treatments have proven to be more effective for certain types of addiction than for others.

About 10 percent of pregnant women report drinking alcohol, and 3 percent admit to binge drinking.

Legal Consequences

Women should never avoiding seeking treatment for addiction because of fear of legal ramifications. Several professional organizations —including the American Society of Addiction Medicine, the American College of Obstetricians and Gynecologists and the American Psychiatric Association — have advocated against incarcerating pregnant women who suffer from addiction.

Many legal cases against women who abused drugs while pregnant have been dismissed on grounds of unconstitutionality. However, in some states women can be convicted of criminal charges for abusing drugs while pregnant.

In 2015, the Tennessee legislature passed a controversial law intended to encourage women to seek treatment for addiction. Under the law, women who continued to use drugs without seeking treatment could be prosecuted. However, the law was revoked after national outcry.

Overall, criminal prosecution has not proven to be an effective deterrent to drug abuse, and it has not positively affected health outcomes for mothers or their children.

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Substance abuse is the third most common reason women seek divorce. It’s among the most common reasons couples seek marriage counseling.

Living With an Addict

Addiction affects families in a variety of ways. The impact is different for each family and often depends on the addict. It’s important for a pregnant woman to put her safety and her child’s safety first.

Family members should encourage their loved ones to seek help, but a person’s decision to seek treatment may be affected by a family member’s attitude toward addiction.

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Abusive Environment

If she lives in an abusive environment, she should seek help from law enforcement or a local domestic violence shelter.

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Drugs in The Home

If drugs or drug paraphernalia are present in the home, she should consider living with a family member or close friend.

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A Family Members Addiction

If a family member’s addiction is causing a high amount of stress or anxiety, she should seek professional therapy or help from a support group.

1

Education

It’s important for every member of a family to understand the science of addiction. A pregnant woman may try to show her loved ones research online or information in the news. Community support groups may be able to help provide educational pamphlets or information for families.

A pregnant woman should talk to her health care provider about the presence of addiction in her home. Health professionals and social workers will be able to provide information and local resources.

2

Intervention

If an addict is unwilling to seek help for themselves, family members may need to step in. Whether it’s her spouse, sibling, parent or other family member suffering from addiction, a pregnant woman can rally close friends and family to participate in an intervention.

When conducted properly and in a safe environment, interventions can be effective motivators for someone suffering from addiction. Interventions show the person the consequences of their actions, and they show them they have a wealth of love and support.

3

Support

Offering support to a loved one seeking help for addiction is crucial. They may desire space during recovery, or they may vent frustrations to their loved ones. A pregnant woman may be asked to attend family therapy sessions, and it’s important that she actively and honestly participate in therapy to help build a healthy home environment.

It’s also important to remember that people recovering from addiction slip sometimes, and it’s a regular part of the process. That doesn’t mean it’s acceptable for a recovering drug addict to use a drug. It means one mistake doesn’t equal relapse. Relapse does occur often, though, and it’s important for family members to support a return to treatment and not to condemn or judge.

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