Pregnancy & Addiction Guide

Using addictive substances during pregnancy increases the risks to both mother and prenatal child. Illicit drugs and alcohol use can lead to physical dependence and addiction as well as mental health concerns for the mother. It also raises the odds for stillbirth, miscarriage, and a host of birth defects and medical concerns for the baby.

Pregnancy can present a barrier to seeking addiction treatment for women who are concerned about potential legal ramifications due to the criminalization of illicit drug use during pregnancy and potential harm to the fetus.

There are several treatment options that can address the specialized needs of a pregnant mother, including residential and supportive communities.

It is important to get professional addiction treatment help as soon as possible for the safety of both the mother and unborn baby.

How Often Do Pregnancy & Addiction Go Together?

In 2020, researchers asked pregnant women how often they used substances. They found that 10% of women admitted to drinking alcohol, and about 40% admitted to using one or more other substances.

In a separate study published in 2020, researchers found that women who continued to use marijuana before or during pregnancy, 74% also smoked cigarettes. Research like this suggests that using one substance could open the door to using another.

Based on studies like this, the Centers for Disease Control and Prevention says that using more than one substance during pregnancy is “common.”

Researchers with the University of South Carolina examined data from the National Survey on Drug Use and Health gathered between 2015 and 2020 to determine how drug use rates varied by ethnicity and over time. They found that women using multiple substances during pregnancy declined from 5.82% in 2015 to 4.51% in 2020. However, people who identify as Hispanic and who live in an urban area were more likely to use multiple substances, and the rate of doing so increased by 14.6% during the study period.

Risks of Drug Use During Pregnancy

The use of illicit drugs can have many negative physical, mental, socioeconomic, and interpersonal effects, including raising the odds for drug tolerance, physical dependence, and addiction. Drug use can make it difficult to hold down a job, support a safe place to live, and maintain healthy relationships. Addiction can also increase stress, anxiety, and depression, and cause many health and medical issues.

Chronic drug use can cause physical and psychological drug dependence that can lead to painful and difficult withdrawal symptoms and cravings when the drugs are not active in the brain and body. As a result, the process of obtaining drugs, using drugs, and recovering from them can become a continuous cycle.

Using drugs during pregnancy carries all these risk factors, but it also creates more potential issues for both the mother and the baby in the womb. A mother is at an increased risk for anemia, hepatitis and other infectious diseases, skin infections, heart and blood infections, and sexually transmitted diseases when using drugs during pregnancy.

Additional risks of drug use during pregnancy include:

• Miscarriage, which is loss of pregnancy before the 20th week of being pregnant.
• Stillbirth, which occurs when the baby is lost after the 20th week or during delivery.
• Preterm labor, which is when labor starts before the 37th
• Placenta issues, where the placenta has difficulty supplying nourishment and oxygen to the baby.

The risk for stillbirth is doubled for pregnant women who use tobacco products, marijuana, stimulant drugs, or prescription painkillers, studies show. Even if a baby is carried safely all the way to birth, there are still many potential complications and long-reaching side effects on the child from drug use during pregnancy.

How Drugs Affect a Prenatal Child

Just like food and nutrients pass through the placenta to the fetus during pregnancy, so can most drugs. Addictive substances used by a mother during pregnancy can therefore cause drug dependence for the baby as well as the mother.

Illicit drugs passing through the placenta to the prenatal child can create long-term issues as well, including birth defects and other deficits.

Babies born to mothers who regularly used illicit drugs during pregnancy can have the following potential issues:

• Low birth weight
• Increased risk for SIDS (sudden infant death syndrome)
• Growth defects
• Birth defects
• Behavioral issues
• Learning and cognitive delays and issues
• Hyperactivity
• Small head circumference
• Premature birth

Alcohol and tobacco use after the first trimester of pregnancy can result in a 12-fold increase for SIDS compared to babies who are not exposed, the National Institutes of Health (NIH) warns.

Impact of Illicit Drugs Used During Pregnancy on the Baby

Specific drugs can impact prenatal children in specific ways.

Sedatives

Medications like antidepressants, antipsychotics, and benzodiazepines can cross the placenta and enter a baby’s body during pregnancy. Children born to mothers who use these drugs can develop “floppy baby” syndrome that’s characterized by the following symptoms:

• Low body temperature
• Lethargy
• Weak breathing
• Feeding difficulties

The American College of Obstetricians and Gynecologists also says babies born to moms taking Xanax, Librium, or diazepam can have withdrawal symptoms that last for several months. Caring for a baby with anxiety and poor feeding caused by withdrawal can be a challenge.

Marijuana

The use of marijuana during pregnancy needs more research, but NIDA warns that the following potential complications could impact the unborn child:

• Increased odds for miscarriage
• Issues with neurological development
• Trouble maintaining attention
• Gaps in memory and problem-solving skills

Cocaine & Methamphetamine

Stimulant drugs, such as cocaine, methamphetamine, and prescription ADHD medications, can cause issues when taken, especially when misused, during pregnancy. Stimulants can cause the blood vessels in the placenta to constrict, not allowing enough blood or oxygen to reach the baby.The following issues can occur:

• Low birth weight
• Premature growth
• Neonatal withdrawal symptoms
• Growth issues
• Stillbirth
• Low Apgar scores
• Miscarriage
• Signs of withdrawal

Alcohol

Alcohol passes directly from the bloodstream of a pregnant woman into the bloodstream of the unborn baby, which can lead to birth defects, neurodevelopmental abnormalities and a wide rage of developmental, behavioral, and cognitive issues that can persist for a lifetime, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) reports. 

The baby can be born with one of the fetal alcohol spectrum disorders (FASD), such as these:

• Fetal alcohol syndrome (FAS)
• Partial FAS (pFAS)
• Alcohol-related birth defects (ARBD)
• Alcohol-related neurodevelopmental disorder (ARND)

Heroin & Opioids

Opioid drugs, including heroin and prescription painkillers, can lead to neonatal abstinence syndrome (NAS), a dangerous withdrawal syndrome that can last for weeks. Babies who are born to mothers who use opioid drugs regularly are also at a higher risk for SIDS, sleep apnea (suddenly stopping breathing), and feeding issues.

Neonatal Abstinence Syndrome (NAS)

One of the big concerns of using drugs such as opioids during pregnancy is the risk for the baby to develop neonatal abstinence syndrome, or NAS. This happens when the baby becomes dependent on a drug that the mother has been using regularly because that drug has passed through the placenta to the unborn child.

Once the baby is born, they can suffer from withdrawal symptoms within one to three days after birth. Withdrawal symptoms may include the following:

• Diarrhea
• Vomiting
• Blotchy skin
• Excessive and high-pitched crying
• Sucking excessively
• Fever
• Irritability
• Poor feeding
• Hyperactive reflexes
• Rigid muscle tone
• Sweating
• Stuffy nose and sneezing
• Rapid breathing
• Tremors
• Seizures
• Difficulty gaining weight
• Sleep issues

A baby suffering from NAS will often need to stay in the hospital under close observation for a least a week, and symptoms can continue for up to six months. Babies suffering from NAS can be difficult to calm, fussy, and have trouble feeding, and therefore growing, at healthy rates.

Antidepressant medications, benzodiazepines, barbiturates, and alcohol use during pregnancy can also cause NAS. The severity of NAS will depend on what drug was used, how much of the drug was used, how often it was used and for how long, as well as the mother’s drug metabolism (which is typically impacted by genetics) and at what stage the baby was born (on time or early).

Impact of Drug Use on the Mother

Much of the research on pregnancy and addiction focuses specifically on how the drugs impact the baby. It’s critical to remember that drugs can harm the mother too. Her risks aren’t very different from those she faces if using drugs while not pregnant, but they’re still very important to know.

Marijuana

The Centers for Disease Control and Prevention says that marijuana can cause many health issues, including the following:

• Cancer, particularly when the drug is smoked
• Poor heart health
• Lung disease
• Mental health issues, such as a higher risk of schizophrenia
• The potential for marijuana use disorder

Cocaine & Methamphetamine

Stimulants like cocaine and methamphetamine can cause serious health problems, including the following:

• Seizures
• High body temperature
• Poor heart health
• Overdose death
• Paranoia
• Psychosis
• Stimulant use disorder

Some stimulants, such as cocaine, are designed for inhalation. Sniffing drugs like this can cause serious nasal problems. Smoking the drug can cause lung problems too.

Alcohol

The Centers for Disease Control and Prevention says nearly half of adult women report drinking alcohol within the last 30 days. Women metabolize alcohol slower than men do, and the effects tend to last longer. This can mean women are more susceptible to the long-term problems associated with alcohol, which can include the following:

• Liver disease
• Cognitive decline
• Heart disease
• Breast, throat, esophageal, liver, and colon cancer

Heroin & Opioids

Opioid medications (including painkillers like Vicodin) and heroin can cause short-term health problems, including opioid use disorders and life-threatening overdoses. Long-term problems can include withdrawal symptoms when people try to quit.

Some people develop problems associated with how they use drugs. For example, people who use heroin with a needle can develop serious infections below the skin. The National Institute on Drug Abuse says additives in street heroin may not dissolve completely, and when they’re injected, they can clog delicate blood vessels that serve the lungs, liver, kidney, or brain. Sometimes, additives or contaminants can lead to bacterial infections of heart valves too.

Co-Occurring Disorders With Addiction During Pregnancy

Pregnancy can raise stress levels and further exacerbate anxiety and depression along with substance use. When someone struggles with mental health issues and substance abuse at the same time, they are dealing with co-occurring disorders.

It is especially important to manage stressors and mental health during pregnancy, for the health of both the mother and baby. Stress, anxiety, and depression are risk factors for substance abuse, and substance use can worsen these mental health concerns as well. Both issues can increase the side effects and incidence of the other, and this phenomenon can be heightened during pregnancy.

About half of all pregnancies are unplanned, and this is more common among women who also battle a substance use disorder. Pregnant women who have a substance use disorder are more likely to also struggle with a mental illness, the American Society of Addiction Medicine (ASAM) reports. Mothers with a substance use disorder are more likely to also develop postpartum depression after the baby is born.

Pregnancy, addiction, and mental health concerns require specialized and comprehensive treatment methods.

Treatment Options for Pregnant Women

Most women who struggle with substance abuse during pregnancy start using drugs or alcohol before they become pregnant, often due to trauma or life stressors.

Pregnant women are often motivated to make changes for the health of the baby. The earlier during pregnancy that addiction can be treated, the better the odds for a healthy pregnancy and baby.

Treatment programs may include the following offerings:

• Medical detox
• Outpatient programs
• Intensive outpatient programs
• Partial hospitalization
• Residential rehab programs

An effective substance abuse treatment for pregnant women will need to offer ongoing medical and mental health support, as well as behavioral health and social services when co-occurring disorders are present. Group and individual counseling and therapies can address substance use, mental health issues, social concerns, and particular factors unique to pregnancy.

The Use of Medications & Medical Detox

Pregnant women benefit from evidence-based treatment methods that may include the use of behavioral therapies and medications.

NIDA reports that medications can be helpful for managing heroin addiction. Many of these medications, while safer than heroin, are still low-dose opioids that will produce withdrawal symptoms in babies. These will need to be addressed at birth. A supervising physician will weigh the risks and benefits of specific types of Medication-Assisted Treatment (MAT) during pregnancy.

Drugs can make physical and chemical changes to the brain when used regularly, and it can be dangerous to stop use suddenly. An inpatient medical detox program is often the first step to manage withdrawal symptoms and offer medical and mental health support for both mother and baby.

Medications can be safely administered during pregnancy under the supervision and direction of medical, mental health, and substance abuse treatment providers.

Residential Rehab

Inpatient treatment programs can offer the highest level of support during pregnancy for women managing substance abuse and addiction. A specialized residential addiction treatment center is staffed with medical and mental health professionals who can monitor the health and well-being of both the mother and unborn child throughout the remainder of the pregnancy.

Proper nutritional support, medication management, and support through drug withdrawal and cravings are important to keep mother and baby stable and healthy.

Peer support groups can provide a social outlet for pregnant women in recovery. In these groups, they can learn to develop coping strategies and find empathy and connection with others.

Addiction treatment during pregnancy should be comprehensive and encompass all of the special needs of a pregnant mother. The goal is to support a lasting recovery, the Substance Abuse and Mental Health Services Administration (SAMHSA) reports.

Legal Consequences of Drug Use During Pregnancy

One of the barriers to substance abuse treatment for pregnant women is often a fear of legal consequences.

With the rise of more laws targeting the protection of a fetus as a prominent public health concern, there may be legal and criminal ramifications for substance use during pregnancy. Many states consider substance use during pregnancy a criminal and punishable offense. Nearly half call it child abuse, and a few list it as grounds for a civil commitment.

There are also many areas that protect the mother legally, especially if seeking out treatment and working to be drug and alcohol-free. If the child is born with a positive drug test, several states will revoke parental rights, start an investigation with Child Protective Services, or mandate that the mother enter into a drug rehab program before being able to seek parental rights.

It is important to seek help as soon as the pregnancy is known in order to protect the baby and your parental rights before birth.

Living With an Addict

Addiction impacts not only the person using drugs or alcohol but also their immediate families, social circles, and society around them as a whole. Drug and alcohol addiction can consume a person, as they will spend the majority of their time seeking out drugs, using them, or recovering from their use. Responsibilities, jobs, social events, and activities that were previous priorities often fall by the wayside.

Drug use and abuse can change a person physically and emotionally, and it can even alter personalities. A person is liable to have significant mood swings, going from high to low with the ebb and flow of drug use. It can be difficult to communicate and keep up with interpersonal relationships.

It is important not to enable someone who is struggling with addiction. Make firm but clear boundaries and expectations.

When someone becomes pregnant while also battling addiction, treatment is the best outcome for both mother and child, and earlier treatment is better for both parties. Intervention and treatment to manage drug use early in the pregnancy, especially during the first trimester, can help the mother and baby to have a healthier labor and fewer complications during pregnancy, birth, and later in life.

Drug abuse treatment programs do not have to be voluntary to be effective, NIDA explains. A rehab program can help someone find the motivation to stop using drugs and take better care of themselves and their unborn child.

Families and loved ones play important supportive roles in drug abuse treatment. They can be especially beneficial when helping pregnant mothers they love who are battling addiction.

Medically Reviewed By Dr. Alison Tarlow

Dr. Alison Tarlow is a Licensed Clinical Psychologist in the States of Florida and Pennsylvania, and a Certified Addictions Professional (CAP). She has been a practicing psychologist for over 15 years. Sh... Read More