Pregnancy & Addiction Guide
Last Updated Dec 2, 2021
Women are at the highest risk for developing a substance use disorder during their reproductive years. As a result, women who become pregnant or are pregnant are at a high risk for substance abuse.
The National Institute on Drug Abuse (NIDA) reports that around 5 percent of women who are pregnant use at least one addictive substance. The most commonly used substances during pregnancy include tobacco, alcohol, marijuana, recreational use of prescription drugs, and street drugs, such as cocaine, heroin, and methamphetamine.
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.
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
- 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
- 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.
- 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 and 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 through.The following issues can occur:
- Low birth weight
- Premature growth
- Neonatal withdrawal symptoms
- Growth issues
- Low Apgar scores
- 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:
- Fetal alcohol syndrome (FAS)
- Partial FAS (pFAS)
- Alcohol-related birth defects (ARBD)
- Alcohol-related neurodevelopmental disorder (ARND)
- Heroin and 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:
- Blotchy skin
- Excessive and high-pitched crying
- Sucking excessively
- Poor feeding
- Hyperactive reflexes
- Rigid muscle tone
- Stuffy nose and sneezing
- Rapid breathing
- 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).
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.
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.
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Combined Prenatal Smoking and Drinking Greatly Increases SIDS Risk. (January 2020). National Institutes of Health (NIH).
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