Drug Abuse During Pregnancy

drug use during pregnancyDrug abuse in the United States may involve opioids, benzodiazepines, barbiturates, alcohol and prescription drugs such as anti-anxiety and anti-depressant medications. The costs of drug abuse are high, and they include crimes against people and property and expenses related to the justice system and the health care system. Recent estimates of the health care costs of opioid drug abuse alone are in the range of $26 billion for 2013 and are more than $78 billion in overall costs.

Statistics About Women and Substance Use Disorders

Substance use disorders are difficult to overcome without treatment. Women are in a unique position when it comes to drug abuse, especially if they experience a pregnancy during their substance use disorder. As many as 5 percent of pregnant women have a drug abuse problem. Women who abuse drugs during pregnancy have a risk of passing the substances to the fetus. This is because many drugs can cross the placenta and enter the fetal blood supply. The child may be born with serious or even life-threatening effects of exposure to drugs.

How Substance Use During Pregnancy Affects a Fetus

There are many serious consequences of drug abuse during pregnancy. A woman who uses illicit substances has a two to three times increased risk of stillbirth. Some drugs cause birth defects in a child. Premature birth, a small head circumference and low birth weight are also risks of substance use during pregnancy.

Drug Withdrawal Symptoms in Babies

When a baby is born, the child may experience symptoms of withdrawal. These symptoms can start just after birth. In some babies, the symptoms of withdrawal take up to 14 days to develop. A newborn might develop withdrawal symptoms, including excessive crying, stiffness, fever, difficulty feeding, vomiting, irritability, slow weight gain and sleep problems. A baby going through withdrawal may also have rapid breathing, tremors or seizures. These symptoms can be difficult to manage, even in a neonatal intensive care unit. Babies who were exposed to drugs in utero are also at a higher risk of sudden infant death syndrome. Without adequate treatment for pregnant women, the numbers of babies affected by withdrawal will increase.

Criminal Charges Related to Drug Abuse During Pregnancy

In attempts to decrease the prevalence of drug abuse in pregnant women, some states are turning to criminal charges such as child abuse as a deterrent. The Pennsylvania Supreme Court has been asked to determine if child abuse charges can be levied against a pregnant woman with an active substance use disorder. The specific case is the result of a baby born at Williamsport Hospital in Clinton County. The infant tested positive for benzodiazepines, marijuana and opioids. The baby’s withdrawal symptoms required 19 days of hospitalization.

The Pennsylvania Child Abuse Case

The parents of the child won the initial court case by arguing that a fetus is not a child, so child abuse charges were not applicable. Pennsylvania state law does not consider to a fetus to be a child. Clinton County Children and Youth Services appealed the ruling, noting that the state law could be applicable if the mother knew that her actions could harm the child after birth. Punishing drug abuse as child abuse could actually deter women from getting the prenatal care they need. This is because doctors are mandated reporters of child abuse. Such a finding could also penalize women for other choices they make while pregnant, such as traveling to a country where mosquitoes carry dengue or Zika.

Rebranding Drug Abuse

Substance use disorders are not uncommon in the United States. In a 2014 health survey of a random sample of Americans throughout the country, about 1 in 10 people reported that they had used an illegal drug or abused a prescription drug in the past 30 days. This is a large population of people in need of treatment. While just a subset of those people are pregnant women, the needs of women during pregnancy are considerably different than the needs of women outside of pregnancy or the needs of men.

For a long time, drug abuse problems have been handled by the criminal justice system. Treating drug abuse as a form of child abuse would keep the problem in the justice system. However, pregnant women in jail or prison may not receive the empathetic and professional care that they need in order to overcome their substance use issues. They may also lack in the appropriate prenatal and postnatal care if they remain in the justice system. By looking at abuse of drugs as a disease instead of a crime, the health and treatment needs of pregnant women with a substance use disorder can be handled appropriately.

What Is the Availability of Treatment for Women With Substance Use Disorders?

Women with substance use disorders typically have a different progression of their disease. Women may have a shorter history of abusing opioids, marijuana or cocaine. However, they usually enter treatment at a later and more severe stage of their disease. This is because women develop dependence on drugs in a shorter amount of time than men do.

When a woman with a drug abuse problem is pregnant, she may be fearful of getting prenatal care. The doctor would be required to report drug abuse, or her test results may show that drugs are in her system. A woman might be scared that her child will be taken away if she seeks treatment. Now is the time to provide an increased level of support to women who seek treatment for substance use disorders during pregnancy. By providing the right combination of prenatal and postnatal health care, child care, inpatient drug treatment and outpatient drug treatment, a woman may be able to overcome a substance problem.

Fortunately, these programs are growing. It is getting easier for a pregnant woman to locate an inpatient or outpatient drug treatment center that provides a full spectrum of essential support services. Federal law also requires that pregnant women receive priority admission into drug treatment programs that receive federal funding. A pregnant woman can even bypass a waiting list for a residential drug treatment program. If the woman does not already have prenatal care services set up, the residential facility has to find them for her.

Treating Women With Substance Use Disorders During Pregnancy

Treatment of a woman with a substance use disorder while pregnant requires special services. If the woman has an opioid addiction, she may need specialty prenatal care in addition to drug treatment services. This is because babies can be dependent on opioids when they are born. While there are not any specific medications that can be given to pregnant women or babies with opioid addiction to prevent withdrawal, drug treatment combined with prenatal care, intensive counseling and the use of methadone or buprenorphine may limit the severity of a baby’s health effects from exposure to drugs during fetal development.

Women who abuse drugs during pregnancy may also have other mental health disorders. A thorough treatment program can identify and treat any comorbid disorders, such as depression or anxiety. By treating any coexisting conditions that a woman has, she may be less likely to experience a relapse of the substance use disorder.

A pregnant woman with a substance use disorder may also need extra parenting support after her baby is born. Outpatient counseling and social services that include parenting classes could increase a woman’s chances at successfully overcoming a substance use disorder and developing excellent parenting skills. Caring for a baby can be stressful, and the extra support provided in an outpatient program could be essential to a woman’s way past the addiction. Extra parenting support could also help a woman maintain custody of her child. The loss of custody is a known trigger for relapse, so helping a woman with her parenting skills could also assist in the prevention of a drug relapse.

Education About Substance Use Disorders During Pregnancy

When a woman visits a physician for prenatal care, non-judgmental information about drug use disorders should be available. Doctors should offer women information about how a substance issue could affect her health and that of the fetus and child after birth. The court system may also provide education and information about substance use disorders, including their unique effects on pregnancy.

Some pregnant women with substance use disorders may not seek out prenatal care. They may not have transportation to a clinic or doctor’s office, or they may have a fear of being reported to the police or taken to jail. These women may stand to benefit the most from education about substance use disorders while pregnant. Education could be provided at pharmacies, schools, methadone treatment centers, social services agencies, health clinics and hospital emergency rooms. At-home pregnancy tests could include information about drug treatment. Friends and family members can also educate themselves about treatment programs for pregnant women who abuse drugs. Encouragement and support of friends and family may be the impetus that a woman needs in order to get professional care.

Overcoming a Substance Use Disorder While Pregnant

Overcoming a substance use disorder allows a pregnant woman to do the best she can for her child. The process of moving past a drug use problem starts with medically supervised detox. When pregnant women have access to medically supervised detox, the process facilitates positive outcomes for their own health and the health of their babies. After the detox is complete, a pregnant woman should participate in counseling. The counseling sessions are meant to help a woman deal with the emotional parts of addiction. Identifying triggers, learning positive ways to manage stress and practicing improved communication skills can help a woman avoid a relapse and move forward in her life. When a woman is pregnant, this phase is combined with prenatal health services and classes to help her be a good parent.

Once a woman is ready to leave an inpatient treatment facility, intensive outpatient support should begin. This is especially important for a pregnant woman. Hormonal changes during and after pregnancy can trigger strong emotions, and being able to handle those feelings in a positive way is key to avoiding a relapse. Some women will enter a sober living facility while others might go to live with a sober family member. In either case, intensive outpatient counseling and prenatal care should continue for the duration of pregnancy. Postnatal care and continued outpatient counseling provide ongoing support.

With the right treatment and support services, a pregnant woman can overcome an addiction. Education about drugs and their effects on pregnancy helps family members, friends and health care providers identify pregnant women who are in need of treatment. Recovery is possible for pregnant women with a substance use disorder if they have the right treatment program and support system in place.