Coping with Drug Use during Pregnancy

Substance Use Disorder in Pregnancy

Substance Use Disorder (SUD) during pregnancy is a serious public health concern that requires immediate attention and intervention. This disorder often leads to adverse health outcomes for both the mother and the baby, including overdose-related deaths and increased mortality rates.

Addressing Overdose-Related Deaths

Overdose-related deaths among pregnant and postpartum women have been a growing concern in recent years. The "Substance Use Disorder in Pregnancy: Improving Outcomes for Families" report by the Office Of National Drug Control Policy in 2022, outlines strategies to address this pressing issue. The report highlights the need for increased awareness, better access to treatment services, and improved healthcare practices to prevent and manage drug overdose cases among pregnant women [1].

The report emphasizes on the importance of early intervention and access to medication-assisted treatment (MAT) for pregnant women with SUD. It also calls for integrating SUD treatment services with prenatal care, which can help to improve health outcomes for both the mother and the baby.

Trends in Opioid Mortality

Opioid use during pregnancy is a significant health risk that has seen a substantial increase in recent years. The American College of Obstetricians and Gynecologists reported a worrying trend in pregnancy-associated mortality involving opioids in the United States from 2007 to 2016. The data revealed a significant increase in the number of pregnant women affected by opioid mortality during this period [1].

The rise in opioid-related deaths among pregnant women underscores the need for targeted interventions to address SUD during pregnancy. These interventions should include comprehensive screening for drug use, access to MAT, and ongoing prenatal care to monitor and manage the health of the mother and the baby.

Understanding and addressing the issue of drug use during pregnancy is crucial for improving health outcomes for mothers and babies. By focusing on prevention, early intervention, and access to treatment, it is possible to reduce the risk of overdose-related deaths and opioid mortality among pregnant women.

Support Strategies for Pregnant Women

For pregnant women grappling with drug use, there are several support strategies and resources available. These resources aim to provide comprehensive care, support, and treatment to help women achieve recovery and ensure the health of both the mother and the baby.

State Programs for Recovery

State programs offer a variety of coverage, care delivery, and financing strategies to support recovery efforts. One such initiative is the State Options for Promoting Recovery Among Pregnant and Parenting Women With Opioid or Substance Use Disorders, provided by the National Academy for State Health Policy in 2018 [1]. These programs focus on creating a supportive environment for recovery and providing accessible and effective treatment options.

These state programs often include services such as:

• Substance use disorder treatment
• Mental health services
• Prenatal and postnatal care
• Parenting support and education
• Housing assistance

These services are designed to address the multifaceted challenges faced by pregnant women dealing with substance use disorders, and to provide them with the necessary tools and resources to achieve recovery.

Resources for Opioid Use Disorders

The Substance Abuse and Mental Health Services Administration (SAMHSA) provides resources specifically tailored for pregnant women with opioid use disorders (OUDs). SAMHSA’s Resources: Pregnancy and Substance Use Disorders, shared in 2018, offers a range of resources to support women in overcoming drug use during pregnancy [1].

One significant measure in treating OUDs is the provision of the Mainstreaming Addiction Treatment (MAT) Act. This provision has eliminated the DATA-Waiver (X-Waiver) program, allowing all DEA-registered practitioners with Schedule III authority to prescribe buprenorphine for Opioid Use Disorder (OUD) in their practice. There are no longer limits on the number of patients with OUD that a practitioner may treat with buprenorphine.

Buprenorphine is a medication used in the treatment of opioid addiction. This medication can not only help manage cravings and withdrawal symptoms but also significantly reduce the risk of overdose. Its use during pregnancy has been found to decrease the severity of neonatal opioid withdrawal syndrome (NOWS), ensuring better outcomes for newborns [2].

These resources and support strategies are crucial in helping pregnant women overcome drug use, ensuring their well-being, and paving the path for a healthier future for them and their babies.

Effects of Drug Use During Pregnancy

Substance abuse during pregnancy has significant implications for both the mother and the baby. It's crucial to understand these effects to make informed decisions and seek help when necessary. In this section, we'll look into the risks of stillbirth and Neonatal Abstinence Syndrome (NAS) associated with drug use during pregnancy.

Risks of Stillbirth

Research indicates that partaking in substances such as tobacco, marijuana, prescription pain relievers, or illegal drugs during pregnancy can double or even triple the risk of stillbirth. It is estimated that about 5 percent of pregnant women use one or more addictive substances.

Moreover, infants whose mothers both smoked and drank beyond the first trimester of pregnancy have a twelvefold increased risk for sudden infant death syndrome (SIDS) compared to those unexposed or only exposed in the first trimester of pregnancy [3].

Neonatal Abstinence Syndrome (NAS)

Neonatal Abstinence Syndrome (NAS), or neonatal opioid withdrawal syndrome (NOWS), is a condition where the baby experiences withdrawal symptoms upon birth due to regular use of certain drugs during pregnancy. Substances that could lead to NAS include opioids, alcohol, barbiturates, benzodiazepines, and caffeine [3].

Despite the challenges associated with NAS, the condition is manageable. Treatment with methadone and buprenorphine during pregnancy can decrease the severity of NAS, and such medication-assisted treatment has not been associated with congenital malformations. Studies show minimal to no long-term neurodevelopmental adverse outcomes in exposed infants.

Furthermore, opiate receptors are distributed throughout the central nervous system and peripheral tissues. Opiate use during pregnancy increases the risk of preeclampsia, premature labor, placental insufficiency, intrauterine growth retardation, and intrauterine death. Neonates born to women using opiates during pregnancy often have low birth weight and experience symptoms of opiate withdrawal [4].

In conclusion, the effects of drug use during pregnancy can be dire. However, with the right treatment and support, these effects can be managed or prevented. It is crucial that pregnant women struggling with substance use seek help as early as possible to ensure the best possible health outcomes for themselves and their babies.

Impact of Specific Substances

Within the broader context of drug use during pregnancy, it's crucial to analyze the effects of specific substances on both the mother and the unborn child. In this segment, the focus will be on cocaine and cannabis, two commonly abused drugs.

Cocaine Use During Pregnancy

Cocaine, a powerful stimulant, poses serious risks when used during pregnancy. According to the National Institute on Drug Abuse (NIDA), pregnant women who use cocaine are at higher risk for various complications, including maternal migraines and seizures, premature membrane rupture and placental abruption.

Furthermore, the impact on the baby can be profound. Babies born to mothers who use cocaine during pregnancy may have low birth weight, smaller head circumferences and may exhibit symptoms such as irritability, hyperactivity, tremors, high-pitched cry, and excessive sucking at birth.

Cannabis Use Trends

The consumption of cannabis, also known as marijuana, during pregnancy has been on the rise. As per NIDA, cannabis use more than doubled among pregnant women in the United States from 2010-2017. Past-month cannabis use increased from 3.4% to 7.0% among pregnant women overall and from 5.7% to 12.1% during the first trimester.

It's important to note that the use of cannabis is more common during the first trimester than in the later stages of pregnancy. The implications of this trend are still being studied, but the rise in usage points to an urgent need for public health interventions and education about the potential risks associated with cannabis use during pregnancy.

As these statistics underline, understanding the specifics of substance use during pregnancy can be instrumental in devising effective prevention and treatment programs. Pregnant women struggling with substance use disorders need supportive, comprehensive care that addresses both their addiction and their unique needs as expectant mothers.

Health Concerns and Public Impact

The repercussions of drug use during pregnancy extend beyond just the mother and child. It can also have significant public health implications due to the long-term impact on the child's life and the associated healthcare costs. In this section, we'll take a closer look at two common substances: alcohol and nicotine, and an illicit drug: methamphetamine.

Alcohol and Nicotine Use

Legal substances such as alcohol and nicotine also come with significant risks when used during pregnancy. According to NCBI, about 8.5% of pregnant women aged 15–44 reported current alcohol use during pregnancy. Alcohol and nicotine can cross the placenta and affect the fetus, leading to a range of complications from fetal alcohol syndrome to low birth weight and premature birth.

In addition to the physical risks, alcohol and nicotine use during pregnancy can also lead to long-term behavioral and learning issues in children. This further underscores the importance of seeking help and support for substance use during pregnancy.

Methamphetamine and Public Health

Illicit drug use, including methamphetamine (METH), among pregnant women continues to be a major public health concern. The NCBI reports that nearly 25 million Americans aged 12 or older are current illicit drug users, representing 9.2% of the population. Moreover, the rate of current illicit drug use among pregnant women aged 15–44 has remained constant at 5.9%.

Specifically, METH use in the United States and other parts of the world remains a significant public health concern, with 1.3% of the general population in Central and North America using amphetamine-type stimulants. The Infant Development, Environment, and Lifestyle (IDEAL) study found that approximately 5% of women self-reported METH use during pregnancy.

METH use during pregnancy can lead to a range of health risks for the baby, including low birth weight, premature birth, and developmental problems. It also contributes to the increasing burden on public health resources due to the need for specialized care and long-term support for these children.

These statistics highlight the critical need for ongoing efforts in prevention, education, and treatment to address drug use during pregnancy and its impact on public health.

Treatment and Prevention Measures

In the face of the challenges posed by drug use during pregnancy, there are significant measures being put in place for treatment and prevention. Notably, the Mainstreaming Addiction Treatment Act and the management of Neonatal Opioid Withdrawal Syndrome stand out as major strides in this area.

The Mainstreaming Addiction Treatment Act

The Mainstreaming Addiction Treatment (MAT) Act marks a significant development in treating opioid use disorder (OUD). This provision has abolished the DATA-Waiver (X-Waiver) program, allowing all DEA-registered practitioners with Schedule III authority to prescribe buprenorphine for OUD in their practice. As a result, there are no longer any limitations on the number of patients with OUD that a practitioner may treat with buprenorphine [2].

This is a significant development in the approach to addiction treatment, as it allows for increased accessibility to medication-assisted treatment for those struggling with OUD. By eliminating the restrictions on the number of patients a practitioner can treat, more individuals are able to receive the necessary treatment for their disorder.

Neonatal Opioid Withdrawal Syndrome

Neonatal opioid withdrawal syndrome (NOWS), previously known as neonatal abstinence syndrome (NAS), refers to a set of conditions experienced by newborns exposed to opioids prenatally. Although it is expected, it is a manageable condition.

Treatment with methadone and buprenorphine during pregnancy can decrease the severity of NOWS. Medication-assisted treatment has not been associated with congenital malformations, and studies show minimal to no long-term neurodevelopmental adverse outcomes in exposed infants [2].

This treatment strategy offers hope to those struggling with drug use during pregnancy by providing a viable option to ensure the health and safety of their newborns. It also underscores the necessity of seeking professional help and following prescribed treatments to mitigate the impact of drug use on both the mother and child.

In conclusion, the Mainstreaming Addiction Treatment Act and the management of Neonatal Opioid Withdrawal Syndrome represent significant advances in the treatment and prevention of drug use during pregnancy. They reflect the commitment and efforts of the medical community and policymakers to address this pressing issue. As such, they offer hope for those grappling with substance use disorders during pregnancy and underscore the need for continued research and development in this area.

References

[1]: https://ncsacw.acf.hhs.gov/topics/pregnancy/

‍[2]: https://www.ncbi.nlm.nih.gov/books/NBK542330/

‍[3]: https://nida.nih.gov/publications/research-reports/substance-use-in-women/substance-use-while-pregnant-breastfeeding

‍[4]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4262892/