Substance Use Disorder During Pregnancy

Over 40 million people in America suffer from a substance use disorder.

These disorders are chronic, but can be treated. They can affect anyone – including people who are pregnant.

What is Addiction?

Addiction is a chronic, relapsing disorder. This means that it is long-term and recurring. It is called a “brain disorder” because circuits which control reward, stress, and self-control are altered in people who suffer from addiction. These altered circuits are what cause compulsive drug seeking, where a person continues to use drugs in spite of the many negative effects on themselves and their loved ones. Brain circuits which have been altered by addiction do not return to normal immediately after a person stops taking drugs, and it may take a long time to reverse any changes. Learn more about addiction here.

The National Institute on Drug Abuse (NIDA) found that around 5% of people use drugs or alcohol during pregnancy.

In order to improve health outcomes for pregnant people and infants, care needs to be easy to access and stigma-free.

Harmful effects of drugs and alcohol during pregnancy:

SUD can cause many health problems for pregnant people and their babies, before, during, and after pregnancy. This includes early (preterm) birth, low birth weight, and even serious health problems such as:

Unexplained death of a baby during sleep (sudden infant death syndrome)
Children taking longer to hit milestones, such as speaking or walking (developmental delays)
Drug withdrawal (neonatal abstinence syndrome)
Birth defects

Different drugs have different impacts on pregnancy and how a child grows.

Many people with SUD suffer from polysubstance use, meaning they use more than one addictive substances. This makes studying the impacts of specific drugs on pregnancy more difficult.

SUD is sometimes hidden from doctors due to fears of discrimination, shame, and the threat of children being taken away from their parents.

How much, how often, and the kind of drug(s) used matters. Learn more about the affects of drugs and alcohol on pregnancy here.

What are the impacts of shame and discrimination?

Evidence shows that increasing criminal punishments for SUD during pregnancy leads to higher rates of neonatal abstinence syndrome (NAS) and other negative outcomes. These policies make pregnant people fear getting the help they need, and this lack of care ends up harming the pregnant person and their infant.

Since SUD is a clinical disorder, criminal punishment does not effectively address it. Instead, these policies can make pregnant people more likely to hide their disorder from both doctors and their loved ones.

The stigma of SUD during pregnancy causes people to avoid treatment, leading to worse health outcomes for both the pregnant person and infant.

According to the American College of Obstetricians and Gynecologists:

“A coordinated multidisciplinary approach without criminal sanctions has the best chance of helping infants and families”

Is Medication Assisted Treatment (MAT) Safe?

Medication-Assisted Treatment (MAT) is the use of medications for opioid use disorder (MOUD), along with counseling and other therapies, to provide a “whole-patient” style of treatment. There are currently three drugs approved by the FDA: buprenorphine, methadone, and naltrexone. All of these medications stop withdrawal, which can be harmful to the pregnant person and infant. Withdrawal is the harmful physical and mental effects of suddenly quitting or cutting back on drugs or alcohol after long term use or addiction.

According to the Centers for Disease Control (CDC), pregnant people with opioid use disorder (OUD) should be encouraged to start treatment with methadone or buprenorphine. There is less information available about the safety of naltrexone, but pregnant people who are already stable on this medication should talk to their doctors to weigh the risks and benefits of continuing. MAT is recommended rather than supervised withdrawal – it has been shown to improve health outcomes and reduce the risk of relapse. You can learn more about MAT during pregnancy here.

Stigmatizing Language

Source: NIDA

Shame, judgement, and fear drive pregnant people away from essential care.

Stigma-free and accessible SUD treatment and pregnancy care are key to improving the health of pregnant people and infants.

Why does care need to be easy to access?

Pregnant people with SUD need more than one type of support and treatment:

Treatment for SUD
Addiction counseling
Peer support
Prenatal care
Postpartum care
Pediatric care.

Connecting all of these services for pregnant people and those who recently gave birth helps to keep families together.

Nearly half of all children in foster care are placed there because their parents have untreated SUD.

SUD often affects people who already have mental health disorders. This can mean that mental health services are a necessary part of recovery.

According to the American College of Obstetricians and Gynecologists (ACOG), more than 30% of pregnant people in a SUD treatment program had moderate to severe depression, and more than 40% had symptoms of postpartum depression.

Connecting treatment for SUD and mental health disorders with pregnancy care makes access easier, especially for people who are struggling. There are already efforts to increase connected care. Currently this includes projects such as: Project Nurture and the CDC’s Quality Care Collaboratives.

Contra Costa Resource Directory: Substance Use Prevention and Treatment for Women and Mothers With Young Children

Comprehensive Perinatal Services Program: a Medi-Cal program that provides a model of comprehensive services for eligible low-income pregnant and parenting women

SAMHSA Treatment Locator: the confidential and anonymous resource for persons seeking treatment for mental and substance use disorders in the US.