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Addiction And Pregnancy Guide

Isaac Alexis, M.D., AAMA, AMP-BC

Medically reviewed by

Isaac Alexis, M.D., AAMA, AMP-BC

February 5, 2019

In the United States, nearly half of all pregnancies are unplanned. Women suffering from a substance or alcohol use disorder may put their babies at risk by using drugs or alcohol when they’re pregnant. During pregnancy, treatment is needed to manage the health risks of addiction for both the mother and baby.

The Risks Of Addiction And Pregnancy

Addiction is a chronic brain disease that affects how a person thinks and behaves. A woman suffering from drug addiction during pregnancy may risk the health and future well-being of her unborn child.

Many substances pass through the placenta (a source of nourishment for the fetus), so whenever a pregnant woman uses drugs or alcohol, they are effectively passing it on to their baby. Babies born from mothers who abused drugs during pregnancy may suffer long-term effects, such as cognitive disabilities and physical malformations.

Understanding the dangers and risks associated with addiction and pregnancy is a crucial step for education and prevention.

Some major problems for a baby exposed to substance abuse during pregnancy may include:

  • Miscarriage—the baby dies before the 20-week mark of pregnancy. There are many potential causes for a miscarriage, and drug or alcohol abuse may be one.
  • Stillbirth—the baby dies after the 20-week mark of pregnancy.
  • Preterm labor and premature birth—preterm labor occurs when labor starts too early. Premature birth happens when the baby is born before 37 weeks with potential health consequences.
  • Birth defects—health or physical abnormalities that are present at birth, such as vision and hearing problems and heart defects.
  • Placental abruption—the placenta is cut off from the wall of the uterus, diminishing the baby’s supply of food and oxygen. Drug abuse increases the risk of placental abruption, where serious bleeding can occur and be lethal for both mother and baby.
  • Neonatal abstinence syndrome—also called NAS, this condition occurs when the baby is exposed to drugs while still in the womb. Once born, the baby will experience symptoms of withdrawal.
  • Fetal alcohol spectrum disorders—also called FASD, this condition occurs as a result of drinking alcohol during pregnancy. As the baby grows older, they’re likely to develop intellectual disabilities, behavioral problems, and growth delays.

Many substances may complicate the health of the fetus during pregnancy, and treatment must address the individual needs of the mother, as well as the specific drug of abuse.

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Opioid Addiction And Pregnancy

Opioid addiction and dependence increase the risk of serious health consequences for both a mother and her baby. More and more infants are being exposed to prescription opioids and heroin as the opioid crisis worsens.

Every time a mother takes opioids, the baby is directly affected by the substance.

The Effects Of Opioid Use During Pregnancy

Some adverse effects of using opioids during pregnancy may include miscarriage, premature birth, birth defects, fetal growth restriction, and neonatal abstinence syndrome.

Neonatal abstinence syndrome (NAS) occurs when a baby goes through opioid withdrawal after it’s born. As a result of the expectant mother’s use of opioids, the baby becomes dependent on the drug while still in their mother’s womb.

Research suggests that opioid misuse leads to NAS and contributes to the majority of all hospital births of babies with breathing problems and low birth weight; 75 to 95 percent of babies born to mothers dependent on opioids will suffer from NAS.

Symptoms for a baby with NAS may include:

  • diarrhea
  • excessive crying
  • fever
  • irritability
  • possible death
  • seizures
  • trouble gaining weight
  • vomiting

Due to the serious health risks of NAS, an expectant mother should quit taking opioids to prevent her baby from going through withdrawal. However, quitting “cold turkey,” or stopping use of the drug abruptly, is likely to cause serious problems for both the mother and her baby.

Stopping opioid use abruptly may cause a condition known as placental abruption. The placenta provides food and oxygen to a woman’s baby during pregnancy.

Placental abruption occurs when the placenta separates from the wall of the uterus or womb. This can cause serious bleeding and may lead to premature birth, as well as be life-threatening for the mother and baby.

Other adverse effects of quitting opioids cold turkey include premature birth or preterm labor, growth defects, and stillbirth.

Pregnant women suffering from opioid addiction should consult their healthcare provider and seek treatment immediately. Opioid addiction is difficult to manage for a person on their own, and, without treatment, expectant mothers may put the future health of their baby at risk.

Treating Opioid Addiction In Pregnant Women

NAS requires careful medical attention at a hospital or inpatient treatment center. Treatment with morphine is administered to the baby to relieve painful and uncomfortable symptoms of withdrawal. The morphine will likely be tapered off, or gradually decreased, until the baby can function without opioids and be free from withdrawal.

Medication-assisted treatment, or MAT, will likely be used to help reduce cravings for the mother while also keeping the baby safe. Medications used for treating pregnant women dependent on opioids include methadone, buprenorphine, and naloxone.

While methadone treatment may cause the baby to experience NAS after birth, it’s effective for helping women deal with cravings during pregnancy. Under medical supervision, it’s safe and effective for both mother and baby.

Buprenorphine, like methadone, also helps manage opioid dependence, but doesn’t produce the intense feelings of calm and sedation produced by other opioids. After birth, the baby will likely go though less morphine tapering than a mother with methadone treatment.

Naloxone can be administered to mothers along with buprenorphine to reduce the withdrawal symptoms for babies born with opioid dependence.

Naloxone is also used to reverse the potentially deadly symptoms of overdose. Depending on the medical conditions of the mother, naloxone (brand name Narcan), should be safe for pregnant women in case of an emergency.

Research shows that careful administration of these medications, as well as prenatal care and an effective drug treatment program at an inpatient treatment center, can improve the well-being of expectant mothers with an untreated opioid addiction.

Alcohol Addiction And Pregnancy

Drinking alcohol, and especially abusing alcohol, during pregnancy is likely to cause severe health problems for both the mother and baby. There is no safe time to drink alcohol during pregnancy, and whenever a pregnant woman drinks alcohol, her baby drinks too.

A pregnant woman suffering from alcohol use disorder, or alcohol addiction, passes alcohol through her blood directly to her baby via the umbilical cord.

The Effects Of Alcohol Use During Pregnancy

Excessive alcohol use during pregnancy is likely to cause miscarriage, stillbirth, and a wide range of physical, mental, and behavioral disabilities. Disabilities found in babies born of mothers addicted to alcohol is called fetal alcohol spectrum disorders, or FASDs for short.

Babies born with FASDs are likely to develop certain abnormalities that can affect behavior and mental cognition or performance.

Once born, babies with FASDs may suffer from:

  • abnormal facial features, including a smooth ridge between the nose and upper lip
  • emotional problems
  • hyperactive behavior
  • learning disabilities
  • heart, kidney, or bone problems
  • low body weight
  • low I.Q., or other intellectual disabilities
  • memory problems
  • poor coordination
  • problems with vision and hearing
  • sleep problems as a baby
  • speech problems
  • thinking and reasoning problems
  • trouble and difficulty in school
  • trouble holding a job

Drinking any alcohol, including wine, beer, or liquor, is dangerous for a baby while still in the womb. Currently, there is no safe amount of alcohol to drink during pregnancy. A baby’s brain and organs are still developing while in the womb, and having any alcohol can seriously affect and damage the growth and development of essential life organs.

Many women may not know they’re pregnant until four to six weeks into the pregnancy. Heavy drinking during this time increases the risk of stillbirth, miscarriage, brain damage, growth and development problems, birth defects, and low birth weight.

Alcohol addiction, or alcohol use disorder, may occur in pregnant women in many forms, all of which may damage their baby long-term. Binge drinking, or having up to five drinks over a few hours, is likely to increase the risk of alcohol-related damage in the baby.

The more a pregnant woman drinks, the more likely their baby will develop FASDs.

The best treatment for alcohol addiction during pregnancy is to stop drinking. If the woman doesn’t drink alcohol, the baby will not be exposed to the health and behavioral risks of FASDs. Stopping drinking, however, can be difficult for a woman suffering from an alcohol use disorder.

Treating Alcohol Use Disorder In Pregnant Women

Pregnant women may require medically-supervised detoxification to allow medical professionals to carefully monitor symptoms of withdrawal, as well as the health of the baby.

Medically-supervised detoxification should take place in a hospital or inpatient treatment center, and is only the first step for treating an alcohol use disorder, not a cure. Effective treatment for an alcohol use disorder must incorporate a multifaceted approach to tackle all aspects of addiction and abuse, as well as attend to the specific needs of the individual.

Some treatment options may include programs specifically tailored to women and children. These programs will likely focus on relationships, family, and the effects of alcohol abuse on children.

Pregnant women suffering from alcohol use disorder should seek treatment at an inpatient treatment center to have access to behavioral therapies. These may include group therapy like Alcoholics Anonymous, one-on-one therapy, or more extensive therapies to help prevent further alcohol abuse in the future.

Stimulant Addiction And Pregnancy

Stimulants include drugs like cocaine, amphetamine, and methamphetamine, and affect the central nervous system and brain, causing people to be more alert and energetic.

It’s estimated that nearly three-quarters of one million pregnant women expose their babies to cocaine or other stimulants each year, and it’s crucial to be aware of the serious health risks involved.

The Effects Of Stimulant Addiction During Pregnancy

The effects of stimulants increase the risk of certain health issues for women who are pregnant, such as high blood pressure, seizures, and migraines. A woman using stimulants during pregnancy may cause problems for the baby, including miscarriage, premature birth, placental abruption, and neonatal abstinence syndrome (NAS).

Babies born from women suffering from stimulant addiction may have smaller heads, lower body weight, and are shorter in length than babies born from stimulant-free women.

After delivery, some stimulants, like cocaine, may still be present in the baby for up to seven days. The baby will likely show some of the effects of cocaine which may include irritability, high-pitched crying, hyperactivity, tremors, and excessive sucking.

Research has found that children born from mothers who used stimulants like methamphetamines during pregnancy grow up to have increased anxiety, depression, and emotional reactivity. They’re also more likely to be withdrawn and show decreased cognitive abilities, resulting in poor performance at school.

Stimulant use during pregnancy can cause behavioral problems in children that may limit their chances of realizing their full potential. As they grow into adolescents, the children may have problems with language and memory, paying attention, and planning.

Treating Stimulant Addiction In Pregnant Women

Pregnant women suffering from a stimulant addiction must receive proper medical and psychological care to reduce the various health risks for themselves and their babies, including drug addiction treatment at an inpatient treatment center.

Many inpatient treatment centers offer resources available to help pregnant women battle addiction. Effective resources may include sex-specific addiction services such as prenatal care, mental health counseling, and parenting skills training.

Some programs will treat pregnant women suffering from addiction with a two-pronged approach: how to learn to live with drug addiction and how to be a good parent. Treatment is likely to emphasize the following points:

  • motivating mothers to show reliable and consistent behavior
  • promoting healthy familial relationships
  • teaching mothers how to be supportive, not prohibitive to their future child

It’s important pregnant women addicted to stimulants seek treatment immediately. Stimulants are highly addictive and dangerous for mothers and their babies, and stopping use can be difficult without help.

Benzodiazepine Addiction And Pregnancy

Benzodiazepines are a class of prescription drugs generally prescribed to treat anxiety and sleeping disorders. While effective when used as directed, many benzodiazepines, including diazepam (Valium) and alprazolam (Xanax), can lead to addiction and abuse.

The Effects Of Benzodiazepine Use During Pregnancy

There is limited research on the effects of benzodiazepine addiction and pregnancy, because many people who abuse benzodiazepines also likely abuse other substances, like alcohol or marijuana.

While more research is needed, some studies have found that benzodiazepine use can lead to preterm delivery and lower birth weight in babies.

A woman suffering from benzodiazepine addiction may continue to take drugs like Valium and Xanax well into pregnancy. If a woman continues to take benzodiazepines into the third trimester, or near delivery, the newborn baby may experience symptoms of withdrawal and develop neonatal abstinence syndrome (NAS).

The baby may experience uncomfortable symptoms such as:

  • excessive crying
  • difficulty breathing
  • irritability
  • muscle weakness
  • shaking
  • tremors
  • trouble sleeping

It’s unclear if benzodiazepine use during pregnancy can cause long-term behavioral issues in children and adolescents. Like stimulants, children born from mothers with benzodiazepine addiction may develop anxiety, the tendency to socially withdraw, and fearfulness.

If a woman gives birth and goes untreated for addiction, and continues to use benzodiazepines, the baby may be exposed to the drug through breast milk.

Breastfeeding while abusing benzodiazepines can cause sedation in the baby, potentially leading to abnormal sleeping and breathing problems.

Treating Benzodiazepine Addiction In Pregnant Women

Benzodiazepine addiction in pregnant women may require sex-specific treatment. There are specific programs that can help expectant mothers stop using drugs in a safe way, while also receiving prenatal care.

Sex-specific, or gender-specific rehab, is likely to offer programs that teach parenting skills, improve relationships, and focus on the particular needs of women and their children.

Many sex-specific treatment programs are likely to take place in an inpatient treatment center. Inpatient treatment centers are effective for pregnant women because they typically offer round-the-clock, 24-hour care to monitor both a mother and her baby’s health.

If a woman’s addiction to benzodiazepines is severe, they may need a medically-supervised detoxification, which allows medical professionals to administer various medications to help with the discomfort of withdrawal.

Medications will only be administered if they’re safe for both the baby and mother. But, it’s important the woman stop using, and detox from benzodiazepines during pregnancy to decrease the risk of birth defects, miscarriage, and stillbirth.

The detoxification process is a not a cure for addiction, and behavioral therapy should follow to help a woman change her thinking and attitudes towards drugs.

Behavioral therapies aim to teach people the skills needed to stay clean after treatment and learn to successfully manage stressful situations that can lead to relapse.

Barbiturate Addiction And Pregnancy

Barbiturates are central nervous system (CNS) depressants and are usually prescribed to treat seizures, and cause relaxation and sleepiness. Abusing barbiturates can cause feelings of drunkenness or severe intoxication.

Pregnant women addicted to barbiturates may cause health complications for their unborn baby, and may also experience loss of memory, irritability, and changes in alertness.

The Effects Of Barbiturate Use During Pregnancy

Mothers abusing barbiturates put their infants at risk by increasing the chances of various health effects. One such effect is the baby may experience serious and life-threatening bleeding within the first 24 hours of life.

Barbiturates may prevent blood from clotting in the baby, and if the baby experiences any trauma coming down the birth canal, it could suffer internal bleeding or brain damage.

Commonly used to treat the seizure disorder epilepsy, barbiturates may contribute to an infant being born with a malformation; because of anti-epileptic medication, there’s a 4-8% chance that women with epilepsy will give birth to a child with a physical defect.

Pregnant women abusing barbiturates further increase the risk of giving birth to a baby with a physical malformation.

Other birth defects may also occur as a result of barbiturate addiction, including:

  • cleft lip
  • cleft palate
  • heart abnormalities
  • spinal cord defects
  • widely spaced eyes

Like other drugs of abuse, barbiturate addiction may cause the mother to pass her drug dependence on to her newborn infant. Once born, the baby may be physically dependent on barbiturates, and can have breathing problems, irritability, fever, and sleeping problems.

A pregnant woman suffering from barbiturate addiction risks her life, and her unborn baby’s life, because continued use increases the chances of overdose and death.

Treating Barbiturate Addiction In Pregnant Women

If pregnant, a woman should seek treatment for barbiturate addiction immediately. A stay at an inpatient treatment center is likely the best course of action because she will have access to a variety of resources, programs, and staff.

Staff will likely monitor and observe both the woman and her baby to ensure both stay healthy during the detoxification process. Medications may also be administered to help with the sickness of withdrawal caused by barbiturate dependence. A medically-supervised detoxification is the safest way to begin recovery for the mother and baby.

Behavioral therapy, or drug counseling, may also be available at an inpatient treatment center. Behavioral therapy for a pregnant woman may include activities that promote relationship building, parenting skills, and understanding the nature of her addiction. The setting for these therapies range from one-on-one to support groups, all of which aim to change her thinking and attitudes towards drugs.

While seeking treatment for addiction, pregnant women may want to consider addressing the potential for mental health conditions as well.

Co-occurring Disorders And Pregnancy

Many people suffer from both drug addiction and mental illness. This is usually referred to as a co-occurring disorder or dual diagnosis.

Pregnant women addicted to drugs or alcohol may also suffer from mental illness, and both the addiction and mental illness must be treated in order to be effective.

Research has found that pregnant women with substance use disorder are more susceptible to mental illness than their nonpregnant counterparts. While there is still more research to be done concerning pregnant women and co-occurring disorders, pregnant women with substance abuse problems may want to address the potential for mental illness.

Treating one disorder, and not the other, is likely to increase the severity of the disorders in the future.

Some of the more common mental health conditions associated with pregnant women include:

  • depression
  • eating disorders
  • panic disorders
  • personality disorders
  • postpartum depression

The relationship between substance abuse and mental illness is complex, and pregnancy further complicates the course of treatment.

Contact us now to speak with a trained professional to address the issue of addiction and pregnancy.

Centers for Disease Control and Prevention - Alcohol Use in Pregnancy

Livestrong - The Effects of Barbiturates on the Fetus in Pregnancy

March of Dimes - Prescription opioids during pregnancy

MedlinePlus - Alcohol and pregnancy

MedlinePlus - Barbiturate intoxication and overdose

Mother To Baby - Benzodiazepine Fact Sheet

National Alliance on Mental Illness - Dual Diagnosis

National Institute on Drug Abuse - Heroin: How does heroin use affect pregnant women?

National Institute on Drug Abuse - Cocaine: What are the effects of maternal cocaine use

National Institute on Drug Abuse - Principles of Drug Addiction Treatment: What are the unique needs of pregnant women with substance use disorders?

National Institute on Drug Abuse - Substance Use in Women

Substance Abuse and Mental Health Services Administration - Family Centered Treatment for Women with Substance Use Disorders

Substance Abuse and Mental Health Services Administration - Women of Childbearing Age and Opioids

U.S. National Library of Medicine - Clinical needs of in-treatment pregnant women with co-occurring disorders

U.S. National Library of Medicine - Diazepam use during pregnancy

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