Pregnancy and Substance Abuse
Pregnant women who use substances such as cocaine, heroin, marijuana, methadone, methamphetamine, and other addictive substances put themselves and their babies at great risk; however, there is increasing evidence that even substances such as alcohol and cigarettes, which are commonly thought of as less dangerous than the previously mentioned substances, are extremely harmful to the newborn. Some forms of treatment have been proven effective in lowering the risks of these adverse pregnancy outcomes; however, many factors influence treatment effectiveness.
The most important factors to consider regarding treatment involve the waiting period for treatment and the existence of an aftercare plan. Treatment providers should be educated about the special accommodations required for pregnant women. The Dangers of Drug Abuse During Pregnancy: Prenatal Developmental Issues That Begin with Substance Abuse Pregnancy is a beautiful experience that will be the beginning of the shaping and development of an individual, the preparation period for bringing a new being into the world.
Unfortunately, this sacred period of time is not immune to tragedy, mistakes, and heartache, especially when addiction or even casual substance use is involved. Pregnant women are not only eating for two, but are also damaging two bodies and souls when they choose to abuse substances during pregnancy. Substance abuse during pregnancy is becoming more prevalent, with substance abusing women of child bearing age accounting for 40% of the treatment population; this does not include those who are abusing substances but have not yet reached out for help or those who may never seek treatment (Mayet et al, 2008).
Pregnant women who use substances such as cocaine, heroin, marijuana, methadone, methamphetamine, and other addictive substances put themselves and their babies at great risk; however, there is increasing evidence that even substances such as alcohol and cigarettes, which are commonly thought of as less dangerous than the previously mentioned substances, are extremely harmful to the newborn (Feldman, 2011).
Additional statistics show that 50% of adult pregnancies are unplanned, and most women do not know they are pregnant until after one month (Kurgans, 2011). Therefore, it is common for women to use substances before they are even aware that they are pregnant, and by one month damage could have already been done to development of the fetus. Additionally, pregnancy is often a consequence of failed judgment during a period of substance abuse, and use of more than one substance is the norm among the substance abusing population (Kurgans, 2011).
Substance use and abuse during pregnancy can have significant adverse affects on the baby to include premature birth, miscarriage, low birth weight, and many other possible cognitive and behavioral issues; however, some forms of treatment have been proven successful in lowering the risk of these issues. Possible Adverse Pregnancy Outcomes: Illicit and Licit Substance Effects Abstinence from illicit substances as well as harmful licit substances is necessary due to proven correlation of substance abuse during pregnancy with adverse pregnancy outcomes.
A study conducted in 2010 found significantly more preterm births with pregnant women who used substances during pregnancy, specifically reporting that 25% of drug abusing women gave birth preterm (Dodd et al). This statistic is paralleled in a study done in 2007 which reported that 23% of children born to substance abusing mothers were born preterm (Topley, Windsor, & Williams, 2007). Additionally, in the 2010 study, where only 8% of women in the control group gave birth to low weight babies, 30. % of women who used substances had this specific pregnancy outcome, showing a 22% greater frequency of low birth weight in babies whose mothers abused substances (Dodd et al, 2010). The risk for placental abruption is also higher among drug abusers, meaning that they are more likely to have a portion of placenta pull away from its original attachment to the uterine wall. In a healthy pregnancy, abruption would happen after the baby is born; when abruption occurs while the baby is still in utero, there is not adequate blood flow, oxygen, or nourishment for the baby.
This means that the risk of birth defects and miscarriage is extremely high (Dodd et al, pp. 140). Another risk for addicted pregnant women is that the newborn baby can suffer from withdrawal. According to studies, withdrawal happens in about 20% of the cases followed where the mother used consistently throughout pregnancy (Topley et al, 2007). Also, a study reporting specifically on methamphetamine use during pregnancy found that heavy methamphetamine use was associated with lower arousal, more lethargy, and increased physiological stress (Smith et al, 2008, pp. 27).
Martha Kurgans (2011), the Women’s Substance Abuse Services Coordinator for the Department of Behavioral Health and Developmental Services, confirms the previous research that newborns who were exposed to substances during pregnancy are at increased risk for premature birth, low birth weight, Sudden Infant Death Syndrome (SIDS), and adds that another risk may be neurological and congenital problems. In addition to these effects of substance abuse during pregnancy that are noticeable immediately after birth, mothers may also be putting their children at risk for longer term complications.
Possible Long Term Effects Long term effects on babies whose mothers used substances when pregnant are likely; however, according to some researchers these effects remain undocumented and under researched (Topley, Windsor, & Williams, 2007). Topley, Windsor, and Williams’ study conducted in 2007 was specifically concerned with longer term effects on children whose mothers used substances, to include developmental, educational, and behavioral outcomes. They found that 74% of the children had no educational or behavioral issues at the time the study was conducted.
None of the children were reported to have special educational needs other than minimal extra support from their teachers at school (Topley et al, 2007). About 20% of the children in this study had behavior or concentration problems; however, some of these could be attributed to other factors such as poor quality parenting. The researchers found that while educational and behavioral issues seemed to be minimal, 42% of the children studied were placed on the Child Protection Register at least once, most due to concerns of continued drug use, neglect, or domestic violence issues.
One pattern that these researchers found was that there were significantly less concerns about these issues when there was a record that the child had seen a health professional in the last year (Topley et al, 2007, pp. 73). This may be evidence that educational and behavioral issues typically associated with prenatal drug use could be better attributed to the neglect or continued drug use of the parents rather than biological issues that occurred prenatally.
In addition to the 42% of children that had been on the Child Protection Register at the time of the study, another 8% had child protection concerns. Therefore, a total of 50% of the children in this study required intervention of social services or removal from their homes in the early years of their lives. This observational study supports previous findings that a safe living environment is essential for all children but especially for children who were exposed to illicit substances prenatally.
Furthermore, a safe living environment can decrease the risks of behavioral and developmental outcomes (Topley et al, 2007, pp. 75). Confirming the findings of this study, Martha Kurgans (2011) of the Department of Behavioral Health and Developmental Services reports that newborns exposed to substances are at increased risk for poor maternal-child bonding, developmental delays, impaired academic development, neglect, abuse, exposure to violent situations, and unsafe living environments.
This information shows that the consequences of substance abuse during pregnancy can not only affect the child immediately after birth, but can cause developmental delays or environmental challenges that have the potential to follow the child for the rest of its life. In addition to illicit substances, there is also increasing evidence that nicotine can be harmful to children, with expecting women who smoke accounting for 12% of the pregnant population (NIDA, 2009). The National Institute on Drug Abuse (2009) found that some children of women who smoked during pregnancy showed difficulty with processing auditory information.
More importantly, studies conducted on rats showed that this can happen very quickly, with rats showing auditory processing issues after only five days of exposure to nicotine. In instances when the mother used cigarettes during the first few days of her third trimester, even when she is only intermittently using cigarettes, the nicotine exposure can cause serious long term auditory processing damage (NIDA, 2009). Even more concerning information regarding nicotine exposure prenatally is the finding that it can affect the likelihood that the child will become addicted to nicotine in he future. Arnold Mann (2004) states that while nicotine exposure does not increase the risk of the child initially experimenting with cigarette use, it does increase the risk that the child will become addicted to nicotine if they do experiment. Mann adds that the researchers involved in this study were able to control for socioeconomic status, maternal age at pregnancy, child’s sex, and the child’s age, therefore being able to conclude that the result is a biological, not environmental, factor.
Nicotine use during pregnancy can “permanently alter cells’ responsiveness in ways that increase vulnerability to tobacco addiction (Mann, 2004). ” Alcohol, another legal substance, can also be very harmful when used during pregnancy, with one of the most common complications to follow alcohol use being Fetal Alcohol Syndrome (SAMHSA, 2006). The Substance Abuse and Mental Health Services Administration (2006) reports that no amount of alcohol consumption has been proven safe during pregnancy, and adds that prenatal alcohol exposure harms about one in every 100 babies born each year.
This is in contrast with recommendations given by doctors in decades past, as doctors used to be of the opinion that the occasional drink would allow the pregnant woman to relax and would not cause harm (SAMHSA, 2006). Additionally, Fetal Alcohol Syndrome is the leading cause of babies born with mental retardation other than hereditary causes. Furthermore, Fetal Alcohol Syndrome is not seen more commonly in any one socioeconomic level, with women at every level having given birth to children with the syndrome (SAMHSA, 2006).
Even though alcohol and nicotine are legal substances, they have been proven very harmful to newborns who are exposed to them prenatally, even in very small doses. Cessation Rates The most obvious way to prevent any further harm to children would be to discontinue substance use as soon as the woman is aware that she is pregnant. However, this is not always easy as addiction can cause the women to only think about the drug, even when her own life and her baby’s life are in danger.
Addiction can alter an individual’s brain chemistry and as a result an addicted pregnant woman, or any addict, may actually not be able to discontinue drug use without professional assistance. One study conducted in 2009 reports that the cessation rate for alcohol use is significantly higher that the cessation rate for drug use, with the alcohol cessation rate shown at 87% and the drug use cessation rate at 56. 1% (Harrison & Sidebottom, 2009).
The difference may be attributed to the frequency at which the women were drinking alcohol as compared to the frequency at which they were using drugs, with alcohol use being reported several times per month but drug use being reported several times per week or even daily (Harrison & Sidebottom, 2009). One issue to consider when thinking about cessation rates is the seriousness of the mother’s addiction, as most women want what’s best for their child and are motivated to discontinue illicit substance use for their baby’s health.
This can be an important motivator for treatment, a window of opportunity; however, if the pregnant woman is not able to discontinue substance abuse even with this motivation, this is an indicator of serious addiction. A woman in this situation would likely need inpatient treatment, medically assisted treatment, or hospitalization in order for her newborn to have a chance at a healthy life (Kurgans, 2011). Treatment Issues One major issue with the treatment of substance abusing pregnant women is that waiting time for treatment effects treatment success and completion (Albrecht, Lindsay, & Terplan, 2011).
A study done on treatment plan completion by pregnant women found that waiting time was a predictor for completion, and that the effects of waiting times were dependent upon the treatment setting. Most pregnant women who entered treatment entered in an outpatient, low intensive treatment setting, and in this type of treatment setting immediate entry into treatment showed the strongest tendency for treatment completion (Albrecht et al, 2011).
In reference to detoxification treatment, the researcher found the opposite trend. Pregnant women who entered immediately into detoxification treatment were less likely to complete the treatment; however, the results for this area did not show statistically significant. Additionally, in instances where the women were referred from the criminal justice program or had a high school education, the rates of treatment success were higher no matter what the treatment setting was (Albrecht et al, 2011).
Finally, at least part-time employment was associated with more frequent treatment completion in outpatient treatment, but the same was not true for residential or detoxification settings. Another study done in 2008 confirms that many factors can change treatment effectiveness; this study found that early access to education and substance abuse treatment resulted in improved outcomes (Mayet et al, 2008). The findings of this research study completed by Albrecht, Lindsay, and Terplan (2011) show a great need for immediate services for pregnant women, particularly in the outpatient settings.
Some states have already begun to require that pregnant women be treated with priority; however, it is necessary for treatment facilities to begin to eliminate limitations that will not allow them to immediately begin to treat pregnant women (Carvahlo & Neil, 2011). Some treatment facilities currently have limitations that would not allow for the immediate treatment of an individual; it would be beneficial if they could eliminate these limitations so that they are better able to serve a population that is in great need.
For example, federal regulations over opiate treatment programs such as methadone maintenance clinics state that the facilities must maintain current policies and procedures that reflect the special needs of pregnant women. Federal requirements for community service boards include being able to provide family focused services to pregnant and parenting women and their children, providing services for pregnant women within 48 hours of the request for services, and the ability to provide child care, transportation, and sufficient case management so that women are able to participate in treatment (Kurgans, 2011).
If a local community service board is not able to provide these services within 48 hours, they are required to provide interim services and reach out to their state regulatory agency for assistance. Virginia legislation requires that prenatal care providers screen all pregnant women for substance abuse, and physicians are required to report substance exposed newborns to Child Protective Services. Additionally, pregnant women must be given a referral to their local Community Service Board after giving birth if they were using substances during their pregnancy (Kurgans, 2011).
Treatment Successes As was mentioned before, pregnancy can be a motivation to remain free of illicit substances for women who would not otherwise find motivation. One form of treatment that has been found successful for opiate abusers is medication assisted treatment. Methadone maintenance remains the “gold standard” for opiate addicted pregnant women, and buprenorphine may also be effective but has not yet been researched in detail (Carvahlo & Neil, 2011).
Methadone has been proven to prevent erratic maternal opioid levels, protect the fetus from repeated episodes of withdrawal, improve maternal health and nutrition, and improves the growth of the fetus. Studies have shown that methadone can also decrease pregnancy complications and preterm labor by 30-40%. While methadone and buprenorphine may still cause withdrawal in the newborn, the risks of the pregnant women continuing to use illicit substances and put themselves in dangerous situations is far more harmful than the withdrawals, which can be monitored closely by doctors when the baby is born (Carvahlo & Neil, 2011).
Withdrawal in newborns is called neonatal abstinence syndrome and can occur from 3-12 days after birth. Symptoms can include sleeping issues, feeding issues, and lack of weight gain. Symptoms can vary due to drugs other than methadone or buprenorphine used by the mother, the mother’s metabolism, and the infant’s metabolism. Some ways to reduce the symptoms of neonatal are decreasing light exposure, minimizing excessive noise, and avoiding unnecessary handling (Carvahlo & Neil, 2011).
The Substance Abuse and Mental Health Administration (2006) recommends identifying and using community resources to help prevent Fetal Alcohol Syndrome and other issues that can result from substance abuse during pregnancy. Specifically, SAMHSA (2006) suggests getting neighborhood groups and community centers, local health departments, civic organizations, employers, the local media, and recreational businesses involved in the effort to prevent and treat substance abuse during pregnancy.
Additionally, aftercare services should be provided for pregnant women so that they can continue to be supported throughout parenthood (Carvahlo & Niel, 2011); this is important as the research shows that if a child does not have developmental of physical issues at birth, there is still a chance they will have educational and developmental difficulties later on due to their home environment. Discussion Pregnant women who abuse substances are not only putting themselves at risk for physical and psychological issues, but are also putting their children at risk for premature birth, low birth weight, significant cognitive and ehavioral issues, and even miscarriage. Despite the risks, some women may find it hard to quit using substances. It is imperative to their children’s well-being that these women are able to enter treatment as quickly as possible. Treatment should educate the women about the disease of addiction, the risks they are taking by abusing substances during pregnancy, and should also provide parenting skills training so that the mother is more able to provide a healthy living environment. It is apparent from the current research that a lot of questions regarding pregnancy and substance abuse remain unanswered.
What we can conclude is that the research seems to show that with treatment and proper medical care, the newborns have a fair chance at a healthy life. However, environmental factors play a large role in whether or not the children will be developmentally and educationally successful. In order for children to grow up to be contributing members of society, there is a continued need for intervention to ensure that the children are living in safe environments free of abuse, neglect, continued abuse of substances by parents, violence, and other dangerous situations.
Future research about pregnancy and substance abuse is needed, specifically as it applies to longer term treatment outcomes. There has been some research on short term outcomes, such as treatment completion; however, it would be beneficial to conduct longitudinal studies to show how cessation, treatment, support systems, and environmental factors effect the outcome of the substance abused child later in childhood and adolescence.
Most importantly, we can conclude from the findings of research that policies at treatment facilities should be in place to ensure that pregnant women have priority when entering treatment in compliance with federal and state regulations. Employees at treatment facilities should be specifically trained in the area of pregnancy, so that they are more able to assist women in making a better life for themselves and their future families.
Ultimately, the goal of substance abuse treatment facilities should be to give pregnant patients priority, as well as to give them knowledge, skills, and tools needed to provide their children with a life free of substance abuse, criminal behavior, violence, and other environmental factors that will contribute to the continuation of the cycle of self destruction by substance abuse. With the collaboration of community resources, the proper training of employees at treatment facilities, and the emphasis of quick entry into treatment for pregnant patients, women and their children will have a better chance at productive and safe lives.