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Pregnant Women: The Dangers of Addiction and Withdrawal

Addiction and withdrawal pose risks for everyone, but for pregnant women and their babies, the dangers are even greater. Substance abuse during pregnancy increases the risk of complications for the mother and makes the fetus susceptible to the symptoms of addiction and withdrawal too.

According to the 2011 National Survey on Drug Use and Health, 5% of pregnant women ages 15–44 reported using illicit drugs during pregnancy, 9.4% reported alcohol use, and 2.6% reported binge drinking.1,2 But women struggling with substance abuse during pregnancy may neglect to seek treatment due to fear of judgment, scrutiny, or legal ramifications. In a recent survey of 30 pregnant women who used drugs or alcohol, 73% reported fear of being identified as a substance user. Still, in spite of the barriers they have faced, 67% of the women surveyed reported seeking some form of treatment in the past.2

Dangers of Addiction and Pregnancy

Drug and alcohol addiction poses many dangers to a pregnant woman and her unborn baby. Even those who use small amounts of substances put themselves and their babies at risk. Some of the potential dangers to the fetus include:1,3–6

  • Miscarriage.
  • Preterm birth.
  • Stillbirth.
  • Slowed fetal growth.
  • Low birthweight.
  • Respiratory issues.
  • Prolonged prenatal hospitalization.
  • Small head circumference.
  • Developmental delays.
  • Cognitive and behavioral problems.
  • Birth defects.
  • Infant mortality.
  • Sudden Infant Death Syndrome (SIDS).
  • Fetal Alcohol Syndrome (FAS).
  • Infant irritability.
  • Excessive crying.
  • Seizures.
  • Gastrointestinal problems.
  • Poor social skills later in life.
  • Poor emotional control.
  • Increased anxiety and depression.
  • Attention deficit hyperactivity disorder (ADHD).
  • Poor academic performance.
  • Learning, memory, and motor difficulties.

Some of the potential risks for the mother include:1,3–6

  • Preeclampsia.
  • Postpartum pain.
  • Maternal migraines.
  • Maternal seizures.
  • Premature rupture of membranes.
  • Placental abruption.
  • High blood pressure.
  • Difficult labor and delivery.
  • Criminal charges.
  • Child Protective Services (CPS) involvement.
  • Loss of child custody.

Women suffering from addiction during pregnancy also face psychological and social challenges. Being pregnant may be an additional stress to a woman’s life that makes it more difficult for her to stop using even if she wants to for the wellbeing of the child. Being unable to control her drug use can lead to feelings of inadequacy, shame, and guilt.

Many women want to seek treatment but avoid doing so out of fear of facing criminal charges or having their child taken away. Some women will not only avoid addiction treatment, they may avoid prenatal care altogether.

For these and other reasons, substance abuse during pregnancy is a serious public health concern. Much controversy exists over how to treat the problem: some view it is a criminal issue while others see it as a mental illness that needs to be treated. While no laws currently exist that directly criminalize prenatal substance use, women have been prosecuted in many states under laws that deal with child abuse, assault, murder, and delivery of drugs to a minor.7

The Dangers of Withdrawal for Women and Fetuses

Regular prenatal substance use can result in fetal drug dependence and may cause the child to experience withdrawal after birth. Withdrawal symptoms may occur in infants prenatally exposed to opiates, cocaine, amphetamines, alcohol, benzodiazepines, barbiturates, nicotine, and caffeine. Withdrawal symptoms and duration can vary significantly depending on the substance used, the amount and frequency of use, the mother’s metabolism, and the length of gestation. Symptoms may occur immediately upon birth and can last as long as 2 weeks.4,8

Common withdrawal symptoms reported in newborns prenatally exposed to drugs or alcohol include:4

  • Excessive or high-pitched crying.
  • Fever.
  • Diarrhea.
  • Irritability.
  • Sweating.
  • Rapid breathing.
  • Feeding issues.
  • Elevated heart rate.
  • Sleep difficulties.
  • Stuffy nose.
  • Sneezing.
  • Trembling.
  • Vomiting.
  • Blotchy skin color.
  • Abnormal reflexes.
  • Increased muscle tone.
  • Slowed weight gain.
  • Seizures.

Prenatal use of opioids may produce a more severe withdrawal syndrome in newborns, referred to as neonatal abstinence syndrome (NAS). More than half of infants born to opioid-dependent mothers will exhibit symptoms of NAS within the first few days of life.6 Babies suffering from NAS have an increased risk of prolonged neonatal hospitalization, low birth weight, feeding difficulties, seizures, respiratory issues, and death.3,5 The most common form of treatment for NAS is morphine hydrochloride combined with supportive care. However, prolonged use of morphine in infants is not recommended since it can have adverse effects on the baby’s developing brain.6

Pregnant women using opioid drugs may also develop dependence and suffer withdrawal symptoms. Opioid withdrawal creates added stress in the body and increases the risk of miscarriage and preterm delivery. For this reason, it is not recommended that opioid-dependent pregnant women experience withdrawal during pregnancy. If a woman does go through withdrawal during pregnancy, symptoms she might experience include:8

  • Nausea.
  • Vomiting.
  • Diarrhea.
  • Muscle cramps.
  • Sweating.
  • Hot or cold flashes.
  • Increased heart rate and blood pressure.
  • Irritability.
  • Anxiety.
  • Insomnia.
  • Drug cravings.
  • Mood swings.

Detox Options for Pregnant Women

For those suffering from substance abuse, detoxification is typically the first phase in treatment. Unfortunately, for pregnant women this can be a barrier to treatment since fetuses are not only susceptible to the effects of withdrawal, but also to the medications typically used to ease the detox process. Many providers may be hesitant to provide detoxification services for fear of liability over fetal outcomes.8 While withdrawal symptoms can be painful and unpleasant for adults, they are potentially fatal to a fetus.2

Detox options for pregnant women are often limited to residential treatment centers and are typically short-term, lasting a week or less.2

Opioid replacement therapy may be an option for certain pregnant women. While no FDA-approved medications to treat opioid addiction in pregnancy currently exist, maintenance medications such as methadone and buprenorphine may be used as substitutes for more potent opioids such as heroin. These medications can help reduce adverse outcomes for fetuses, but they typically still result in the newborn experiencing withdrawal symptoms. However, buprenorphine often results in shorter hospital stays and fewer symptoms of NAS than methadone.3,5 While these drugs can be helpful for women, they may be difficult for pregnant women to obtain, especially without fear of social judgment.

Pregnant women face many other barriers to substance abuse treatment, including:1,7

  • Lack of appropriate childcare.
  • Fear of CPS involvement.
  • Fear of criminal charges.
  • Fear of being shamed or judged by others.
  • Limited number of treatment centers available that accept pregnant women.
  • Difficult admission criteria for centers that do offer treatment.
  • Lack of prenatal care and screening.
  • Lack of personnel who are sensitive to the needs of addicted pregnant women.
  • Lack of coordination between resource providers.
  • Lack of experienced healthcare providers.
  • Addicted partners who are unwilling to seek treatment too.
  • Depression, anxiety, or other comorbid mental health conditions.
  • Stigmatization.
  • Healthcare provider bias.
  • Transportation issues.
  • Little to no insurance coverage.
  • Financial difficulties.

Sources

  1. Crawford, C., Sias, S., & Goodwin, L. (2015). Treating Pregnant Women with Substance Abuse Issues in an OBGYN Clinic: Barriers to Treatment. VISTAS Online.
  2. Stone, R. (2015). Pregnant Women and Substance Use: Fear, Stigma, and Barriers to Care. Health and Justice, 3(2).
  3. National Institute on Drug Abuse. (2012). What Are the Unique Needs of Pregnant Women with Substance Use Disorders?
  4. National Institute on Drug Abuse. (2016). Substance Use in Women: Substance Use While Pregnant and Breastfeeding.
  5. Shainker, S., Saia, K., & Lee-Parritz, A. (2012). Opioid Addiction in Pregnancy. Obstetrical & Gynecological Survey, 67(12): 817–25.
  6. Unger, A., Metz, V., & Fischer, G. (2012). Opioid Dependent and Pregnant: What Are the Best Options for Mothers and Neonates? Obstetrics and Gynecology International, Volume 2012.
  7. Lester, B., Andreozzi, L., & Appiah, L. (2004). Substance Use During Pregnancy: Time for Policy to Catch Up with Research. Harm Reduction Journal, 1(5).
  8. Geneva: World Health Organization. (2009). Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings: Withdrawal Management.
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