Drugs and Pregnancy: How to Safely Detox While Pregnant
The detrimental prenatal and postnatal effects of drugs and alcohol on infants are well documented. Women who continue to use drugs during pregnancy greatly increase the risk of giving birth to infants with serious birth defects, neonatal abstinence syndrome (NAS), and lifelong challenges for the child due to drug exposure in utero.
According to the 2013 U.S. National Survey on Drug Use and Health, 5.4% of all pregnant women reported current illicit drug use.1 The majority of pregnant women who use illegal substances during pregnancy also use legal drugs, which can have negative repercussions on the unborn baby. The actual number of children who have been exposed to drugs in utero is likely much greater than statistics indicate. Many women do not report this because of the associated stigma and fear of losing their baby to child protective services.
When a law was passed by the Tennessee legislature in 2014, it became the first and only state with an explicit criminal law that enabled mothers of NAS babies to be charged with a crime called “fetal assault.” Alabama and Wisconsin prosecuted new mothers under similar laws, and Oklahoma and North Carolina attempted to pass similar laws. Evidence has shown these laws end up discouraging women from not only seeking drug abuse treatment, but any type of prenatal care, exposing babies to more risks while failing to reduce the high costs of treating newborns who suffer from NAS. Tennessee legislators realized the law backfired and it has since been overturned.2,3 Bills pending at the federal level could help improve this situation by forcing the U.S. Department of Health and Human Services to provide a clearer action plan for improving treatment programs for pregnant women struggling with substance use addictions.4
Drug Abuse and Pregnancy Facts and Stats
According to a Vanderbilt study, the problem of drug use in pregnant women is worsening in the U.S., with a drug-dependent baby born every 25 minutes at a cost of $1.5 billion in additional healthcare.3
In the U.S., a baby is born dependent on opiates every 30 minutes.2
According to a study published in the August 2015 issue of Journal of Perinatology, nearly six in 1,000 babies born in the U.S. in 2012 were diagnosed with NAS, about double the rate seen in 2009.2
In a survey of 946 pregnant opioid-using women entering treatment in the U.S., 86% reported a history of at least one unintended pregnancy. Women who reported recent use of illicit drugs other than cannabis were almost three-and-a-half times more likely than other women to report an unintended pregnancy.5
Women are at highest risk for developing a substance use disorder during their reproductive years (ages 18 to 44), especially between the ages 18 to 29.6
In the only prospective study on prenatal substance use, 78% of women with marijuana use and 73% of women with cocaine use succeeded in achieving abstinence during pregnancy.6
More pregnant women seek drug addiction treatment for opioid abuse than any other substance.7 Research indicates other drugs for which pregnant women seek treatment include:
Tranquilizers and sedatives (1.2%)
Hallucinogens and PCP (0.6%)7
The Role of Prevention
Screening for substance abuse is a part of complete obstetric care and should be done with cooperation of pregnant woman. Prior to pregnancy and early in the first trimester, all women should be routinely asked about their use of alcohol and drugs, including prescription opioids and other medications used for nonmedical reasons. Maintaining a caring and nonjudgmental approach and assuring women information provided will be kept confidential are key to obtaining the most complete disclosure regarding substances used.8
Substance Abuse Treatment for Pregnant Women
Although many women successfully quit using drugs during pregnancy, there is a dramatic rise in substance use from six to 12 months postpartum. Maternal relapse occurs at a time when babies have near constant needs and infant development is dependent on maternal bonding. A majority of substance use treatments for pregnant women are behavioral in nature.6 These include:
Contingency management (CM): The premise behind CM is to systematically use reinforcement techniques, such as monetary vouchers, to modify behavior in a positive and supportive manner. Originally used for the treatment of cocaine use, this method is now utilized for opioids, marijuana, cigarettes, alcohol, benzodiazepines and other drugs.
Motivational interviewing (MI): This is a patient-centered, collaborative and highly empathic therapy approach for eliciting behavioral changes by helping clients explore and resolve ambivalence.
Cognitive Behavioral Therapy (CBT): This type of therapy helps people recognize irrational and unhealthy thought patterns and behaviors, and teaches them how to replace them with healthy and empowering ones.
Detox for Pregnant Women
Weaning a pregnant addict and her baby off drugs can be both costly and difficult, with little evidence-based science to back up the methodologies. It is feasible to safely detox while pregnant, but it must be done under the care of a multidisciplinary team with specialized skills due to the inherent risks to both mother and child. Most physicians recommend a gradual tapering of less harmful medications, paired with a comprehensive addiction treatment program.
Treatments specifically focused on stopping marijuana use during pregnancy are lacking. The current recommendation for lowering the use of marijuana in pregnant women includes routine screenings to increase early identification of marijuana use and encourage abstinence. Currently, there are no evidence-based pharmacological treatments for prenatal cocaine use. However, a recent randomized, placebo-controlled trial showed positive results using oral micronized progesterone as an intervention for postpartum cocaine use. Treatments for other stimulants such as methamphetamine are also limited. Recent research indicates reinforcement-based therapy (RBT) combined with a women-focused intervention among pregnant methamphetamine users has the potential to reduce meth use over time. However, more extensive research is required to determine its effectiveness.6
Lessons Learned From the MOTHER Study
The Maternal Opioid Treatment: Human Experimental Research (MOTHER) trial was undertaken to understand the complex issues involved in treating opioid-dependent pregnant women. This encompassed the safety and impact of medications used for detox in pregnant women and fetuses.9 The trial included 131 pregnant women who were addicted to opioids including heroin or prescription pain medication, with low rates of other illicit drug use.10 Evidence from the MOTHER study indicated that compared to methadone, buprenorphine was acceptable for managing opioid dependence during pregnancy. While there were no statistical differences in the maternal outcome between buprenorphine and methadone, buprenorphine resulted in less severe cases of NAS.7
If you are pregnant or somebody close to you is and struggling with substance abuse, call us today at 888-478-7519 for a confidential assessment.
Konijnenberg C1. Methodological Issues in Assessing the Impact of Prenatal Drug Exposure. Subst Abuse. 2015 Nov 8;9(Suppl 2):39-44. doi: 10.4137/SART.S23544. eCollection 2015.
Black KI, Day CA. Improving Access to Long-Acting Contraceptive Methods and Reducing Unplanned Pregnancy Among Women with Substance Use Disorders. Subst Abuse. 2016;10 (Suppl 1):27-33. doi:10.4137/SART.S34555.
Forray A. Substance use during pregnancy. F1000Res. 2016;5:F1000 Faculty Rev-887. doi:10.12688/f1000research.7645.1.
Jumah NA. Rural, Pregnant, and Opioid Dependent: A Systematic Review. Subst Abuse. 2016 Jun 20;10 (Suppl 1):35-41. doi: 10.4137/SART.S34547. eCollection 2016.