The choices made by a pregnant woman not only impact her body and quality of life but those of her unborn child as well. Even choices to eat certain foods or take over-the-counter medications can have an impact on the development of a fetus – imagine how even a one-time use of an illicit substance like cocaine or heroin, or use of substances like alcohol or marijuana, can impact the child’s growth in utero.
For women who are already chronic drinkers or drug abusers, and for those who are addicted to one or more substances, pregnancy can pose significant issues. Protecting the child is paramount, but simply quitting the drug of choice may not be the best option for everyone’s health.
If you are pregnant and struggling with substance abuse, it is important to seek immediate medical care and to share the facts of your drug history with your provider as soon as you know you are pregnant. Treatment is available, and the help you get now can save your life as well as your baby’s life and help both of you to have a better quality of life going forward.
Risks to the Mother
Abuse of or dependence upon any drug of addiction can be harmful to a woman in pregnancy just as they would be if she were not pregnant. In fact, because the body is in a state of great change due to fluctuations in hormones and the biological need to protect the fetus, it may even be more harmful for the mother to abuse drugs and alcohol. In some case, lesser amounts of the substances may trigger overdose and medical emergency. That is, a dose of the drug of choice that would have created a high prior to pregnancy may now be more than enough to cause an overdose.
In addition to overdose, there are a host of complications during pregnancy and childbirth that can be deadly to the mother, which may be more likely with drug use. Different medical emergencies may be more likely with the use of different drugs, just as different risks to the child may be more threatening depending upon the substance of choice.
Risks to the Unborn Child
Depending upon the drugs used by the mother, the risks to the unborn fetus vary considerably. None are without harmful effect, however, and even with drugs that are non-addictive, any use during pregnancy can cause negative changes in the child’s development. It is important to consider carefully the potential effects of everything taken into the body during pregnancy.
Though there are very few studies that look at the effects of different drugs on the fetus and the mother during pregnancy, there is a great deal of research based on the medical records of women who have abused different substances during pregnancy and the outcomes in their children over the following years. Some of the results include the following information.
- Heroin abuse. Heroin abuse during pregnancy can cause a number of health problems, due in part to the fact that few people use the drug recreationally. Most mothers who abuse heroin are dependent upon the drug. Because it is rarely recommended that she simply stop taking the drug when she is pregnant, it is almost guaranteed that the baby will experience certain health effects due to ongoing opiate use even if treatment is received. Not receiving treatment, however, poses grave dangers to the child. According to the March of Dimes, these may include:
- Placental abruption: This happens when the placenta separates from the uterine wall prior to the birth of the baby. Because the placenta is what gives the baby oxygen and food via the umbilical cord and because its separation from the uterine wall is usually accompanied by heavy bleeding, it can be deadly for both the mother and the unborn child.
- Prematurity: Being born too early can create its own set of problems for babies. Any birth before 37 weeks is considered premature, and for every day that the child is not allowed to develop safely in the womb, various problems are more likely to occur.
- Born too small: Having a low birth weight, too, can contribute to health problems. Babies born weighing less than 5 pounds, 8 ounces are considered to be of low birth weight.
- Birth defects: Varying from one child to the next, birth defects are characterized by an abnormal shape or development of a specific part or system of the body. In many cases, this can contribute to serious health problems for the child.
- Neonatal abstinence syndrome: This term refers to any number of conditions that impact a child if the baby is born to a mother who is living with an active addiction to heroin. Usually, for heroin-addicted mothers, it means a baby who is born dependent upon opiates and who experiences serious withdrawal symptoms that require medical supervision in the hospital during the first weeks of life.
- Stillbirth: When a baby dies in utero after 20 weeks of pregnancy, it is termed a stillbirth rather than a miscarriage.
- Sudden infant death syndrome: Commonly known as SIDS, this describes the unexplained death of a child before the age of 1.
Cocaine abused by a pregnant woman will stay in the fetus longer than it will remain in the woman’s system – up to a week, according to the Organization of Teratology Information Specialists (OTIS). OTIS reports that the following may be expected if a pregnant woman uses cocaine:
- Miscarriage: In the early weeks of pregnancy, use and abuse of cocaine can cause the newly pregnant mother to lose the baby.
- Premature birth: In later weeks of pregnancy, cocaine use can cause the baby to be born before it is ready.
- Placenta abruption: Separation of the placenta from the uterine wall can cause medical emergency for both baby and mother.
- Withdrawal symptoms: Regular use of cocaine by the mother during pregnancy can contribute to cocaine addiction in the unborn baby characterized by withdrawal symptoms in the first weeks of life.
- Birth defects: Heavy use of cocaine during pregnancy can contribute to birth defects in the child.
- Behavioral issues in first weeks: Jitteriness, irregular sleep patterns, sensory issues, and more have been noted in babies in the first 8 to 10 weeks of life after being born to a mother who used cocaine.
- Learning disabilities: Delays in learning and the need for special education are higher among babies born to cocaine-using mothers as compared to the general population.
- Behavioral disabilities: Children whose mothers abused cocaine during pregnancy may have a more difficult time with behavioral control and emotion management during early childhood and school years.
There are few studies that definitively describe the effects of marijuana abuse on unborn babies. Mothers who abuse marijuana during pregnancy often abuse other substances, including cigarettes and alcohol. The chemicals that coat marijuana plants are varied and may come with their own fetal impacts as well. However, there may be an increase in the rates of babies experiencing gastroschisis, an intestinal abnormality, and/or heart defects when exposed to marijuana in utero, according to OTIS. Additionally, there may be an increased chance of the following issues when a mother smokes marijuana during pregnancy:
- Low birth weight
- Premature birth
- Stunted growth
- Learning disabilities
- Other disabilities
Use of methamphetamine, PCP, ketamine, ecstasy, and other drugs can be harmful to both mother and child during pregnancy even if used recreationally and not on a regular basis. According the March of Dimes, because women who abuse these drugs may also drink alcohol and smoke, it’s not always clear which risks are associated specifically with use of these drugs. However, they say that the risks of abusing these drugs during pregnancy may include:
- Low birth weight: A birth weight of less than 5 pounds, 8 ounces can contribute to a greater chance of early and unexplained death as well as an increased rate of experiencing other illnesses or health problems in childhood.
- Premature birth: Birth before 37 weeks gestation may mean that certain systems are not fully developed, leaving the baby vulnerable in the first weeks of life.
- Neonatal abstinence syndrome: Mothers who chronically abuse these drugs – even if they are not addicted themselves – may cause their unborn child to develop a dependence that is characterized by the experience of withdrawal symptoms at birth when they are no longer getting a regular dose of the drug of choice.
No amount of alcohol is safe during pregnancy, but it is unclear exactly how much is too much when it comes to impacting an unborn child’s growth and development. However, any alcohol the mother drinks will cross the placenta and enter the child’s system so even a small amount can contribute to significant problems that, according to the March of Dimes, may include:
- Preterm birth
- Low birth weight
- Birth defects
- Vision problems
- Hearing problems
- Fetal alcohol syndrome disorder
- Cognitive functioning difficulties
- Delays in speech and language development
- Irregular sleep patterns
- Learning disabilities
- Behavioral problems
Fetal Alcohol Spectrum Disorders
The term “fetal alcohol spectrum disorders” (FASD) refers to a range of issues that are all caused in a child by a mother’s use of alcohol while pregnant. Fetal alcohol syndrome (FAS) is the most severe of these and characterized by:
- Difficulties with cognitive functioning
- Learning disabilities
- Behavior management difficulties
- Difficulty understanding and following directions
- Social issues
- Problems communicating with others
- Emotion management difficulties
- Difficulty caring for oneself on a day-to-day basis
- Facial structure abnormalities
There is no cure for FAS or any FASD. There are, however, a range of medications and behavioral therapies that may be appropriate in different circumstances.
Treating Addiction During Pregnancy
Depending upon the drug of choice, the course of prenatal care for an expectant mother will be different. In some cases, it may be appropriate to simply stop all abuse of all substances. For those who recreationally use illicit substances, including alcohol, this can be the best possible way to protect the unborn child from unwanted negative consequences.
In some cases, however, medication management and/or ongoing psychotherapeutic intervention and group support may be the better choice. This will be more appropriate for women who:
- Have a long history of drug use and abuse
- Discovered that they were pregnant late in the pregnancy and abused drugs or drank heavily during the first trimester
- Are unable to stop drinking or using drugs without help
- Are addicted to their drug of choice, especially opiates of any kind
- Need help learning how to remain drug-free after the baby is born
Each person’s situation is different, but the one thing that applies in every situation across the board, no matter the drug of choice, is that prenatal care is needed as soon as the pregnancy is identified, and any and all drug or alcohol use should be reported to the physician.
Born Addicted to Opiates
Women living with an active opiate addiction (e.g., dependence upon painkillers or heroin) face a unique medical situation in pregnancy. Abrupt cessation of use of these drugs can trigger a miscarriage or serious medical emergency in the unborn child. Certain drugs – especially methadone or buprenorphine – may help pregnant women to stop taking the drug of choice and start on a managed regimen of care that will protect their health and the health of their child as they begin the process of skills training and psychotherapeutic treatment that will help them learn how to live without drugs and alcohol for the long-term. Though the baby will be born addicted to opiates and require a hospital stay, the hope is that the damage to the child’s growth and development will be far lower overall.
Long-Term Success for Mom and Baby
Drug and alcohol dependence is more than just a physical problem. Though the initial focus will be on limiting the physical harm to both mother and child, in the long-term, it is essential for the mother to engage in a comprehensive substance abuse treatment program that will enable her long-term sobriety. Learning how to stop using drugs and alcohol means more than detox. It requires intensive psychotherapeutic treatment that addresses the unique underlying issues that are specific to each patient’s needs.
When pregnancy and motherhood are a part of the equation, it is essential that the addicted person have all the help she needs in the first few years of motherhood to make healthy choices for herself and her baby. This can mean:
- Group therapy sessions specific to addiction
- Support groups specific to parenting and addiction issues
- Parenting classes
- Assistance finding a job, a safe home, securing utilities and transportation, etc.
- Treatment for co-occurring mental health issues
- Marriage and/or couples counseling
- Assistance for the father, especially if addiction is an issue for him as well
- Ongoing follow-up and aftercare to identify potential threats to sobriety before they result in relapse
If you are pregnant and living with an addiction, or if someone you love needs treatment during pregnancy, don’t wait to seek help. Contact us at Axis today and learn more about our rehabilitation program and how it can help you and your growing family heal.