Treatment Options for Pregnant Women

Some women struggle with drug abuse or addiction when they are pregnant. It is estimated that approximately five percent of women who are pregnant use at least one addictive substance.

When a woman is using drugs during pregnancy, there are risks to both her and her unborn child. Since many substances travel through the placenta, drugs taken during pregnancy can get directly to the fetus. This may cause problems for the baby in utero and after they are born.

Commonly Abused Drugs Among Pregnant Women

MARIJUANA

When someone smokes marijuana, the chemicals in the drug can interfere with the level of oxygen the baby is receiving. Marijuana causes increased levels of carbon dioxide and carbon monoxide in the blood. This is what is responsible for the reduced oxygen level.

COCAINE

This drug gets into the baby’s circulation by crossing the placenta. Compared to an adult, a fetus eliminates cocaine from their body at a much slower pace.

HEROIN

Heroin also crosses the placenta. This can cause an unborn baby to become dependent on heroin before birth. Dependency in the fetus is also possible if a pregnant woman abuses other opioids, such as hydrocodone or oxycodone.

METHAMPHETAMINE

A pregnant woman’s heart rate increases when she uses stimulants. The baby’s heart rate can also increase.

ALCOHOL

When a fetus is exposed to alcohol, certain congenital disabilities are possible. When a woman is pregnant, no amount of alcohol is considered safe.

Risks of Drug Abuse for Pregnant Women

When a pregnant woman has a substance use disorder, the drugs may affect her and the baby. The following are potential effects for the mother:

  • Weakened immune system
  • Abdominal pain and nausea
  • Weight loss and appetite reduction
  • Stroke or brain damage
  • Confusion
  • Seizures
  • Attention, memory, and decision-making difficulties
  • Heart issues, such as heart attack and heart arrhythmia
  • Liver damage or failure
  • Lung diseases

Effects on the Fetus

Placental abruption is a concern with pregnant women who have a substance use disorder. The placenta is responsible for ensuring that the baby gets enough oxygen and food via the umbilical cord.

When this condition occurs, the placenta pulls away from the uterine wall during pregnancy. This can result in the baby not getting enough nutrients and oxygen before birth. Some women can also experience significant bleeding when this condition occurs.

When placental abruption occurs, growth problems with the baby can take place. This condition also increases the risk of premature birth and stillbirth.

There are many other ways that drugs can affect a fetus. The overall impact depends on several factors:

  • The fetus’ stage of development
  • The mother’s genetic makeup since this impacts drug availability and how much of it is active
  • The dose and strength of the drug

It is possible for babies to experience withdrawal symptoms if their mothers abuse drugs during pregnancy. It may take up to 14 days for these symptoms to occur, but they may also start right away. The issues experienced may also be referred to as neonatal abstinence syndrome.

  • Blotchy skin
  • High-pitched or excessive crying
  • Fever
  • Increased muscle tone
  • Poor feeding
  • Seizures
  • Slow weight gain
  • Sweating
  • Vomiting
  • Diarrhea
  • Abnormal sucking reflex
  • Hyperactive reflexes
  • Irritability
  • Rapid breathing
  • Sleep problems
  • Sneezing and stuffy nose
  • Trembling

Some babies may be born with low birth weight or have a head that is smaller than normal.
Congenital disabilities can also form as a result of a mom abusing drugs when she is pregnant. Some literature says that the risk of sudden infant death syndrome is higher when the mother uses drugs when pregnant.

Certain effects of drug abuse during pregnancy can affect babies over the long term. For example, some children develop behavioral problems as a result of their mother using drugs when pregnant.

The exact effects a baby experiences ultimately depend on the drugs that were used during pregnancy.  Addressing drug abuse as soon as possible during pregnancy can help to reduce the risk of these effects.
After birth, the baby may require treatment to help them get through the withdrawal period. The methods that doctors prescribe will depend on the baby’s overall health, the drug the baby is withdrawing from, and the overall severity of their symptoms.

Behavioral Treatments

Treatment options vary based on the drug the woman is abusing, her medical condition, and the duration of her substance abuse. Often, a combination of medication or medical supervision and behavioral therapy will be used.

The following behavioral methods may be used:

MOTIVATIONAL INTERVIEWING

This method helps people to resolve and explore ambivalence to recovery. It may help to improve retention and treatment readiness.

CONTINGENCY MANAGEMENT

This technique is centered around positive reinforcement to influence positive behavioral changes. This can be used for abuse of a variety of substances, including opioids, cigarettes, benzodiazepines, marijuana, and alcohol.

COGNITIVE BEHAVIORAL THERAPY

This is a type of psychotherapeutic treatment. The person learns strategies to aid them in understanding the different situations that resulted in undesirable feelings, behaviors, or thoughts. They then use this information to break old habits and patterns and replace them with those that are healthy and positive.

Medication Options for Pregnant Women

A pregnant woman should never stop taking a substance suddenly without first consulting a doctor. Doing so could result in miscarriage and other complications.

In some instances, medications may be used during recovery.

Medications should only be used under the supervision of a physician.

Currently, there are no evidence-based pharmacological treatments to help pregnant women struggling with cocaine use. However, there is a trial that explored using oral micronized progesterone for women in the postpartum phase.

Pregnant Treatment

The trial lasted for 12 weeks. The preliminary results suggest that this method may help women in the postpartum phase to decrease their cocaine use.

Pregnant women with an opioid use disorder may be administered methadone maintenance. This treatment is given in a medically supervised environment. Methadone maintenance offers several possible benefits, including reduced risk of relapse, enhanced prenatal care compliance, decreased risk-taking behavior, and better neonatal outcomes.Some facilities are using buprenorphine for pregnant women who have opioid use disorder. One study compared methadone and buprenorphine. It showed that buprenorphine might reduce how much NAS treatment a baby needs and decrease how long a baby needs to be in the hospital after being born.

Prompt Care Is Important

If a pregnant woman is using an illicit substance, it is imperative to reach out for help as soon as possible.
There are many treatment options that focus on pregnant women, and often, pregnancy moves a woman to the front of the treatment line if there is a waiting list. The sooner comprehensive addiction treatment is given, in combination with prenatal care, the better the potential outcome for both the mom and baby.