Addiction During Pregnancy: An Overview
People with substance use disorders suffer from the stigma of being addicts. Because of societal stereotypes, woman are stigmatized far more than are men. With pregnancy added to the mix, the pressure can be immeasurable. It intensifies the effects of the stigmatization on the physical and mental health of the mother, and this affects the well-being of the fetus.
It can also mean that the mother will not seek proper prenatal care, or the help that she needs to manage her addiction and its effects on her unborn child. This is a serious problem of which all health care providers need to be aware. If a pregnant woman fears judgement from her doctors, she is less likely to be honest with them, so, it is incumbent on obstetricians, psychiatrists, social workers, and other members of the health care profession to manage their own biases.
Whether the mother is using heroin, meth, alcohol or painkillers, substance abuse of any kind during pregnancy will have both short and long term effects on the baby.
The short term risks include miscarriage, stillbirth, premature labour (preterm delivery), a low birth weight baby, birth defects, and multiple medical complications including placental abruption, neonatal abstinence syndrome (NAS) and sudden infant death syndrome (SIDS).
Longer term, these children are at greater risk for substance abuse problems, depression and anxiety, as well as behavioural and learning challenges. Later in life, they face a host of problems, including difficulties with personal relationships and sustaining meaningful employment.
Even if the infant has been exposed to a harmful substance, limiting or greatly reducing the amount consumed now and in the future can minimize the impact on the child and the mother. Substance abuse is a complicated medical issue, so trying to deal with it alone is dangerous. Consulting a physician, a gynecologist, and/or a social worker as soon as possible is essential, and will give both mother and child the best chance of reducing the effects of substance abuse on them both.
Drinking alcohol at all while pregnant is risky. Complete abstinence by pregnant women is recommended by medical experts. Alcohol passes from the mother’s blood to the baby through the umbilical cord, and can harm the baby’s cells as they are being formed. This can result in a fetal alcohol spectrum disorder, and permanent physical, behavioural, and intellectual impairment.
Also known as fetal alcohol syndrome disorder (FASD), these disabilities are a result of pregnant women consuming alcohol while pregnant. Infants born with this disorder often have distinctive facial features, growth problems, birth defects, learning and behavioural problems, and difficulty with bonding and feeding as a newborn.
The likelihood and severity of the problems is impacted in part by the stage of pregnancy at which alcohol is consumed, whether consumption is on a daily basis, and the number of drinks taken. Drinking alcohol later in pregnancy is riskier than earlier on, and consuming five drinks at any one time constitutes heavy use. Another factor to consider is whether or not the mother uses any other drugs during her pregnancy.
Women with a substance use disorder who are planning to become pregnant should seek help for drug or alcohol addiction prior to conception. Once a woman discovers that she is pregnant, she should report any alcohol use to her health care provider immediately. This is the only way to ensure that the fetus, and later, the young child, will receive the proper medical care to address challenges related to alcohol consumption during pregnancy. If the mother is dealing with an alcohol abuse problem, addressing her addiction through counselling, substance abuse treatment and other methods is paramount.
Smoking and Exposure to Second Hand Smoke
Cigarette smoke is extremely harmful to the health of an unborn baby. Nicotine, carbon monoxide, and a host of other poisons are carried through the mother’s bloodstream directly to the fetus in the same way that alcohol is passed from the mother’s blood to her baby’s. The results are equally devastating, now and in the future.
Smoking while pregnant will increase the likelihood of miscarriage, stillborn or preterm delivery (premature labour), having a low birth weight baby, respiratory problems for the baby, birth defects, and sudden infant death syndrome (SIDS). Also, as with alcohol, no amount is safe, and the more the pregnant mother smokes, the greater the risk for the baby and herself.
Second hand smoke – smoke that is inhaled by the mother from an outside source in the room – is even more harmful. The smoke that is produced by the cigarette as it burns and is released into the air contains more toxins than the smoke inhaled directly by the smoker. Avoiding any inhalation of cigarette smoke at all during pregnancy is very strongly advised.
Any woman planning to become pregnant should quit smoking immediately and manage any possible exposure to second hand smoke, as part of her prenatal planning.
Alternatively, as soon as she learns that she is pregnant, she should consult with her physician immediately.
Over the Counter (OTC) Medications
Over the counter (OTC) products, like acetaminophen or cold remedies, can also be extremely harmful to a developing fetus. Pregnant women must use them with caution, under the supervision of a health care provider.
The danger with OTC drugs is that, because they are readily available, everyone assumes that they are completely safe. Nothing could be further from the truth. Anything that a pregnant woman ingests, her unborn baby does as well, through the placenta.
Because the baby is not fully developed, prenatal exposure to over the counter drugs is much more dangerous for the baby than it is for the mother. She can appear to have no ill effects at all, while her baby is suffering very serious consequences in utero.
The medical field has learned a great deal about the effects of prescription drugs on unborn babies, and their use with pregnant women has dramatically decreased. As a result, some patients are self-medicating with non-prescription alternatives almost on a daily basis, thinking they are harmless. OTC drugs should only be taken by pregnant women when absolutely necessary, and after consulting a health care provider.
Prescription Medications, Painkillers and Opioids
Any prescription drug being taken by a pregnant woman will affect her baby. As with OTC medicines, only prescriptions that are absolutely necessary should be taken during pregnancy. A prenatal appointment with a medical practitioner to discuss cessation of the use of medications prior to becoming pregnant is the ideal scenario. If that does not happen, then as soon as a woman discovers that she is pregnant, she needs to alert her medical team to plan how to safely and effectively manage any health issues she may have.
Use, or rather, misuse of prescription painkillers, has been a significant area of focus for addiction research and for the media, as addiction to these drugs has reached alarming levels worldwide. The effects of the misuse of these medications on the mother is startling, but the short term and long term impacts on the child are cause for serious concern. Addiction to prescription opioids deserves all of the attention it has been receiving.
The opioid class of drugs include medications that can be obtained legally from a doctor, such as hydrocodone (Vicodin), oxycodone (OxyContin), codeine, morphine, and some prescription cough medications. Illicit forms in the same class include heroin and fentanyl, a synthetic opioid that is similar to morphine, but far more powerful. These drugs are painkillers, but they also have harmful side effects. In many patients, they produce a sensation of euphoria and extreme well-being that makes them highly addictive.
Whatever a pregnant woman ingests, her baby does as well, and opioids are no exception. Any use will impact the baby. Opioid dependence in the mother increases the severity of these effects. An increased risk of miscarriage, stillbirth, preterm delivery, fetal growth restriction, preeclampsia, postpartum heavy bleeding, placental abruption and neonatal abstinence syndrome (NAS) are all linked to opioid use during pregnancy.
Placental abruption occurs when the placenta separates from the uterus while the baby is in the womb. The placenta provides oxygen and nutrients to the baby that are vital for life. If it separates prior to childbirth, the baby loses that supply of oxygen and nutrients, and is in grave danger of fetal distress, miscarriage, stillborn or preterm delivery, and low birth weight. The mother will likely have severe bleeding, lower abdominal pain, and dangerously low blood pressure, and will need to see a medical professional immediately. Placental abruption is a very serious complication that can occur as a direct result of opioid use during pregnancy.
Neonatal abstinence syndrome (NAS) is perhaps the most tragic of the possible consequences for these babies of the mother’s addiction to opioids. The baby develops a drug addiction in the mother’s womb, and is born with an opioid dependency. Because the new baby is no longer getting the drugs after birth, he or she suffers severe withdrawal symptoms.
These symptoms include tremors, jitteriness, diarrhea, irritability, poor sleep, high pitched crying, and uncoordinated sucking reflexes that lead to poor feeding. These symptoms appear within hours after birth and can last several weeks. The best way to ensure that the fetus, and later, the young child, does not suffer the effects of opioid use is to avoid the use of these drugs completely.
Women planning to become pregnant should stop opioid use prior to conception, in consultation with a health care provider. Suddenly stopping the use of these medications is dangerous for the mother, and can be harmful to the baby, and should only be done with the help of a medical professional. Any opioid use disorder or opioid addiction should be treated prenatally.
Treating opioid use disorder in pregnant women involves a combination of opioid replacement medication, counselling and behaviour therapy. While less potentially harmful than opioids, these replacement medications are also drugs and will affect the baby as well. The only way to guarantee the safety of mother and baby is to avoid opioid use completely while pregnant.
Illicit or illegal drugs, like heroin, methamphetamine (meth or Ecstasy), methadone, cocaine and marijuana are the most dangerous substances, potentially harmful to pregnant women and their babies. These drugs alter the brain chemistry, creating a host of physical, emotional, and behavioural problems that can lead to death, divorce, difficulties maintaining employment, and/or prison. Overdose is an ever-present risk.
They are also highly addictive. A single use can create a physical dependence that leads to cravings. Those cravings can only be satisfied by taking more of the drug. Symptoms of withdrawal occur when the user stops. These can be very severe, depending on the substance taken, and can include heart palpitations and seizures. This prompts the person suffering from an illicit drug use disorder to begin taking the drug again, and this time, even more will be needed to satisfy the cravings.
Eventually, a psychological dependence on the drug develops as the user begins to feel as if they need the drug just to function throughout the day, to feel like themselves.
The best way to manage an addiction to illegal drugs is in a rehab program at an inpatient treatment facility. A team of medical professionals, including doctors, addiction counsellors and psychiatrists, can use a multidisciplinary approach to address the root cause of the substance abuse disorder, including any underlying mental illness, and provide the most appropriate addiction treatment options that include individual therapy and group therapy.
Quitting these drugs “cold turkey”, or all of a sudden, is very dangerous, and can lead to death. Seeking the help of a health care provider is essential not only for the sake of safely managing withdrawal symptoms, but also to ensure access to proper prenatal care.
Taking illicit drugs such as heroin, cocaine or meth, may actually make it difficult for a woman to get pregnant at all, as infertility is one of the problems associated with the use of these drugs. If a women does become pregnant, no amount of illicit drug use is safe, as these drugs are absorbed by the fetus in utero.
After the baby is born, they may be passed through the breast milk. There is a greatly increased risk of miscarriage, stillbirth, maternal death, preterm delivery, low birth weight, placental abruption, neonatal abstinence syndrome (NAS), SIDS, and birth defects. If the mother uses shared needles, there is also a risk of and infections like HIV (AIDS), and hepatitis C.
Later in life in life, if they survive the pregnancy and the months following it, these children will likely suffer from learning and behavioural challenges, slower than normal growth, difficulties with relationships, and difficulty maintaining employment.
Becoming pregnant while taking heroin and other illicit drugs is a potential death sentence for both the mother and her baby. All of the dangers associated with their use for the mother are compounded for the child. No amount of illegal substances is safe for either, and addressing the substance abuse disorder immediately with a health care provider is essential.
1. Licit and Illicit Drug Use during Pregnancy: Maternal, Neonatal and Early Childhood Consequences
Report prepared for the Canadian Center on Substance Abuse, 2013
Drug Withdrawal in Newborns (Neonatal Abstinence Syndrome)
BC Health Links: Health Wise Staff, Current as of March 28, 2018
Quitting Smoking and Avoiding Smoke During Pregnancy
BC Health Links: Health Wise Staff, Current as of November 21, 2017
Substance Use During Pregnancy
CDC – Centers for Disease Control and Prevention
Page last reviewed: July 24, 2019
Opioid Use During Pregnancy
March of Dimes
Last updated September 2017
Bleeding During Pregnancy
ACOG – American College of Obstetricians and Physicians
Copyright, July 2016
Picture Credit: Mosaic Science. This picture has a Creative Commons attribution licence.