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Pregnancy and Substance Use

Addiction and withdrawal pose risks for everyone, but for pregnant people and their babies, the dangers are even greater. Some types of substance use during pregnancy can increase the risk of complications for the mother and make the newborn susceptible to some withdrawal symptoms too.

According to the 2018 National Survey on Drug Use and Health, 5% of pregnant women reported using illicit drugs in the past month and 9.9% reported alcohol use in the last month.9 But women struggling with substance abuse during pregnancy may neglect to seek treatment due to fear of judgment, scrutiny, or legal ramifications. In a 2015 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 Alcohol or Drug Addiction and Pregnancy

Drug and alcohol addiction poses many dangers to pregnant parents and unborn babies. 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 birth parent 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 person’s life that makes it more difficult to stop using substances even if they want to for the wellbeing of the child. Being unable to control 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, but they may also 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

Withdrawal Risks for Babies

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 alcohol, opiates, cocaine, amphetamines, benzodiazepines, barbiturates, nicotine, and caffeine. Withdrawal symptoms and duration can vary significantly depending on the substance used, the amount and frequency of use, and the length of gestation. Symptoms may occur immediately upon birth and can last as long as 2 weeks.4,8 But don’t lose hope. Effective treatments exist to help you and your baby get through this difficult time. Ask your doctor about treatment options.

If you use opioids, you should know that 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. Again, effective treatments exist to help you through this time. Opioid maintenance medicines are evidence-based treatment that can help reduce the risks for you and your baby while pregnant, and continue after pregnancy as you start your addiction recovery.

Barriers to Addiction Treatment During Pregnancy

Unfortunately, pregnancy can be a barrier to treatment since not all treatment programs are able to treat pregnant people. Pregnant people 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.

If you’re pregnant or thinking of getting pregnant and use drugs or alcohol, it can be difficult and even frightening to ask for help; however, reaching out to a formal detox or substance use treatment program can help keep you and your baby safe.

While we understand that not only women get pregnant, we have used that term here to reflect the language used in the studies referenced for this article.