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Substance Use in Pregnancy

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Substance Use in Pregnancy 1 Editor Joann Grayson, Ph.D. Editorial Director Ann Childress, MSW Sponsored by Editorial Assistant Wanda Baker Child Protective Computer Consultant Services Unit Phil Grayson, MFA Student Assistants Virginia Department Anthony Chhoun of Social Services Tigrai Harris Hayden Heath Summer, 2016 Virginia Child Protection Newsletter Volume 106 SUBSTANCE USE IN PREGNANCY compared to 14.5 million or 5.8% in 2007). Legal substances also impact pregnancy. Sandra grew up in a nice neighborhood, at- Della started abusing prescription pain Alcohol is a widely-used substance by wom- tended a private school, and graduated from medication and smoking marijuana in her en of child-bearing age. In a national sample, college. She had been dabbling in drugs teen years. She still functioned and was 17.9% of pregnant women were found to since high school but did not discover heroin employed. She quit illicit drug use during drink alcohol during the first trimester of until her senior year in college. After gradu- her first pregnancy. She relapsed and later pregnancy. The numbers drop to 4.2% in the ation, she relocated to a fast-paced city just discovered that she was pregnant again. This second trimester and 3.7% in the third tri- to be close to drug activity. She obtained time, she could not quit. mester (SAMHSA, 2013). Over 20% of the a good job but lost it within a year due to population smokes cigarettes. In a national absences and poor performance. When she sample, 18.9% of pregnant women were discovered that she was pregnant, she began smoking cigarettes (Havens et al., 2009). a methadone program and entered a sober Legally-prescribed substances and medi- home, but relapsed anyway. To avoid another cations can be misused or, even if taken as relapse, she entered a residential program prescribed, may affect the developing fetus. which was effective, along with the metha- Substance use in pregnancy has also done maintenance, in controlling her illicit changed over the past three decades. The drug use. Still, Sandra feels she has lost so incidence is believed to be increasing and the much of what she valued and she is worried substances used also change (Keegan et al., about maintaining abstinence and providing 2010). Each year in the United States, an es- for her baby when she leaves the hospital. timated 400,000 to 440,000 infants (10-11% Substance use in pregnancy can cause of all births) are affected by prenatal alcohol medical complications depending on how or illicit drug exposure (National Center on At 28 weeks pregnant, Tiffany presents to substances are administered. Pregnant wom- Substance Abuse and Child Welfare). Ac- a neighborhood health clinic with cramps. en who abuse substances, including legal cording to Young and Gardner (2007), more She has not started prenatal care and has a substances such as alcohol and nicotine, than 7 million children and youth under age 3-year-old with her. The fathers of both chil- have a greater-than-normal risk of medical 18 have been exposed prenatally if nicotine dren are in prison. Tiffany smokes 2 packs complications. These women should be and alcohol are included along with use of of cigarettes daily, drinks a six-pack of beer monitored regularly for signs of anemia, illicit substances and misuse of prescription several times a week, and occasionally uses poor nutrition, increased blood pressure, hy- medications. Most are not detected at birth cocaine. She grew up in foster care and has perglycemia, sexually transmitted diseases, and leave the hospital without any follow-up never had a fixed address. hepatitis, and preeclampsia. Infections such or services. as Hepatitis B and C, tetanus, and cellulitis About half of pregnancies in the Unit- can be profoundly harmful to both women ed States are unintended. Women who Josh is seven days old and weighs 5 pounds. and their fetuses, especially if unrecognized abuse substances are at even higher risk of He’s in the neonatal care unit experiencing and untreated (Treatment Improvement Pro- the symptoms of opioid withdrawal. His tocol Series, No. 43). mother, Mary, followed her doctor’s advice Illicit drug use in the United States is in- and took methadone during her pregnancy creasing, according to the National Institute instead of continuing heroin use. Now Josh on Drug Abuse (2015). In 2013, an estimated must be weaned from the methadone. Mary 24.6 million Americans aged 12 or older- understands his pain. Still, hearing his high- about 9.4% of the population- used an illicit pitched cries is agonizing. Josh is swaddled drug within the past month. In 2003, the and held in a spot with dim lights and gentle percentage was 8.3. The increase is mainly music. due to increased use of marijuana (19.8 mil- lion users- about 7.5% of those over age 12 continued on page 2 2 cellulitis and HIV which further complicate risk of serious infectious diseases, especially pregnancy (Keegans et al., 2010; Shan- if used intravenously. Individuals addicted to karan et al., 2004). Maternal nutrition and prescription opioid pain relievers sometimes health status affect the developing fetus and switch to heroin because it produces similar intersect with substance use as women who effects and may be cheaper and easier to are abusing substances may have nutritional obtain (Mactier, 2013; National Institute of deficiencies (Huestis & Choo, 2002). Drug Abuse). Substance use is associated with a According to a review by Wilder, Lewis number of other factors that can negatively & Winhusen (2015), the percentage of preg- affect maternal prenatal care. Mothers who nant women who use opioid drugs has tri- use substances have been found to be more pled in the ten years between 2002 and 2012 likely to have no partner, receive Medicaid, with 1.2% of all pregnant women reporting Substance Use in have lower SES, and have less education opioid use in 2012. Certain subgroups appear Pregnancy than abstainers. Substance-using women to be at higher risk. For example, a Canadian continued from page 1 may start prenatal care later and attend a study (Kelly et al., 2011) found 17.2% of lower percentage of prenatal visits (Nguyen neonates in their study of First Nations pop- unintended pregnancies (Grant et al., 2014). et al., 2010). ulation in Ontario were exposed to narcotics. Women who don’t plan on pregnancy may Exposure to substances in utero can affect According to Winklbaur et al. (2008), for be using alcohol or other substances during individuals across the lifespan (National illicit drug use in pregnancy, opiate use is the the early months of pregnancy without Institute on Drug Abuse, 2011). Estimat- second only to marijuana use and is almost realizing they are pregnant. The majority of ing the full extent of the consequences of four times greater than use of cocaine. women stop risky behaviors and substance maternal drug abuse is difficult for many Opiate-abusing mothers tend to have use as soon as they learn they are pregnant. reasons. According to the Centers for decreased health and poor nutrition, are Women who continue to use may be uned- Disease Control (2014), little is known less likely to obtain adequate prenatal care, ucated about the negative effects of sub- about the use of most medications during and are likely to abuse other substances stances on the fetus or they may be addicted pregnancy. Less is known about use of illicit (CRC Health Group, 2016). Poor obstetric and unable to quit use without additional substances. Factors that can determine the outcomes such as pregnancy complica- support and treatment (Virginia Department effects include: dose (how much is taken); tions, spontaneous abortions and premature of Behavioral Health & Developmental when during the pregnancy the substance is labor can be up to six times higher (600% Services, 2014). Pregnant women who are taken; the mother’s other health conditions; increase) if the mother is abusing opiates unemployed, unmarried and experiencing and other substances taken or used. As noted (CRC Health Group, 2016; studies reviewed current psychopathology are at greater risk above, multiple individual, family, and envi- in Holbrook & Nguyen, 2015; Keegan et of continued use of substances (Havens et ronmental factors (including but not limited al., 2010). For those using illicit intravenous al., 2009). to nutritional status; when prenatal care was heroin, risk of medical complications such as In 2012, the substance used by the largest begun; socioeconomic conditions) can make infectious diseases, abscesses and sexually number of pregnant women was tobacco, it difficult to tease out the effects of sub- transmitted diseases are increased (Winkl- followed by alcohol and then illicit drugs stances. Conversely, some effects from drug baur et al., 2008). (National Center on Substance Abuse and exposure are believed to be mitigated by Of the opiates, heroin has been the most Child Welfare). Changes in the type of sub- positive and supportive home environments frequently studied substance. It crosses stances used by pregnant women have been and quality parenting. the placenta readily and enters fetal tissues noted. The 2010 National Survey on Drug Even with challenges, there is some within an hour of maternal use. According Use and Health found decreasing numbers consensus about some of the possible effects to a National Public radio report (Tribble, of pregnant women abusing alcohol while of substance use in pregnancy. The projected 2016) a baby is born with Neonatal Absti- drug abuse increased (Virginia Department effects can differ by the type of substance, so nence Syndrome in the United States every of Health, Office of the Chief Medical Ex- the next sections will discuss findings about 25 minutes. Others offer a slightly higher aminer, 2015). A 2013 report by SAMHSA a particular substance or class of substances.
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