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What Drug Treatment Options Are Available for a Pregnant Woman?

Pregnancy should be a time of joy and excitement.  However, it can also be a time of uncertainty for many who are struggling with substance dependency.

Specialized addiction treatment options are available for pregnant women. Physician supervision is required throughout all aspects of recovery due to the complex medical situation occuring.

A Difficult Situation

Every mother wants to be the best parent she can be and provide her child with the best life possible. But pregnancy does not stop an addiction.

A pregnant woman who is dependent on a substance still faces the same cravings and side effects she did before pregnancy.
Withdrawal can be incredibly difficult while pregnant. In fact, the stress of withdrawal could be harmful to an unborn child.
Expectant women may worry about the stigma of being pregnant with drug issues and facing judgment from others, even if they are seeking help.

Understanding Addiction 

Pregnant women who are struggling with an addiction problem can receive harsh judgment from others, including friends, family members, and even health professionals. They may suffer from low self-esteem and self-loathing, as they struggle between caring for their unborn child and working through the intense physical and emotional urges to use. 

Today, there is a greater understanding of substance abuse and addiction problems. This better should offer individuals — including pregnant women — the opportunity to face their addiction problems with honesty, without being treated poorly or stigmatized.

The highly publicized opioid epidemic and the rise of methamphetamine problems throughout the country has resulted in a greater awareness of addiction and substance abuse problems. Most people from nearly all walks of life know someone affected by addiction — not as a criminal or villain, but as someone whom they love is struggling. 

This has helped people to recognize addiction is “a chronic disease of the brain” — a condition rather than a bad choice an individual is making over and over again. Research has shown that repeated drug use actually changes the way the brain responds to stimuli and stress, and even a user’s ability to self-regulate. 

All these factors, in addition to the intense physical side effects of addiction, are part of why it is so hard for an individual to stop using a substance they are addicted to even when they know they should and truly want to. 

Pregnancy, Women, and Addiction

Pregnant women face all of these obstacles too. The news of expecting a baby and all it entails can trigger a female user to use more intensely to assuage the physical and emotional effects of insecurity and addiction. 

The Numbers:

It is estimated that 5.4 million women abused opioids or heroin in 2016 in which approximately 26,000 were pregnant.

In 2016, the National Institute on Drug Abuse estimated that approximately 5 percent of pregnant women use one or more addictive substances, and there were about 750,000 cocaine-exposed pregnancies that year.

Up to two-thirds of women diagnosed with substance use disorders (SUD) had histories of physical and/or sexual assault in their childhood.

About 30 to 59 percent of women diagnosed with SUDs were also diagnosed with post-traumatic stress disorder compared with 11 percent of women in the general population who were diagnosed with PTSD.

Pregnancy and Drug Complications

The symptoms and complications drug-dependent pregnant women face vary widely, depending on a number of factors, particularly what drug they are dependent on. 

Stimulants (cocaine, methamphetamine)

Stimulants work mainly by affecting the action of the brain chemical dopamine, which plays a big part in the brain activity responsible for pleasure and reward patterns. Negative side effects may include increased heart rate and blood pressure, decreased hunger, and mood disturbances. 

In addition to problems caused by these general side effects, pregnant women who are dependent on stimulants may be at a higher risk for placental abruption and placental hemorrhages, and postpartum mood disorders. The higher blood pressure caused by stimulant use is also a danger, as high blood pressure is always a risk to maternal health and can affect a mother’s health after birth as well. 

There was a great deal of research linking pregnant women who used crack or cocaine to sick newborns, or infants with malformations, during the “crack baby” hysteria of the 1980s and 1990s. Much of this research has been debunked.

Even so, cocaine use during pregnancy is linked to lower birth weights. There is ongoing research into whether it may result in behavioral patterns in children.

Opioids (heroin, prescription painkillers)

Skyrocketing use of opioids in the U.S. has received a great deal of attention since pharmaceutical companies began pushing opioids as safe pain relievers, and health care providers began prescribing them at high rates. Many users became dependent on highly addictive drugs.

Some turned to heroin, which was already a major problem in the U.S., and it was often cheaper and more accessible. According to the National Institute on Drug Abuse (NIDA), more than 130 people die every day as a result of overdosing on opioids. 

Of course, the opioid crisis affects pregnant women as well. Between 1999 and 2014, the number of pregnant women with opioid use disorder (OUD) more than quadrupled, according to research from the U.S. Centers for Disease Control and Prevention (CDC). 

Users of opioids and heroin quickly develop dependency and tolerance. Opioid use is linked to fatal overdose, miscarriage, and malnourishment in pregnant mothers.

Studies show a link between prenatal opioid use and low birth weight, neonatal withdrawal, and neonatal abstinence syndrome (NAS), during which the infant may experience withdrawal symptoms. 

Because opioid withdrawal is so extreme and may result in pregnancy problems, most medical professionals treat opioid-dependent pregnant women with opioid agonist pharmacotherapy rather than complete withdrawal

Alcohol

While alcohol use by adults over the age of 21 is legal, drinking — particularly binge drinking and excessive drinking — can cause severe health problems. Side effects can include loss of motor skills, speech problems, and mental confusion. Long-term effects may include depression, liver problems, and brain damage.

Data shows that 20 to 30 percent of women drink at some point during their pregnancy. Research on the risks of occasional drinking during pregnancy is ongoing, as is research about the effects of drinking early in pregnancy. 

Studies show that drinking during pregnancy can be very dangerous. Prenatal alcohol exposure is the leading preventable cause of birth defects and neurodevelopmental abnormalities in the U.S.

Drinking during pregnancy can also result in fetal alcohol spectrum disorders (FASD), which include fetal alcohol syndrome (FAS), alcohol-related neurodevelopmental disorder (ARND), and alcohol-related birth defects (ARBD). 

Because alcohol withdrawal can be very extreme and even dangerous to pregnancy, most medical professionals use drugs to treat withdrawal symptoms during pregnancy. Benzodiazepines, while also highly addictive, are often used under medical supervision. More recently, naltrexone has also been prescribed to pregnant women.

Non-Drug Treatment Options for Pregnant Women

Although medication may be necessary to avoid dangerous withdrawal symptoms in some cases, other treatment options will also be necessary. 

  • Cognitive behavioral therapy (CBT) can help pregnant women learn to cope with daily stresses and triggers without substances.
  • Community reinforcement approach (CRA) increases positive reinforcement of abstaining from drugs via access to alternative activities and programs.
  • Contingency management (CM) works to help individuals see the negative consequences of using and the positive effects of abstaining from using.
  • Group therapy provides individuals with a positive sense of community and accountability.

Choosing a Treatment Center for Pregnant Women

Enrolling in a treatment program can provide pregnant women with their best chances of success in overcoming addiction. Along with personalized attention and therapy, professionals can monitor the administration of needed withdrawal medications and ensure these expectant mothers are getting the nourishment and encouragement they need for a healthy pregnancy. 

The right treatment center will depend on the individual and the particular substances they are struggling with as well as the type of environment they are looking for. 
The treatment center should be very familiar with the unique challenges faced by pregnant women who are struggling with addiction. In addition to medical care, they should offer a comprehensive addiction treatment program to ensure success during their pregnancy and beyond. 

Sources

(February 2018) Homeless. Addicted to Heroin. About to Give Birth. Julia Lurie. Mother Jones. Retrieved February 2019 from https://www.motherjones.com/politics/2018/02/pregnant-opioid-drug-use/

(August 2018) The Number of Women with Opioid Use Disorder at Labor and Delivery Quadrupled from 1999-2014. U.S. Centers for Disease Control and Prevention (CDC). Retrieved February 2019 from https://www.cdc.gov/media/releases/2018/p0809-women-opiod-use.html

(February 2017) Pregnant Women and Substance Use. Jacobs Institute of Women’s Health. The George Washington University. Retrieved February 2019 from https://publichealth.gwu.edu/sites/default/files/downloads/JIWH/Pregnant_Women_and_Substance_Use_updated.pdf

(May 2018) Children of the Opioid Epidemic. Jennifer Egan. The New York Times. Retrieved February 2019 from https://www.nytimes.com/2018/05/09/magazine/children-of-the-opioid-epidemic.html

(May 2013) Revisiting the ‘Crack Babies’ Epidemic that was Not. Michael Winerip. The New York Times. Retrieved February 2019 from https://www.nytimes.com/2013/05/20/booming/revisiting-the-crack-babies-epidemic-that-was-not.html

(May 2016) What are the Effects of Maternal Cocaine Use? National Institute on Drug Abuse (NIDA). Retrieved February 2019 from https://www.drugabuse.gov/publications/research-reports/cocaine/what-are-effects-maternal-cocaine-use

(January 2019) Opioid Overdose Crisis. National Institute on Drug Abuse (NIDA). Retrieved February 2019 from https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis

(August 2017) Opioid Use and Opioid Use Disorder in Pregnancy. The American College of Obstetricians and Gynecologists. Retrieved February 2019 from https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Opioid-Use-and-Opioid-Use-Disorder-in-Pregnancy?IsMobileSet=false

(January 2013) Fetal alcohol exposure: consequences, diagnosis, and treatment. Pruett, D. PubMed.gov. Retrieved February 2019 from https://www.ncbi.nlm.nih.gov/pubmed/23322082

(August 2016) The Treatment of Alcohol and Opioid Dependence in Pregnant Women. National Institutes of Health. Retrieved February 2019 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4976292/

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