Substance use in pregnancy could be the most important yet most under-resourced field of perinatal medicine. Every year, thousands of fetuses are exposed to drugs, alcohol, or tobacco in utero, and subsequently, thousands of infants are born with complications after exposure, which significantly impact their quality of life. Yet, with how commonplace it is, stigma and a lack of funding and resources divert far too many pregnant persons from appropriate education and treatment.
Substance use in pregnancy impacts the person using substances and the person growing inside them. Substance use can cause Fetal Alcohol Spectrum Disorders (FASD) from alcohol exposure (resulting in physical deformities, low birth weight, premature birth, and neonatal abstinence syndrome (NAS) – where infants show withdrawal symptoms from the illicit drug used (1 in 100 infants are born with opioid-related NAS, for example). Cocaine creates preterm births, low birth weight, and NAS as well, and even methamphetamines through maternal use have been shown to cause negative effects on infants, including increased risk for stillbirth. Tobacco increases stillbirth rates and risk for sudden infant death syndrome (SIDS).
Yet not all pregnant women are bad decision-makers. Many women with substance-use disorder have comorbid social determinants of perinatal care, such as poverty, trauma, reduced access to healthcare, and comorbid mental illness. For many, legal recourse or Child Protective Services involvement prevents them from getting any prenatal care at all. For example, in various states across America, medication in pregnancy is deemed child abuse.
Experts clarify that punishment prevents nothing. Where stigma should be avoided, evidence-based, compassionate treatment emerges as the better alternative. When substance use treatment and prenatal care are simultaneous treatments during pregnancy, mothers enjoy better health outcomes, reduced preterm births, and an increased chance for long-term recovery. Medication-assisted treatments like methadone or buprenorphine provide comfort throughout this extensive procedure because they avoid withdrawal without a detrimental impact to the mother and non-inundating impact to the fetus.
As for international research, it’s hit or miss. Low and middle-resource countries find similar rates of substance-using pregnant women, although no treatment exists. The World Health Organization (WHO) supports more public health-based initiatives, from longer-term access to harm reduction strategies to guaranteed safety and provision during prenatal checkups and beyond to assess socioeconomic determinants for substance use in the first place.
Every pregnancy deserves healthy beginnings – and that of mothers who also happen to be along the continuum of addiction. By addressing and understanding substance abuse from a health standpoint instead of a morally deficient one, society can beat intergenerational trauma into submission while simultaneously improving health outcomes for the better for society and all children.
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