Maternal Substance Abuse: Effects on Mother and Child at BrighterDay

Prevalence of Maternal Substance Abuse

Maternal substance abuse is a widespread concern with significant implications for both maternal and child health. It's crucial to understand the prevalence of this issue in order to develop effective prevention and intervention strategies.

Statistics on Substance Use During Pregnancy

The use of substances during pregnancy is more common than some might think. In 2019, approximately 20% of pregnant individuals aged 15–44 in the United States reported using alcohol, 13% reported cigarette use, and 6% reported marijuana use during pregnancy. Substance abuse during pregnancy is associated with several adverse outcomes, including preterm birth, low birth weight, major birth defects, neonatal abstinence syndrome, and stillbirth [1].

Furthermore, opioid use during pregnancy has also seen a significant rise, contributing to the wider opioid epidemic's impact on maternal and neonatal health.

Demographics of Maternal Substance Abuse

In the U.S., the prevalence of polysubstance use during pregnancy is highest among pregnant individuals aged 15–17 and those with public insurance. Women who use alcohol, tobacco, and other drugs are also more likely to experience intimate partner violence (IPV) before or during pregnancy.

According to the NCBI Bookshelf, between 2005 and 2014, 11.5% of adolescent and 8.7% of adult pregnant women reported drinking alcohol, and 23% of adolescent and 14.9% of adult women reported using tobacco. Furthermore, a U.S. national survey in 2012 showed that 5.9% of pregnant women reported using illicit drugs, 8.5% reported drinking alcohol, and 15.9% reported smoking cigarettes during pregnancy. Similar use and fetal exposure to these substances have been reported in Europe and Australia.

Moreover, retrospective reviews demonstrate that 2.5% of all pregnant women and about 20% of those with U.S. Medicaid insurance received at least one prescription for an opioid during pregnancy. Most pregnancies in mothers with Opioid Use Disorder (OUD) are unplanned. Polysubstance use is frequent during pregnancy, similar to the general population.

These statistics underscore the importance of ongoing efforts to raise awareness of the risks associated with maternal substance abuse, as well as the need for supportive programs and policies that can help tackle this pressing issue.

Consequences of Substance Abuse During Pregnancy

The impact of maternal substance abuse is profound and far-reaching. It not only affects the health and well-being of the mother but also has serious implications for the neonate and can result in long-term effects on the child.

Impact on Maternal Health

Substance abuse during pregnancy can lead to a variety of adverse effects on the mother. It significantly increases the likelihood of maternal mortality and morbidity, with a higher risk of complications such as placental abruption. Beyond the immediate physical health concerns, substance abuse can also lead to mental health issues, social isolation, and financial difficulties. The use of substances such as tobacco, marijuana, and prescription pain relievers is associated with double or even triple the risk of stillbirth.

Impact on Neonatal Health

The effects of maternal substance abuse extend to the neonate as well. Babies born to mothers who used substances during pregnancy are at a higher risk of preterm birth, low birth weight, and neonatal abstinence syndrome. In addition, they are more likely to experience sudden infant death syndrome (SIDS) and be stillborn. The risk of these adverse outcomes is further increased with polysubstance use.

Long-Term Effects on Children

Maternal substance abuse doesn't just impact the child in the neonatal period. It can have far-reaching effects that extend into childhood and beyond. Children exposed to substances in utero are more likely to have long-term neurodevelopmental deficits. These may present as learning disabilities, behavioral problems, and mental health issues later in life [2].

In addition to these cognitive and behavioral challenges, children born to mothers who abused substances during pregnancy may also suffer from social and emotional issues. These children might require additional educational support and mental health services throughout their life.

Understanding the severe consequences of maternal substance abuse is crucial for developing effective prevention strategies and treatment programs. It underscores the need for early identification and intervention, as well as comprehensive support services for affected mothers and their children.

Types of Substances Abused During Pregnancy

Substance abuse during pregnancy poses significant health risks to both the pregnant person and the developing fetus. Various substances, including alcohol, tobacco, and illegal drugs, are commonly used during pregnancy, each with its own set of harmful effects.

Alcohol and Tobacco Use in Pregnancy

In 2019, it was reported that approximately 20% of pregnant people aged 15–44 used alcohol, and 13% reported cigarette use during pregnancy in the United States. Both alcohol and tobacco consumption during pregnancy can lead to severe consequences.

Alcohol use can result in Fetal Alcohol Spectrum Disorders (FASDs), which can cause a range of developmental, cognitive, and behavioral problems in the child. On the other hand, tobacco use is associated with preterm birth, low birth weight, and sudden infant death syndrome (SIDS).

It's also important to note that women who use alcohol, tobacco, and other drugs are more likely to experience intimate partner violence (IPV) before or during pregnancy.

Illicit Drug Use in Pregnancy

Illicit drug use during pregnancy, such as the use of opioids, is a growing concern. In recent years, the rate of opioid use during pregnancy has increased significantly in the United States, contributing to the opioid epidemic's effect on maternal and neonatal health [1].

Other commonly used illegal drugs during pregnancy include marijuana, cocaine, and methamphetamines. Each of these drugs can have harmful effects on the developing fetus. Marijuana use, for example, has been linked to low birth weight and developmental problems, while cocaine use can lead to preterm birth and developmental issues.

Maternal substance abuse during pregnancy, including the use of illicit drugs, has been linked to a higher risk of preterm birth, low birth weight, neonatal abstinence syndrome, and long-term neurodevelopmental deficits in children.

Addressing the issue of maternal substance abuse during pregnancy requires comprehensive strategies that include prevention, early identification, and access to treatment. By understanding the types of substances commonly used during pregnancy and their effects, healthcare providers and policymakers can better design interventions and policies to support pregnant people and reduce the harmful effects of substance use on neonatal health.

Addressing Maternal Substance Abuse

Addressing maternal substance abuse during pregnancy necessitates a comprehensive, multi-faceted approach. This involves the early identification of substance use, ensuring access to substance abuse treatment programs, combating stigma associated with substance use disorders, and implementing policies that bolster maternal and child health [2].

Importance of Early Identification

Early identification of maternal substance abuse is critical in mitigating the detrimental impacts on both the mother and the infant. Universal screening for substance use is recommended during pregnancy, with the provision of effective interventions if necessary. Such early detection can significantly enhance the health outcomes for both mother and child, reducing the risk of complications and fostering healthier development for the infant.

Access to Treatment Programs

Ensuring access to treatment programs is a key component in addressing maternal substance abuse. Substance use disorders among pregnant individuals continue to be a significant public health concern, posing risks to the child’s development and imposing socioeconomic burdens on society by increasing needs for medical and social services [6]. Treatment programs need to be readily accessible and equipped to address the unique needs of pregnant individuals struggling with substance abuse.

Overcoming Stigma and Policy Implementation

Overcoming the stigma associated with substance use disorders is a crucial aspect of addressing maternal substance abuse. Pregnant women who use substances often face social stigma, creating barriers to accessing evidence-based treatments.

Collaborative efforts across healthcare providers, social services, public health agencies, and community organizations are essential in developing effective interventions. These collaborations can help foster an environment of understanding and support, rather than judgment, for pregnant individuals struggling with substance abuse.

In addition, it is vital to implement policies that support maternal and child health. Such policies should focus on promoting access to healthcare resources, reducing societal stigma, and ensuring that pregnant women have the necessary support to overcome substance abuse. These efforts combined can help to mitigate the long-lasting implications for brain structure and function in infants exposed to drugs in utero.

Support and Resources for Maternal Substance Abuse

Addressing the issue of maternal substance abuse requires a comprehensive and compassionate approach. Fortunately, there are several resources available at both the national and provincial levels, as well as online, to provide support for individuals grappling with substance use during pregnancy.

National Support Services

Canada-wide services are available at any time for individuals in need of help with substance use, including maternal substance abuse. These services can be accessed through various helplines such as:

1-800-668-6868
Text 686868
1-855-562-2262

These helplines offer immediate assistance, providing information, advice, and referral services to individuals struggling with substance use [7].

Provincial and Territorial Health Services

In addition to national support services, provincial and territorial health and support services can also provide assistance to individuals dealing with substance use, including maternal substance abuse. These services can be accessed via:

1-800-665-1822
Email: keltycentre@cw.bc.ca

These resources offer localized support and tailored programs to address the unique needs and challenges associated with maternal substance abuse in different regions [7].

Online Support Groups and Harm Reduction Centers

Online support groups can offer a valuable platform for parents struggling with substance use. These groups facilitate connections with others experiencing similar challenges, providing a safe space for sharing, learning, and mutual support.

Moreover, harm reduction centers in Canada provide essential services for individuals struggling with substance use, including maternal substance abuse. These centers can be reached at:

1-902-470-8888
1-888-470-5888
1-833-292-3698

Harm reduction centers offer resources and strategies to minimize the negative impacts of substance use, promoting safer practices and improved health outcomes. One such resource is the Naloxone Finder – Take Home Program, which can be accessed by calling or texting 1-855-662-6605 or 1-866-531-2600. This program is particularly beneficial for individuals dealing with opioid use, providing a means to prevent opioid overdoses.

Overall, while maternal substance abuse is a complex issue, the availability of various support services and resources provides hope for those affected. By reaching out and accessing these services, individuals dealing with substance use during pregnancy can receive the help they need to navigate this challenging situation.

Guidelines and Recommendations for Pregnant Women

This section is dedicated to guidelines and recommendations for pregnant women who may be struggling with substance use. The focus is on three key areas: screening during pregnancy, medication-assisted treatment for opioid use, and recommendations on breastfeeding and substance use.

Screening During Pregnancy

Universal screening for substance use is recommended during pregnancy, with access to effective interventions if indicated. However, it's crucial to note that pregnant women who use substances often feel stigmatized, and barriers to evidence-based treatments exist. The key is to create a supportive environment for these women, encouraging them to seek help and access the necessary interventions without fear of judgement or discrimination.

Medication-Assisted Treatment for Opioid Use

For pregnant women with opioid use disorder (OUD), medication-assisted treatment is recommended as the standard of care. Methadone and buprenorphine are the recommended medications for OUD in pregnancy. These medications, when coupled with comprehensive care, can promote positive behavioral change in pregnant women with OUD and improve outcomes for both the mother and the child.

Recommendations on Breastfeeding and Substance Use

Breastfeeding holds numerous benefits for newborns, including those affected by maternal substance use. In fact, breastfeeding is associated with a decreased severity of neonatal opioid withdrawal syndrome (NOWS) symptoms and a decreased need for pharmacotherapy in affected newborns. However, it's important to note that women using illicit substances, including marijuana, are advised to abstain from breastfeeding. This is to ensure the safety and well-being of the newborn.

In summary, abstinence and medication-assisted treatment improve outcomes for pregnant women and their children. Pregnancy often serves as a strong motivator for abstinence, and most women refrain from or decrease their use of tobacco, alcohol, marijuana, and cocaine by the second trimester [10]. By following these guidelines and recommendations, pregnant women struggling with substance use can seek help and work towards a healthier future for themselves and their children.