Substance abuse is one of the key factors having a negative impact on pregnancy outcomes. The illicit drug use in women of reproductive age increases year by year in many countries, and the use of drugs, along with misuse of prescriptive drugs such as antidepressants and pain killers during pregnancy is common. Nicotine and alcohol which are the major risk factors for the fetal development itself are often used in combination with other drugs. Many women under special treatment report “polydrug usage” (Whittaker, 2003), a substance abuse can be accompanied by poverty, psychological distress and victimization. According to study by Harrisson and Sidebottom (2009), 24% of pregnant women participating in the research reported that they used nonmedical drugs before pregnancy. 11% reported that they continued using drugs after they learnt they’re pregnant.
Substance use can result in various negative outcomes: obstetric complications, miscarriage, or other significant problems with the fetus.
For example, incidence of neonatal abstinence syndrome (NAS), which is a common opiate withdrawal, increased by 300% between 2000 and 2009 (Prasad, 2014.) Smoking marijuana during pregnancy results in sharp decrease of oxygen and nutrients supply to the fetus. Oxygen deficiency can lead to restrictions in the child’s growth (including overall length, weight, head size and foot length). According to the National Cannabis Prevention and Information Centre, in some cases it can cause miscarriage, stillbirth or premature birth, delayed commencement of breathing in newborns. Drug abuse, as well as nicotine smoking, also increase the risk of Sudden Infant Death Syndrome in infants (Zalewska et al., 2013.) Prenatal-methamphetamine-exposure studies (Jones, 2006) showcased cleft palates, fetal growth restriction, cardiac and cranial abnormalities. Rhabdomyolysis, as well as acute kidney injury, are frequent complications of heroin addiction (Cengiz, 2013.)
According to study conducted by Pinto and colleagues in 2010, there are statistically significant incidence of preterm births among drug-using women, with premature births complicating 25% of births among drug users. The incidence of low birth weight was 31% amongst drug-users compared to 8% in a control group. The incidence of growth restriction and abruption was higher in drug using women than in a control group as well.
The other part of the problem described is medications misuse. According to the studies conducted by Zalewska and her colleagues (2013), the self-medication is a rising problem in a specific group of women – mostly young, with lower education, low self-esteem and smokers. The study displayed an alarming figure – 40% of pregnant women take medications without consulting a physician. There’s a proven relationship found between usage of anti-inflammatory drugs and the incidence of fetal development problems such as incidence of heart defects, cleft palate, reduced birth weight, etc. Using prescription drugs (for example, opiates, benzodiazepines, stimulants, etc.) exposes a mother and a fetus to increased risk of development anomalies and other complications.
Substance abuse has a detrimental effect not only on a fetus but also on the mother’s health. The results, according to Whittaker (2003), may include anaemia, respiratory problems, blood-borne viral infections (HIV, hepatitis), abscesses and endocarditis associated with injections, liver diseases, accidental injury, behavioural and mental health problems in women. Chaotic lifestyle of drug users creates risk of receiving poor medical care in pregnancy and while giving birth due to late registering for prenatal care, poor attendance, late presentation during labour, etc. Many deaths of pregnant women are associated with drugs. According to Nancy Hardt and colleagues (2013), 54% pregnant women unnatural death cases studied involved prescription drugs and 46% - illicit drugs usage. Accumulation on various negative factors associated with drug abuse (social, economical, et.) have a great negative impact on women and children (Jones, 2006.)
Approach to prevention substance abuse in women of reproductive age should be women- and family-centered, holistic, non-judgemental and focused on harm-reduction (Whittaker, 2003).
One of the effective prevention strategies can be screening for use of alcohol, tobacco, prescription and illicit drugs among women of reproductive age, mostly in primary health care settings. This strategy, along with others (unintended pregnancies prevention and responsible prescription drug usage promotion) was implemented in Sonoma County, CA in 2011-2013. This strategy allows to identify risk groups and, along with proper intervention (informing about risks of substance-exposed pregnancy, offering treatment programs for high-risk groups) results in decrease of substance-exposed pregnancies rate (The Prevention of Substance-Exposed Pregnancies Collaborative Report, 2013.)
The second approach, that can be presented as successful is “Five points of intervention” strategy, implemented by joint efforts of Montgomery County FASD Task Force, local communities and health care organizations in Montgomery County, Ohio. This prevention strategy has five key directions: pre-pregnancy and public awareness, prenatal screening for substance use, education and support, screening and birth, services to parents, services to infants and youth. The main target of this program was not only to reduce alcohol and drug-exposed pregnancies, but in general to promote a healthy lifestyle in families. The program assumed an identification of risk groups, integration of screening into primary care, training and coaching to the health care staff, numerous educational events for community, special programs targeting a business community and proper media support. Also, a lot of work was done with families (education, informing, networking, etc.) The outcomes of this strategy are long-term and overall – people hear the same information from everyone: healthcare providers, educators, media, etc. It facilitates fundamental changes in behavior and general culture of the community.
These are just a couple examples of preventive strategies, combining efforts at different levels – government, community, school, family, individual –to promote wellbeing of mother and child. Various health promotion strategies (family intervention, parent education, healthy life promotion at school, peer intervention, health service re-orientation, regulation) to reach their full potential must be combined with proper social and economic strategies to target context factors accompanying drug abuse in women.
- Whittaker (2003). Substance misuse in pregnancy. A resource pack for professionals in Lothian. Retrieved from < http://www.nhslothian.scot.nhs.uk/MediaCentre/Publications/ForProfessionals/Documents/SubstanceMisusePregnancy.pdf >
- Harrison PA, Sidebottom AC (2009). Alcohol and drug use before and during pregnancy: an examination of use patterns and predictors of cessation. Maternal & Child Health Journal (MATERN CHILD HEALTH J), 2009 May; 13 (3): 386-94.
- Center for Substance Abuse Treatment. Substance Abuse Treatment: Addressing the Specific Needs of Women. Rockville (MD): Substance Abuse and Mental Health Services Administration (2009). Treatment Improvement Protocol (TIP) Series, No. 51. Chapter 3: Physiological Effects of Alcohol, Drugs, and Tobacco on Women. Retrieved from: http://www.ncbi.nlm.nih.gov/books/NBK83244/
- Prasad, M. (2014). When opiate abuse complicates pregnancy. Modern Medicine Network. Retrieved from < http://contemporaryobgyn.modernmedicine.com/contemporary-obgyn/content/tags/drug-abuse/when-opiate-abuse-complicates-pregnancy?page=full >
- National Cananbis Prevention and Information Centre. Marijuana and Reproduction/Pregnancy. Retrieved from < http://learnaboutmarijuanawa.org/factsheets/reproduction.pdf >
- Zalewska, L. et.al. (2013). Exposure to drugs, medications and stress during pregnancy. Polish Journal of Public Health. 2013, Vol. 123 Issue 4, p280-284. 5p.
- Pinto, S.M., Dodd, S., Walkinshaw, S.A., Siney, C., Kakkar, P. and Mousa, H.A. (2010). Substance abuse during pregnancy: effect on pregnancy outcomes. European Journal of Obstetrics & Gynecology & Reproductive Biology. Jun2010, Vol. 150 Issue 2, p137-141. 5p.
- Hardt, N., Wong, T. D., Burt, M., Harrison, R., Winter, W., Roth, J. (2013). Prevalence of Prescription and Illicit Drugs in Pregnancy-Associated Non-natural Deaths of Florida Mothers, 1999-2005. Journal of Forensic Sciences (Wiley-Blackwell). Nov2013, Vol. 58 Issue 6, p1536-1541. 6p.
- Jones, H. (2006). Drug Addiction During Pregnancy. Advances in Maternal Treatment and Understanding Child Outcomes. Current Directions in Psychological Science (Wiley-Blackwell). Jun2006, Vol. 15 Issue 3, p126-130. 5p.
- Cengiz, H. et al. (2013) Maternal and Neonatal Effects of Substance Abuse During Pregnancy: A Case Report. Medical Bulletin of Haseki / Haseki Tip Bulteni. Jun2013, Vol. 51 Issue 2, p76-78. 3p. 1 Chart.
- Preventing Alcohol, Tobacco, and Other Substance-exposed Pregnancies: A Community Affair. Confrent report. September 23-24, 2008. Rockville, Maryland
- The Prevention of Substance-Exposed Pregnancies Collaborative Report. (2013) CityMatCH, Omaha, NE.