Pregnancy

Effects of Smoking While Pregnant

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Effects of Smoking While Pregnant

Smoking increases the risks of prenatal issues, complicated birth, and a number of peripartum and newborn health issues.

In the U.S., there are an estimated 42 million people (nearly 18% of the total population) who currently smoke 1. Tobacco use is the leading cause of preventable disease, disability and death in the U.S. In fact, smoking accounts for nearly 1 in every 5 deaths each year 2.

Effects of Smoking on a Baby

Cigarette smoke contains thousands of harmful chemicals. When a woman smokes during pregnancy, these toxic chemicals enter her bloodstream and increase the risk of fetal injury. The nicotine and carbon monoxide in cigarettes are especially harmful because they can damage a baby’s developing brain and make it difficult for a baby to get enough oxygen. Nicotine narrows the blood vessels in the umbilical cord, which can result in inadequate levels of oxygen exchange for the developing baby.

Smoking increases the risks of prenatal issues, complicated birth, and a number of peripartum and newborn health issues. Risks include 3,4,5 :

  • Roughly 1 in 10 women report that they smoked during the last 3 months of their pregnancy6.
  • Approximately 50-60% of women who quit during pregnancy will start again within 1 year after the birth of their child7.
  • Miscarriage.
  • Low-birth weight.
  • Premature birth.
  • Stillbirth.
  • Ectopic pregnancy.
  • Spontaneous abortion.
  • Placenta previa.
  • Placental abruption.
  • Sudden infant death syndrome (SIDS).

When babies are born too early, they are deprived of the safe environment and regular developmental duration they would have otherwise experienced in the womb. The earlier a baby is born, the greater the chance that they will experience health issues. In some cases, premature birth can result in infant death.

Premature babies may experience 8,9:

  • Problems with feeding.
  • Respiratory distress.
  • Cerebral palsy.
  • Delays in development.
  • Problems with hearing or eyesight.

If a baby is born prematurely, they will often need to be hospitalized for days or even months so that doctors and nurses can safely monitor their progress.

The harmful effects of prenatal exposure to smoking are not limited to childhood. Negative effects can last throughout a child’s lifetime. Studies have found that children who are exposed to tobacco in utero have significantly higher odds of having a learning disability later on 10. Children born to mothers who smoked a pack or more a day during pregnancy are also significantly more likely to be smokers themselves when they grow up 11.

E-cigarettes

Electronic cigarettes (also referred to as e-cigarettes) are hand-held battery-operated devices that people use to smoke a liquid that is made of nicotine, flavoring, and other chemicals. The battery in the device heats the liquid nicotine to create an aerosol that the smoker then inhales 12.

The use of e-cigarettes has become increasingly popular. According to Forbes, e-cigarette sales generate over $1 billion every year.

People often think that they are safer than tobacco cigarettes, which may lead them to smoke more freely during pregnancy 13. For pregnant women, the chemicals in e-cigarettes can cause adverse effects to their baby.

E-cigarettes contain nicotine—a potent teratogen or, in other words, an agent that can be profoundly harmful to prenatal development 13. Nicotine crosses the placental barrier and studies have found that it can cause a significant amount of damage to the development and well-being of a fetus.

In animal studies, nicotine has been found to cause 14,15:

  • Respiratory problems, including impaired lung function and decreased lung size. (This may affect both first- and second-generation offspring.)
  • Reduced fertility for female offspring.

Some people turn to e-cigarettes to help them stop smoking tobacco. However, there is no evidence that e-cigarettes are a safe alternative to cigarettes. In fact, to date, no e-cigarette is approved by the FDA for smoking cessation purposes 16. This is due in part to the fact that e-cigarettes are currently unregulated and contain nicotine at varying levels.

If you are pregnant and currently smoking e-cigarettes, talk to your doctor about the risks and benefits of exposing your baby to nicotine during pregnancy.

Dangers of Secondhand Smoke

Secondhand smoke (SHS) refers to the potentially inhaled smoke resulting from another person’s doing it. Just like immediately inhaled cigarette smoke, SHS is a human carcinogen – which means it contains chemicals that cause cancer 17.  SHS can cause a number of negative health problems in children and adults.

Exposure to SHS during pregnancy is associated with an increased risk of 18,19:

  • Low birth weight.
  • Preterm delivery.
  • SIDS.

Babies who are exposed to SHS after they are born are more likely to die from SIDS compared to babies who are not exposed to cigarette smoke 19.

Babies exposed to SHS also have weaker lungs than other babies, which can increase their risk for other chronic health problems such as asthma, ear infections, bronchitis, and pneumonia 19.

Credit: American Medical Association

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Did You Know?

Below are some interesting facts and statistics about smoking during pregnancy:

  • Smoking reduces a woman’s chances of getting pregnant 20,21,22. Approximately 15% of couples have trouble getting pregnant. One of the causes for this is female infertility. Smoking and secondhand inhalation are risk factors for decreased female fertility 23. In a study on infertile couples, males who smoked had significantly lower sperm quality. Cigarette smoking was associated with reduced sperm density and sperm count 24.
  • Smoking during pregnancy can increase the risk of tissue damage in an unborn baby: Studies show that maternal smoking can cause tissue damage in the baby’s lungs, brain, and increase the risk of the baby having a cleft lip 25,26.
  • Nicotine passes freely into breast milk: The amount of nicotine transferred through breast milk is more than double the amount transferred through placenta 27. However, breastfeeding is beneficial to a baby’s health and even if a woman smokes, she will be encouraged to breastfeed vs. use formula, as evidence shows the milk itself still provides protection against respiratory illness 27.

Quitting Smoking While Pregnant

Quitting smoking during pregnancy is one of the most important steps a woman can take to improve her health. It will help you feel better and provide a healthier environment for your baby.

Keep in mind that many people try to quit multiple times before they are successful. It is difficult to quit smoking, and you are not a failure if you “slip.” The important thing is to keep trying.

Benefits of Quitting for Mothers

Mothers who quit smoking will get numerous health benefits. If you quit smoking, you’re likely to experience 17:

  • Reduced likelihood of developing heart disease, stroke, lung cancer, chronic lung disease, and other smoke-related diseases.
  • Increased levels energy.
  • Increased ease of breathing.
  • Better financial prospects, as money previously put toward cigarettes will be available for other expenses.
  • A sense of peace about the choices you made for yourself and your baby.

If you are in the process of quitting smoking, below are some useful strategies to help you handle cravings and avoid triggers 28.

  • Engage in physical activity, such as walking, jogging, running, swimming, or dancing.
  • Practice deep breathing at least once a day. Take long, slow breaths to center yourself.
  • Talk to friends and loved ones.
  • Write down your thoughts and feelings in a journal or blog.
  • Remind yourself that you are not a smoker—identity is powerful, and identifying yourself as a nonsmoker can help you quit and stay tobacco-free.
  • Spend time with people who don’t smoke.
  • Ask others not to do it in front of you.
  • Establish a “smoke-free” zone in the car or house.
  • Identify triggers, such as people or stressful situations that cause you to want to smoke. Avoiding these triggers can help you stay drug-free.
  • Redirect your focus and attention when a trigger makes you want to smoke: immediately go for a walk, listen to music, call a friend, or brush your teeth.
  • Reduce stress in your life, such as work stress or personal stress.
  • Eat a healthy diet, drink plenty of water, and get at least 8 hours of sleep each night.

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When you stop smoking, your baby will be able to get more oxygen. Quitting will also reduce the risk that your baby is born prematurely.

Some women may feel guilty or ashamed about their smoking. But every mother wants the best for her child. Try not to let fear stand in the way of getting help. There are numerous resources available for individuals looking to quit. For example, this virtual clinic  is free for those looking for help to stop smoking. You can also call 1-800-44U-QUIT, a national quitline for pregnant women seeking to end their tobacco use.

If you are abusing any other substances like alcohol that may also cause potential harm during your pregnancy, reach out to us today at 1-800-980-3927Who Answers?. You and your baby deserve to be healthy.

Are Nicotine Replacement Therapies Safe During Pregnancy?

While nicotine replacement therapy (NRT) is shown to be highly effective in non-pregnant individuals, there is not evidence to determine whether or not NRT is safe and effective for use among pregnant smokers 29. More data is needed to determine whether or not NRT is safe to use during pregnancy given that there is conflicting and inconclusive evidence in the research community regarding its use 30.

Gynecologists may recommend nicotine replacement therapy only after a woman has tried behavioral therapy interventions and they have failed 31. A doctor should first discuss the risks and benefits of nicotine replacement therapy before prescribing it to a pregnant patient.

Woman putting on a nicotine patch

Below are a few facts about these medications 30,31:

  • Varenicline acts on the brain’s nicotine receptors.
  • Bupropion is an antidepressant.
  • Both of these medications are transferred through breast milk.
  • The U.S. Food and Drug Administration recently added warnings on these products because they increase the risk of psychiatric symptoms and suicide.

There is currently not enough evidence to conclude whether any of these medications are safe to use during pregnancy.

Mothers can breastfeed while being on nicotine replacement therapy as long as the dose is less than the number of cigarettes usually smoked. Women should first consult their doctor before breastfeeding and using nicotine replacement therapy, since a baby can be exposed to nicotine through a mother’s breast milk. Additionally, the FDA discourages lactating women from using other smoking cessation pharmacotherapies such as bupropion or varenicline 32.

Handling Nicotine Withdrawal

An addiction to tobacco can have both physiologic and psychological components, potentially compounding the difficulty in quitting.

In order to quit smoking, a physician may recommend any of the following cessation techniques 33:

The acute nicotine withdrawal syndrome has a number of unpleasant associated symptoms. These are normal and will last a few days to a few weeks.

Symptoms of withdrawal may include 10:

  • Negative moods.
  • Urges to smoke.
  • Difficulty concentrating.

Women who smoke during pregnancy are encouraged to stop smoking and seek help. Although physicians recommend quitting smoking before 15 weeks of gestation for the greatest benefits to the baby and the mother, quitting at any point is beneficial 34.

Additional Resources to Help You Quit

If you are addicted to smoking and looking for ways to quit, below are a few resources designed to help you.

Additionally, extra cessation therapy is offered to pregnant women under the Affordable Care Act, or ObamaCare.35. This includes free counseling and medication – as approved by a doctor 36.

Quitting smoking can be challenging. But there are more resources than ever to help you quit.

If you’re struggling with substance addiction, don’t wait to get help. Our treatment placement specialists at 1-800-980-3927Who Answers? can help you find the care you need to quit today and become as healthy as possible for yourself and your child.

References:

1 Jamal, A., Agaku, I. T., O’Connor, E., King, B. A., Kenemer, J. B., & Neff, L. (2014). Current cigarette smoking among adults—United States, 2005–2013. MMWR Morb Mortal Wkly Rep, 63(47), 1108-1112.

2 Centers for Disease Control and Prevention. (2016). Current Cigarette Smoking Among Adults in the United States.

3 Pineles, B. L., Park, E., & Samet, J. M. (2014). Systematic review and meta-analysis of miscarriage and maternal exposure to tobacco smoke during pregnancy. American journal of epidemiology, 179(7), 807-823.

4 Centers for Disease and Control. (2015).  Highlights: Impact on Unborn Babies, Infants, Children, and Adolescents.

5 Cnattingius, S. (2004). The epidemiology of smoking during pregnancy: smoking prevalence, maternal characteristics, and pregnancy outcomes.Nicotine & Tobacco Research, 6(Suppl 2), S125-S140.

6 Centers for Disease Control and Prevention (2016). How Does Smoking During Pregnancy Harm My Health and My Baby?

7 American College of Obstetricians and Gynecologists. (2015). Smoking Cessation During Pregnancy: Committee Opinion.

8 Centers for Disease Control and Prevention. (2015).  Preterm Birth.

9 Been JV, Lugtenberg MJ, Smets E, van Schayck CP, Kramer BW, Mommers M, Sheikh A. (2014). Preterm Birth and Childhood Wheezing Disorders: A Systematic Review and Meta-Analysis. PLOS Medicine.

10 Anderko, L., Braun, J., & Auinger, P. (2010). Contribution of tobacco smoke exposure to learning disabilities. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 39(1), 111-117.

11 Buka, S. L., Shenassa, E. D., & Niaura, R. (2003). Elevated risk of tobacco dependence among offspring of mothers who smoked during pregnancy: a 30-year prospective study. American Journal of Psychiatry, 160(11), 1978-1984.

12 Centers for Disease Control and Prevention (2016). E-Cigarettes and Pregnancy.

13 Baeza-Loya, S., Viswanath, H., Carter, A., Molfese, D. L., Velasquez, K. M., Baldwin, P. R., … & De La Garza, R. (2014). Perceptions about e-cigarette safety may lead to e-smoking during pregnancy. Bulletin of the Menninger Clinic, 78(3), 243.

14 England, L. J., Bunnell, R. E., Pechacek, T. F., Tong, V. T., & McAfee, T. A. (2015). Nicotine and the developing human: a neglected element in the electronic cigarette debate. American journal of preventive medicine, 49(2), 286-293.

15 Petrik, J. J., Gerstein, H. C., Cesta, C. E., Kellenberger, L. D., Alfaidy, N., & Holloway, A. C. (2009). Effects of rosiglitazone on ovarian function and fertility in animals with reduced fertility following fetal and neonatal exposure to nicotine. Endocrine, 36(2), 281-290.

16 Siu, A. L. (2015). Behavioral and pharmacotherapy interventions for tobacco smoking cessation in adults, including pregnant women: US Preventive Services Task Force Recommendation Statement. Annals of internal medicine, 163(8), 622-634.

17  World Health Organization, & International Agency for Research on Cancer. (2004).  Tobacco smoke and involuntary smoking(Vol. 83). Iarc.

18 Khader, Y. S., Al-Akour, N., AlZubi, I. M., & Lataifeh, I. (2011). The association between second hand smoke and low birth weight and preterm delivery. Maternal and child health journal, 15(4), 453-459.

19 Centers for Disease Control and Prevention. (2016). Health Effects of Secondhand Smoke.

20 US Department of Health and Human Services. (2006). The health consequences of involuntary exposure to tobacco smoke: a report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 709.

21 U.S. Department of Health and Human Services. (2010).  A Report of the Surgeon General: Highlights: Overview of Finding Regarding Reproductive Health.

22 Meeker, J. D., & Benedict, M. D. (2013). Infertility, pregnancy loss and adverse birth outcomes in relation to maternal secondhand tobacco smoke exposure. Current women’s health reviews, 9(1), 41-49.

23 Hyland, A., Piazza, K., Hovey, K. M., Tindle, H. A., Manson, J. E., Messina, C., … & Wactawski-Wende, J. (2015). Associations between lifetime tobacco exposure with infertility and age at natural menopause: the Women’s Health Initiative Observational Study. Tobacco control, tobaccocontrol-2015.

24 Künzle, R., Mueller, M. D., Hänggi, W., Birkhäuser, M. H., Drescher, H., & Bersinger, N. A. (2003). Semen quality of male smokers and nonsmokers in infertile couples. Fertility and sterility, 79(2), 287-291.

25 Leslie, E. J., & Marazita, M. L. (2013). Genetics of cleft lip and cleft palate. In American Journal of Medical Genetics Part C: Seminars in Medical Genetics (Vol. 163, No. 4, pp. 246-258).

26 Centers for Disease Control and Prevention. (2016). Smoking During Pregnancy.

27 Massachusetts General Hospital. (2007). Smoking While Breastfeeding: What Are the Risks.

28 American College of Obstetricians and Gynecologists. (2011). Smoking Cessation During Pregnancy.

29 Pollak, K. I., Oncken, C. A., Lipkus, I. M., Lyna, P., Swamy, G. K., Pletsch, P. K., … & Myers, E. R. (2007). Nicotine replacement and behavioral therapy for smoking cessation in pregnancy. American journal of preventive medicine,33(4), 297-305.

30 Pfizer Labs. (2010). Chantix® (varenicline) tablets: highlights of prescribing information.

31 American College of Obstetricians and Gynecologists. (2008). Use of psychiatric medications during pregnancy and lactation. Obstet Gynecol,111(4), 1001-1020.

32 Sachs, H. C., Frattarelli, D. A., Galinkin, J. L., Green, T. P., Johnson, T., Neville, K., … & Van den Anker, J. (2013). The transfer of drugs and therapeutics into human breast milk: an update on selected topics. Pediatrics,132(3), e796-e809.

33 American College of Obstetricians and Gynecologists. (2015). Smoking Cessation During Pregnancy: Committee Opinion.

34 England, L. J., Kendrick, J. S., Wilson, H. G., Merritt, R. K., Gargiullo, P. M., & Zahniser, S. C. (2001). Effects of smoking reduction during pregnancy on the birth weight of term infants. American Journal of Epidemiology, 154(8), 694-701.

35 ObamaCare. (n.d.). ObamaCare and Smokers.

36 Substance Abuse and Mental Health Services Administration. (n.d.). How the Affordable Care Act Affects Tobacco Use and Control.

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Using Painkillers During Pregnancy

Using Painkillers During Pregnancy

Prescription painkillers, or opioids, are commonly used to treat pain. Opioid painkillers include drugs such as hydrocodone (Vicodin), oxycodone (OxyContin), codeine, and morphine. In addition to their inclusion in the many opioid analgesic formulations, opioids are also found in some prescription cough medicines 1.

Opioids exert their painkilling effects by binding to opioid receptors in the brain. For many people, the pain relief experienced after taking opioids is often accompanied with euphoric or rewarding sensations that promote continued use. However, these pleasurable effects come with some serious dangers as use increases. Too-high or too-frequent doses can result in respiratory depression, coma, and even death.

The rates of prescription painkiller use and abuse are rising in the United States, and pregnant women are no exception. According to the Centers for Disease Control and Prevention (CDC), 28% of women who were of reproductive age (15-44 years old) and who had private insurance filled a prescription written by a healthcare provider for an opioid medication. The number is significantly higher in the Medicaid population, with 39% of women who were of reproductive age filling a prescription 2. With more women of reproductive age taking these drugs than ever before, opioid use during pregnancy has become a major concern in the medical community. The potential effects of opioids on a pregnant mother and her developing baby are troubling.

Did You Know?

Data from a study in Tennessee found that 29% of pregnant women enrolled in Medicaid filled a prescription for an opioid painkiller between 1995 and 2009. A nationwide study of Medicaid-enrolled women found that 21.6% filled at least one opioid prescription during their pregnancy.

The most commonly filled opioid painkillers in these studies included codeine, hydrocodone, oxycodone, and propoxyphene 6.

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Effects of Opioid Painkillers on a Developing Fetus

A developing fetus who is exposed to opioid painkillers in utero is at a higher risk for complications.

A population-based study led by the CDC found a link between birth defects and opioid painkillers taken during pregnancy. The CDC study found an association between the following conditions in babies and opioid painkiller use by the mother 1:

In this study, researchers noted a significant increase in the number of heart defects a baby had, including hypoplastic left heart syndrome 1. Hypoplastic left heart syndrome is a condition in which the left side of the heart doesn’t develop correctly.

One study found that when women used opioid painkillers right before they got pregnant or during the first trimester of their pregnancy, they were twice as likely to have a baby born with a heart defect 1.

Taking opioids during pregnancy might also cause 3:

  • Preterm birth (before 37 weeks’ gestation).
  • Neonatal abstinence syndrome (NAS).

Some studies found that opioid use during pregnancy is associated with clubfoot and cleft lip 4. However, the findings are not consistent and warrant further investigation.

Despite the evidence of possible negative effects that opioids can have on a developing fetus, studies show that opioids remain among the most commonly prescribed medications used by pregnant women.

Neonatal Abstinence Syndrome (NAS)

When a woman uses opioid painkillers during pregnancy, it can cause her baby to develop neonatal abstinence syndrome (NAS)—essentially, opioid withdrawal.

NAS can occur when a pregnant woman takes opioids, such as 5:

  • Codeine.
  • Oxycodone (OxyContin, Percocet).
  • Methadone.
  • Hydrocodone (Lortab, Norco, Vicodin).

When a pregnant woman uses substances such as opioid painkillers, the drugs can pass through her placenta. The placenta connects the developing fetus to its mother. This results in the baby developing a dependency to opioids along with the mother. If a pregnant woman uses drugs during the week or so before she delivers, the chances are extremely high that her baby will be born with a dependence on the drug at birth. After birth, the newborn’s supply of drugs is abruptly cut off, potentially causing withdrawal in the newborn 5.

The severity of a baby’s withdrawal will depend on several factors, including 5:

  • How much of the drug the mother used and for how long.
  • How well the body clears the drug out of its system.
  • What type of opioid the mother used.
  • Whether the baby was born early.

NAS symptoms can begin 1-3 days after the baby is born. If doctors believe that the baby may be at risk for more complications, they may have the baby stay at the hospital for up to a week for medical supervision and monitoring.

Symptoms of NAS might include 5:

  • Blotchy skin coloring (mottling).
  • Rapid breathing.
  • Stuffy nose and/or sneezing.
  • Sweating.
  • Vomiting.
  • Diarrhea.
  • Excessive crying or high-pitched crying.
  • Irritability.
  • Sleep problems.
  • Excessive sucking.
  • Fever.
  • Hyperactive reflexes.
  • Hypertonicity (pathologically increased muscle tone).
  • Trembling (tremors).
  • Seizures.
  • Convulsions.
  • Poor feeding.
  • Slow weight gain.

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Treating NAS

The recommended treatment for NAS will depend on what type of drug the mother used, the infant’s health, and whether the baby was born full-term or preterm. Babies with NAS are usually fussy, so doctors may ask the parents to use “TLC”, or tender loving care, to help the baby calm down. Strategies may include 5:

  • Gently rocking the baby back and forth.
  • Swaddling the baby.
  • Turning down the lights and minimizing noise around the baby.

When babies are born with severe NAS, they may need medicines such as morphine and methadone to help treat their withdrawal symptoms. In some cases, a second medicine such as clonidine may be added to manage troublesome symptoms. Doctors may also recommend breastfeeding if the mother is using methadone or buprenorphine.

A baby with NAS may require treatment anywhere from 1 week to 6 months, depending on severity. After that, the baby may continue needing special care and attention 5.

Are Any Medications Safe to Use During Pregnancy?

It is increasingly common for women to use use opioid painkillers during pregnancy. In fact, in a study of more than 1 million pregnant women enrolled in Medicaid, about 1 in 5 were prescribed opioids by their doctors between 2000 and 2007 7.

Many women experience pain during pregnancy, such as low back pain, pelvic pain, or migraines. Although doctors may prescribe opioids to manage acute pain during pregnancy, the American Pain Society warns that the potential risks should be carefully considered prior to prescribing opioid therapy to a pregnant woman 6.

Most prescription opioids are labeled under category C by the FDA. This categorization indicates that there is evidence of potential harm to the fetus from animal studies—and that there is not enough evidence from human studies—to conclude that it is safe. However, oxycodone is classified in category B, which means that there is no evidence of harm to the fetus from animal studies but, as with category C, there is not enough evidence from human studies to deem it safe 8.

Due to the unknown safety of opioid painkillers for pregnant women, a woman and her doctor should always thoroughly discuss the risks and benefits of taking opioids to manage pain during pregnancy. 

Quitting Painkillers While Pregnant

Opioid addictions are, in part, characterized by physical dependence and tolerance. When a person becomes tolerant to opioid painkillers they will need higher doses to feel the same effects. Physical dependence is a common result of continued use. Once a person develops a physical dependence, they will likely experience withdrawal symptoms if they stop using opioid painkillers.

If a pregnant woman abruptly stops taking opioid painkillers, it could result in unwanted health consequences, including 9:

  • Preterm labor.
  • Fetal distress.
  • Fetal death.

There are options to help with withdrawal from opioids. Methadone is the most researched drug for use during pregnancy 10. Although methadone is not formally sanctioned by the FDA for treatment of opioid dependence during pregnancy, it is currently the standard of care and recommended by many doctors for opioid-dependent women who are pregnant 10.

Despite support from the medical community for methadone use during pregnancy, the drug does come with a risk of side effects. For example, methadone can cross the placenta and reach the developing fetus, which can alter fetal heart rate 10. Methadone can also cause s withdrawal syndrome in 60-80% of neonates 11.

Methadone maintenance therapy has a long history of use, dating back to the late 1960s. Buprenorphine maintenance therapy has been used to treat opioid dependence among pregnant women since the mid-2000s. Buprenorphine is prescribed in an outpatient setting, while methadone maintenance requires a woman to go to a clinic daily to receive her dose. More studies are needed in order to properly understand the risks and benefits of these two therapies 4.

Methadone therapy is often preferred by physicians because it provides better rates of relapse prevention, reduces the fetus’s exposure to drugs, improves a woman’s adherence to medical care, and decreases the risk of unfavorable neonatal outcomes, such as low birth weight.

Given that the consumption of prescription opioids has increased dramatically in the United States, it is important for women to understand the risks of taking these medicines while they are pregnant. If you are pregnant, talk to your health care provider about the medications you are taking to prevent potential harm to your developing fetus.

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Treatment for Opioid Addiction

If you or a loved one is facing an addiction to opioids during pregnancy, there are options for treatment. The most important and first step to take is to tell your doctor about your opioid use. Every mother wants the best for her baby, and by disclosing your drug use with your doctor, you are taking the necessary steps to ensure your baby’s health and wellbeing.

Depending on your level of opioid dependence, your doctor may recommend inpatient or outpatient treatment.

Inpatient programs are residential facilities where individuals are required to live at the facility for the duration of the program. Programs usually last 30 to 90 days but may last longer.

Inpatient programs provide 24/7 supervision and will typically include some combination of:

Some facilities may also offer aftercare services such as postpartum support. This can be extremely helpful in preventing relapse after leaving the facility.

It is important for treatment programs—either inpatient or outpatient—to address underlying issues of dependence with behavioral treatment. Treatment types may include:

  • Cognitive behavioral therapy (CBT): This type of intervention helps you to develop coping mechanisms for when you have a craving or urge to use opioids. CBT has been shown to be effective in preventing relapse.
  • Contingency management: This type of intervention uses positive reinforcement like rewards and incentives. Your therapist may reward you with a gift card, voucher, or special privilege if you reach a treatment goal such as attending counseling sessions or staying drug-free.

Outpatient programs offer more flexibility and are a great option for mothers with obligations outside of treatment such as school, childcare, or work. Unlike inpatient treatment, you can live at home while you receive care. Generally, outpatient programs are less expensive than inpatient programs. Since therapy is at the crux of outpatient treatment, most programs offer group therapy sessions several hours each week.

Before considering going through withdrawal, detox, and/or rehab for opioid addiction, it is best to first talk to your doctor about your current opioid use. Your doctor can complete an assessment and direct you to the proper resources.

If you or a loved one is looking for treatment, give us a call today at  1-800-980-3927. Our treatment placement specialists are available 24/7 to help you find a facility that fits your needs.

References:

  1. Centers for Disease Control and Prevention. (2014). Key Findings: Maternal Treatment with Opioid Analgesics and Risk for Birth Defects.
  2. Centers for Disease Control and Prevention. (2015). Key Findings: Opioid Prescription Claims among Women of Reproductive Age.
  3. American College of Obstetricians and Gynecologists. (2016). Opioid Abuse, Dependence, and Addiction in Pregnancy.
  4. Yazdy, M. M., Desai, R. J., & Brogly, S. B. (2015). Prescription Opioids in Pregnancy and Birth Outcomes: A Review of the Literature. Journal of pediatric genetics, 4(02), 056-070.
  5. National Institutes of Health. (2016). Neonatal abstinence syndrome.
  6. Yazdy, M. M., Desai, R. J., & Brogly, S. B. (2015). Prescription Opioids in Pregnancy and Birth Outcomes: A Review of the Literature. Journal of pediatric genetics, 4(02), 056-070.
  7. Desai, R. J., Hernandez-Diaz, S., Bateman, B. T., & Huybrechts, K. F. (2014). Increase in prescription opioid use during pregnancy among Medicaid-enrolled women. Obstetrics and gynecology, 123(5), 997.
  8. Nørgaard, M., Nielsson, M. S., & Heide-Jørgensen, U. (2015). Birth and Neonatal Outcomes Following Opioid Use in Pregnancy: A Danish Population-Based Study. Substance abuse: research and treatment, 9(Suppl 2), 5.
  9. American College of Obstetricians and Gynecologists. (2016). Opioid Abuse,.Dependence, and Addiction in Pregnancy.
  10. Jones, H. E., Martin, P. R., Heil, S. H., Kaltenbach, K., Selby, P., Coyle, M. G., … & Fischer, G. (2008). Treatment of opioid-dependent pregnant women: clinical and research issues. Journal of substance abuse treatment, 35(3), 245-259.

Meth and Pregnancy

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Meth and Pregnancy

Methamphetamine use has increased in the United States since the 1980s 1, and today is the most commonly used drug behind alcohol and marijuana in a large number of states 1. The 2014 National Survey on Drug Use and Health (NSDUH) found that 1.6 million people reported using meth in the past year and that 569,000 people were currently using meth at the time of the survey 2. One of the reasons meth is so prevalent is because it can be made with relative ease from legal (yet toxic) ingredients, such as Freon® and paint thinner 3.

One study of meth-related emergency room visits found that more than 400,000 reproductive-aged women reported using meth in the prior month.

As use of the substance continues to rise, so do treatment and hospital admissions. In 2012, meth ranked first in drug-related treatment admissions in Hawaii and San Diego 4. Females have also been found to start using meth at a younger age and intake higher amounts of meth compared to men 5.

With increasing numbers of methamphetamine users, meth abuse during pregnancy is a growing public health concern 6. One study of meth-related emergency room visits found that more than 400,000 reproductive-aged women reported using meth in the prior month 6. Another study found that meth was the primary substance requiring treatment during pregnancy between 1994 and 2006 6.

As a stimulant, meth is extremely potent 7. When a person uses this substance, they may experience a range of feelings, such as 8:

  • Euphoria.
  • Heightened alertness.
  • Increased energy levels.
  • Irritability.
  • Aggressive behavior.

The negative health effects that may occur from meth use include 1,8:

  • Tachycardia (abnormally rapid heart rate).
  • Diaphoresis (sweating).
  • Hypertension (high blood pressure).
  • Hyperthermia (high body temperature).
  • Seizures.

To date, the medical community’s knowledge of meth’s effects on a child in utero is limited. Conclusive evidence about the potential effects of methamphetamine use during pregnancy is lacking, as much of it comes from animal research or from studies with difficult to control variables such as the presence of polysubstance use in the maternal population being examined. While we cannot draw definite conclusions about how meth affects a baby’s development, there is evidence to suggest that meth is harmful to a developing fetus 9.

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Effects of Methamphetamine on the Mother

Meth is a dangerous substance that can harm a woman’s body and put her at risk for maternal complications. For example, women who abuse meth tend to have a significantly lower body mass index (BMI). This can make her pregnancy riskier. One study found that lower BMI increased a woman’s chance for pregnancy complications, including more frequent hospitalizationsand longer hospital stays 10. The anorectic effects of meth can also result in intrauterine growth retardation (poor growth of the fetus in the womb) 11.

Using meth during pregnancy can also reduce a woman’s placental blood flow. This can cause fetal hypoxia, an insufficient amount of oxygen to the fetus 12.

Since 2003, meth has been the most common substance that women are admitted with for treatment at US federally funded health centers. To complicate matters, meth is often used in combination with other substances 6, such as prescription painkillers, marijuana, cigarettes, and alcohol 11. These substances can have additional devastating effects on the fetus. For example, alcohol consumption can lead to fetal alcohol syndrome, which is irreversible.

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 Effects of Methamphetamine on a Baby

How many pregnant women use meth?

There is limited data on the prevalence of meth use during pregnancy. National estimates range from 0.7% to 5.2% 12.

Meth use during pregnancy can harm the way a child develops in utero. Meth use can put a woman at risk for having a baby that has 1:

  • A low birth weight.
  • Small size for gestational age.
  • An increased risk for neurodevelopmental problems.

Most of what we know about the effects of meth on a developing fetus come from animal studies. In rats, prenatal exposure to meth caused 11,13:

  • Increased mortality in the mother and her child.
  • Retinal defects.
  • Cleft palate.
  • Malformations of the ribs.
  • Slowed physical growth.
  • Delayed motor development.
There are few studies on humans that allow us to draw conclusions about the effects of meth on a fetus. However, from the handful of studies available, meth is associated with adverse health outcomes.

These include 11,14:

  • Higher rates of preterm birth.
  • Placental abruption.
  • Cardiac anomalies.
  • Smaller head circumference.
  • Fetal distress.
  • Fetal growth restriction (at rates similar to those for pregnant women who use cocaine).

One study found that only 4% of babies exposed to meth were treated for withdrawal after birth. However, the study was unable to control for a mother’s use of drugs other than meth 7.

There are reports that meth can lead to long-term adverse health outcomes. These include negative impacts on a child’s behavior, cognitive skills, and physical dexterity.

In a Swedish study, children who were exposed to meth in utero were tested at birth, at 1 year, and at 4 years. Researchers found that females exposed to meth were significantly shorter and lighter than the males.

At age 8, there was a significant correlation between how much meth a fetus was exposed to in utero and the level of aggressive behavior and social maladjustment. When the children were tested at age 14 and 15 years old, they performed significantly worse than their peers on math tests. However, this study was also confounded by variables outside of the researchers’ control, such as maternal polysubstance use, stress levels, environment, number of siblings, and foster care placements 11.

Some studies suggest that the use of meth during pregnancy can result in fetal abnormalities 8.  Other studies have reported that meth use during pregnancy can increase the risk of cleft lip in babies 8. A case control study found that mothers who used drugs during the first trimester had over 3 times the risk of having a baby with gastroschisis 8. Gastroschisis is a birth defect in which the baby’s intestines stick outside of the body from a hole near the belly button 15.

When babies are exposed to meth for at least two-thirds of the pregnancy, certain brain structures were more likely to be smaller than those in non-exposed fetuses 8. It is important to note, however, that overall, exposure to meth during pregnancy is not consistently associated with birth defects. More studies are needed in order to control for confounding variables such as maternal polysubstance use, small sample sizes, and recall bias. It is important to note, however, that overall, exposure to meth during pregnancy is not consistently associated with birth defects. More studies are needed in order to control for confounding variables such as maternal polysubstance use, small sample sizes, and recall bias 8.

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Quitting Meth While Pregnant

There is a common trend of women experiencing “turning points” during pregnancy. Being responsible for the life of another human helps many women stop using drugs.

Being responsible for the life of another human helps many women stop using drugs.

If you are currently using meth and you are pregnant or thinking about getting pregnant talk to your doctor about your options for meth addiction treatment. Your doctor may recommend entering a treatment facility.

The two main types of treatment you will encounter are outpatient and inpatient treatment.

Outpatient treatment is an option for women who have less severe addictions and who aren’t additionally contending with serious medical or mental health issues. In outpatient treatment, you will periodically check in with your doctor and counselor for medications and therapy, while still being able to live at home.

Inpatient treatment programs offer an immersive treatment environment, with 24/7 supervision and access to medical services, when needed. In inpatient treatment, you will be free of distractions and able to focus fully on your journey to recovery. As a pregnant woman, you will be monitored closely to ensure the health of you and your baby.

In treatment, you may participate in group and individual counseling. Some examples of therapy may include:

  • Group and individual counseling. You can engage in group and/or individual counseling as part of your treatment. Counseling can offer you support throughout your recovery.
  • Cognitive-behavioral therapy (CBT). CBT can help you understand the triggers and situations that contribute to your use meth. People who struggle with addiction often have underlying issues that drive their addictions. CBT can help you address these issues in a healthy and productive way. In CBT, you can learn how to cope with life’s challenges without meth.
  • Family involvement. Family is important to the recovery process. As a pregnant woman, you may or may not have a partner with whom you would like to engage in therapy with. No matter what your situation is, involving your family in your recovery can help you get sober. Family members can offer invaluable support, often providing encouragement and motivation. Note that some individuals do not have healthy relationships with members of their family, so it’s important to do whatever feels right to you and invite those who are positive forces in your life to be part of your treatment.
  • Addiction support groups. 12-step programs are available to help you receive peer support. Groups can help you create a community of people going through the same situation as you. Having this type of support can help prevent relapse. Attending support groups can help ensure a woman’s long-term success.
  • Contingency-management: This is a strategy used to enforce positive and healthy behavior change. When you meet treatment goals, your therapist may give you a tangible reward in exchange for maintaining sobriety. Incentives could include money, vouchers, or special privileges.

Overall, there are many tools that can help you turn your life around. Pregnancy can present a window of opportunity to improve the health of you and your baby. Call us today at 1-800-980-3927

References:

  1. American College of Obstetricians and Gynecologists. (2013). Committee Opinion: Methamphetamine Abuse in Women of Reproductive Age.
  2. Hedden, S. L. (2015). Behavioral health trends in the United States: results from the 2014 National Survey on Drug Use and Health.
  3. US Department of Justice. (n.d.). Meth Awareness.
  4. National Institute on Drug Abuse. (2013). What is the scope of methamphetamine abuse in the United States?
  5. He, J., Xie, Y., Tao, J., Su, H., Wu, W., Zou, S., … & Guo, J. (2013). Gender differences in socio-demographic and clinical characteristics of methamphetamine inpatients in a Chinese population. Drug and alcohol dependence, 130(1), 94-100.
  6. Terplan, M., Smith, E. J., Kozloski, M. J., & Pollack, H. A. (2009). Methamphetamine use among pregnant women. Obstetrics & Gynecology,113(6), 1285-1291.
  7. Hudak, M. L., Tan, R. C., Frattarelli, D. A., Galinkin, J. L., Green, T. P., Neville, K. A., … & Bhutani, V. K. (2012). Neonatal drug withdrawal. Pediatrics, 129(2), e540-e560.
  8. Viteri, O. A., Soto, E. E., Bahado-Singh, R. O., Christensen, C. W., Chauhan, S. P., & Sibai, B. M. (2015). Fetal Anomalies and Long-Term Effects Associated with Substance Abuse in Pregnancy: A Literature Review. American journal of perinatology, 32(05), 405-416.
  9. National Institute on Drug Abuse. (2013). What are the risks of methamphetamine abuse during pregnancy?
  10. Denison, F. C., Norwood, P., Bhattacharya, S., Duffy, A., Mahmood, T., Morris, C., … & Scotland, G. (2014).Association between maternal body mass index during pregnancy, short‐term morbidity, and increased health service costs: a population‐based study. BJOG: An International Journal of Obstetrics & Gynaecology, 121(1), 72-82.
  11. Wouldes, T., LaGasse, L., Sheridan, J., & Lester, B. (2004). Maternal methamphetamine use during pregnancy and child outcome: what do we know. NZ Med J, 117(1206), 1-10.
  12. Derauf, C., LaGasse, L. L., Smith, L. M., Grant, P., Shah, R., Arria, A., … & Liu, J. (2007). Demographic and psychosocial characteristics of mothers using methamphetamine during pregnancy: preliminary results of the infant development, environment, and lifestyle study (IDEAL). The American journal of drug and alcohol abuse, 33(2), 281-289.
  13. Smith, L. M., Diaz, S., LaGasse, L. L., Wouldes, T., Derauf, C., Newman, E., … & Della Grotta, S. (2015). Developmental and behavioral consequences of prenatal methamphetamine exposure: a review of the infant development, environment, and lifestyle (IDEAL) study. Neurotoxicology and teratology, 51, 35-44.
  14. Hudak, M. L., Tan, R. C., Frattarelli, D. A., Galinkin, J. L., Green, T. P., Neville, K. A., … & Bhutani, V. K. (2012). Neonatal drug withdrawal. Pediatrics, 129(2), e540-e560.
  15. Centers for Disease Control and Prevention. (2015). Facts about Gastroschisis.

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MDMA (Ecstasy) Abuse While Pregnant

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MDMA (Ecstasy) Abuse While Pregnant

Ecstasy is an illicit drug that is frequently abused among a young adult demographic. This drug (chemical name: 3,4-methylenedioxymethamphetamine, or MDMA for short) is structurally similar to amphetamine and has both stimulant and hallucinogenic effects.

Effects During Pregnancy

People who take it may experience a wide range of effects, including euphoria, a sense of openness, and increased energy. However, heavy, chronic use is associated with depression and problems with memory. Among pregnant women, ecstasy can lead to hyperthermia (elevated body temperature) and anorexic effects—both of which may directly affect the developing fetus 1.

When pregnant women use drugs like ecstasy, it can cause serious harm to their babies, including 2:

  • Premature birth.
  • Developmental issues including delayed growth.
  • Cardiovascular issues (e.g., heart problems, increased stroke risk).

What If I Took Ecstasy Before I Knew I Was Pregnant?

Ecstasy is widely used by young people, including women of reproductive age. According to the 2015 National Survey on Drug Use and Health (NSDUH), 1.8% of young adults aged 18 to 25 years old were current users of hallucinogens, including ecstasy. Approximately 166,000 women of childbearing age (15 to 44 years old) reported past month use of the drug 3. With so many women of reproductive age experimenting with ecstasy, it is common for women to have used the substance prior to finding out they were pregnant.

If you are worried because you took it before you knew you were pregnant:

  • Take a deep breath and try to relax.
  • Schedule an appointment with your doctor as soon as possible and let them know about your concerns.
  • Stop taking ecstasy and any other illicit drugs.

If you are unable to stop using ecstasy and/or any other drugs, call us today at 1-800-980-3927 to learn about your treatment options.

Ecstasy’s Effect on the Mother

One study found that women who used ecstasy during pregnancy had the following characteristics 4:

  • Higher rates of unplanned pregnancy.
  • Higher rates of therapeutic abortion.
  • More likely to report binge drinking during pregnancy.
  • More likely to report smoking cigarettes during pregnancy.
  • More likely to use other illicit drugs such as marijuana, cocaine, amphetamines, and ketamine during pregnancy.

In addition, the use of ecstasy can adversely affect the mother’s physical and mental health. Ecstasy causes an increase in an individual’s stress hormones and this can lead to overstimulation and hyperthermia (i.e., high body temperatures). Also, after using ecstasy, a person can experience a number of changes that affect their behavior, mental state, and routine that include 5:

  • Decrease in appetite.
  • Sadness.
  • Anger.
  • Aggression.
  • Trouble sleeping.

Another serious danger of using ecstasy during pregnancy is that the drug often contains adulterants. A person may think that they are taking pure MDMA when in reality they are ingesting a number of unknown chemicals. One study found that a single ecstasy tablet contained over 14 compounds other than MDMA 6. One of the most concerning adulterants is the powerful opioid fentanyl, which can be deadly even in very small doses.

When a mother is healthy and abstaining from harmful substances like ecstasy, it goes a long way to ensure the safety of the baby both in utero and after birth. If you need help for an addiction to ecstasy, give us a call today and speak to a qualified rehab placement specialist about available treatment options.

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Effects on the Baby After Birth

Using ecstasy during pregnancy may have a negative impact on your child’s health after birth. Clinical studies have shown that MDMA exposure in utero in the first trimester may lead to behavioral changes down the line, such as long-term memory problems and impaired learning 1.

In addition, a handful of case studies in the United Kingdom and the Netherlands found the following effects in babies who were exposed to ecstasy in utero 7:

  • Increased risk of congenital defects.
  • Cardiovascular anomalies.
  • Musculoskeletal problems.

Some studies have also found that babies who are born to mothers who use ecstasy have increased odds of 1,5:

  • Reduced birth weight.
  • Alterations in gender ratio (more likely to have boys).
  • Motor development delays.
  • Poor milestone achievement at 4 months.

Quitting Ecstasy While Pregnant

If you are pregnant and addicted to ecstasy, the safest choice you can make for you and your baby is to seek professional treatment. In a rehab program, you can learn the skills to help you cope with stress and triggers that fuel your use. When you are pregnant, your safety and health are extremely important, and there are programs designed specifically to help ensure that you carry your baby to term in the healthiest manner possible. Give us a call today to learn more about your options for professional treatment at 1-800-980-3927.

If you are currently using ecstasy and you are thinking of quitting, there are ways to do it safely. Recovering from an ecstasy addiction can take time, but you do not have to do it alone. There are a multitude of treatment options that can help you learn how to address the underlying reasons for using substances.

Treatment for ecstasy addiction is often based on cognitive behavioral therapy (CBT) interventions. Cognitive behavioral interventions help teach individuals new skills such as how to find healthier ways to cope with life problems and how to modify negative behaviors that may have led to the development of addiction.

Treatment program options may include:

  • Inpatient or residential treatment: Inpatient treatment programs typically last 30 to 90 days and allow you to live on-site while you move through treatment.
  • Outpatient treatment: Outpatient treatment requires you to visit the facility for a set number of hours per week. You will meet with a therapist to develop a treatment plan and attend group therapy with other people who are being treated for an addiction to ecstasy.
  • Luxury or executive treatment: These inpatient programs offer flexibility to work while living at the center and a number of amenities not normally available in standard residential programs.

It’s not too late to make a change that can positively influence you and your baby. Give us a call today to speak to a trained treatment support representative 1-800-980-3927 so you can start your journey to recovery.

References:

  1. Singer, L. T., Moore, D. G., Min, M. O., Goodwin, J., Turner, J. J., Fulton, S., & Parrott, A. C. (2012). One-year outcomes of prenatal exposure to MDMA and other recreational drugs. Pediatrics, 130(3), 407-413.
  2. National Institutes on Drug Abuse for Teens. (2013). Using Drugs When Pregnant Harms the Baby.
  3. Center for Behavioral Health Statistics and Quality. (2016). Results from the 2015 National Survey on Drug Use and Health: Detailed Tables. Substance Abuse and Mental Health Services Administration, Rockville, MD.
  4. Ho, E., Karimi-Tabesh, L., & Koren, G. (2001). Characteristics of pregnant women who use ecstasy (3, 4-methylenedioxymethamphetamine). Neurotoxicology and teratology, 23(6), 561-567.
  5. Singer, L. T., Moore, D. G., Fulton, S., Goodwin, J., Turner, J. J., Min, M. O., & Parrott, A. C. (2012). Neurobehavioral outcomes of infants exposed to MDMA (Ecstasy) and other recreational drugs during pregnancy. Neurotoxicology and teratology, 34(3), 303-310.
  6. Green, A. R., King, M. V., Shortall, S. E., & Fone, K. C. F. (2012). Ecstasy cannot be assumed to be 3, 4‐methylenedioxyamphetamine (MDMA). British journal of pharmacology, 166(5), 1521-1522.
  7. McElhatton, P. R., Bateman, D. N., Evans, C., Pughe, K. R., & Thomas, S. H. (1999). Congenital anomalies after prenatal Ecstasy exposure. The Lancet, 354(9188), 1441-1442.

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Smoking Marijuana While Pregnant

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Smoking Marijuana While Pregnant

 Effects of Marijuana on a Developing Fetus

Although marijuana is one of the most widely used illicit drugs, there is limited data on the prevalence among pregnant women. One report estimated marijuana use during pregnancy to be anywhere from 2-5% 1. It is likely that these numbers are lower than actual figures, since women may underreport the use of drugs during pregnancy for fear of stigma and/or legal consequences.

A woman’s use of marijuana tends to peak when she is in her early 20s. This overlaps with the average age of a woman’s first pregnancy (23 years), making marijuana use during pregnancy a public health concern 2. There is even more cause for concern in light of the fact that average potency of the drug has gone up, and, due to legalization of the drug in many areas, more people are using it than ever 2.

When a woman smokes marijuana or consumes cannabis edibles during pregnancy, its active psychoactive components are able to cross the placental barrier. The primary intoxicating substances in marijuana are fat-soluble and able to traverse the fetal blood brain barrier and bind to cannabinoid receptors in the baby’s brain 2.

What About Marijuana Use During Breastfeeding?”

To date, there is not enough evidence to determine the safety of breastfeeding while using marijuana. Due to the absence of sufficient data, gynecologists and obstetricians discourage breastfeeding for women who consume marijuana 1.

Although many women of reproductive age use marijuana, there is limited and conflicting evidence on how it affects birth outcomes. According to information from the World Health Organization (WHO) and several studies, marijuana use during pregnancy may cause 3,4.

  • Impaired fetal development.
  • Preterm birth.
  • Small size according to gestational age.
  • Low birth weight.
  • Rare forms of cancer.

One study found that children born to mothers who smoked marijuana during pregnancy were more likely to require neonatal intensive care unit (NICU) admission and had higher rates of hospitalization after birth 5.

Research evidence indicates that repeat exposure to marijuana can disrupt portions of fetal brain development by altering signaling pathways that involve receptors for naturally occurring endocannabinoid molecules. The developmental course of very high-level brain connections (in the fetal cortex) may also be irreparably altered. In other words, marijuana use can adversely affect behavioral, neuropsychiatric, and executive functioning—and these effects could last forever 6.

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Did You Know?

Some facts about marijuana include the following:

  • Marijuana can stay in the body for up to 30 days, which means that pregnant women may expose their baby to the drug for a significant amount of time.
  • Marijuana smoking produces as much as 5 times as much carbon monoxide as cigarette smoking, which may make it difficult for the fetus to get enough oxygen.
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Marijuana’s Effects on the Baby After Birth

Our understanding of the effects of marijuana on a developing brain would benefit from continued research. Though animal studies suggest that marijuana use during pregnancy can alter the course of normal brain development 9, the long-term effects of human intrauterine exposure to marijuana is poorly understood 10.

The active ingredient in marijuana, delta-9-tetrahydrocannabinol or THC, may put a baby at risk for developing long-term problems. Studies have found that prenatal marijuana exposure is associated with 11:

  • Attention problems.
  • Hyperactivity.
  • Impulsivity.
  • Increased delinquent behavior.

Children who are exposed to marijuana as a fetus are more likely to use marijuana and cigarettes in young adulthood 2.

It is difficult to draw conclusions from studies on women who smoke marijuana during pregnancy for a number of reasons. In addition to not feeling comfortable disclosing their smoking status due to fear or stigma, women who use marijuana during pregnancy may also be using other substances (either illicit or legal), as well as smoking tobacco cigarettes 12. The potential influence of other drugs and/or toxic combustibles (from cigarette smoke) makes it difficult for researchers to pinpoint causation for marijuana only.

Many expecting mothers wonder whether it is okay to smoke or eat marijuana during pregnancy. There is no clear answer, given the conflicting research on the topic, but many studies do indicate the potential for risk. Naturally, expectant mothers wanting the best for their babies are advised to avoid the use of drugs that are not absolutely necessary for their health.

Is Medical Marijuana Use Okay?

A recent study found that among pregnant women, 3.9% used marijuana in the past month and 7% had used it in the past 2-12 months. Past-month use was highest when women were in their first trimester and lowest in the third trimester 13.

Researchers have noted higher rates of marijuana use in states that have legalized medical marijuana 14. It’s important to note that the legality of a drug does not indicate its safety for use during pregnancy, and this applies to a multitude of drugs outside of marijuana such as prescription narcotics.

Anytime you are considering a substance while you are expecting, it is important to discuss it with your doctor.

Marijuana is not regulated or evaluated by the U.S. Food and Drug Administration. This makes it difficult for doctors to provide recommendations about its use during pregnancy and beyond. There are no standard doses for doctors to prescribe. Due to the harmful effects of smoking on a baby’s oxygen supply, doctors cannot medically condone smoking marijuana during pregnancy and lactation 1.

According to the American College of Obstetricians and Gynecologists, pregnant women or women thinking about getting pregnant should be encouraged to stop using marijuana for medicinal purposes. Doctors may recommend alternative therapies that are proven to be safe for women who are pregnant. The medical community is still waiting on published, high-quality studies in order to deem marijuana and other cannabis products safe for use during pregnancy and lactation 1.

Quitting Marijuana While Pregnant

Every woman wants a healthy life for her baby. In order to get started, it is important that you disclose your marijuana use with your provider. Let your doctor know how often you use marijuana, as an honest assessment is required to help them develop a treatment plan that will fit your needs.

Quitting marijuana use while you are pregnant requires a combination of approaches so that you can address the physical, emotional and psychological aspects of your addiction. Currently, there are no FDA-approved medications for marijuana dependence. Treating an addiction to marijuana will often begin with behavioral therapy.

The type of behavioral therapy that your doctor will recommend will depend on you and your level of marijuana use. Below are some common methods that may be used during treatment 14:

  • Motivational enhancement therapy: MET helps to produce and increase motivation from within to make healthy changes. Rather than tell you the changes you need to make, the therapist will work with you to find the internal motivation and desire for positive change.
  • Cognitive-behavioral therapy (CBT) : This form of psychotherapy addresses the thoughts, feelings, and behaviors that may be contributing to your drug use. The therapist works with you to adjust them so you can overcome damaging thoughts and belief patterns to achieve and maintain sobriety.
  • Contingency management : This approach uses a reward system to enforce positive behaviors. You and your therapist may set goals for your treatment. When you reach a goal or when you fail to reach a goal, there is a built-in system of rewards or removal of rewards.

Some programs incorporate  alternative therapies into their treatment model. These could include:

  • Meditation.
  • Yoga.
  • Mindfulness.
  • Acupuncture.
  • Art therapy.

If your dependence to marijuana is putting your baby at risk, you may want to consider entering a drug addiction treatment program that is skilled at working with pregnant women. There are several options when it comes to marijuana addiction rehab.

Inpatient treatment programs allow you to stay at a facility while you go through treatment. This amount of support and attention can help you properly address any underlying issues related to your marijuana use. Inpatient programs also offer a safe and medically supervised environment. If you are pregnant, this is especially important, as it ensures the safety of you and your baby.

Outpatient programs are a wonderful option if you are unable to leave home and/or work while you go through treatment. Outpatient allows you the flexibility of receiving treatment a couple times a week and allows for periodic check-ins for therapy and medical monitoring.

If you’re struggling with mental health issues like anxiety or depression, you can seek the help of a dual diagnosis program that will work to help you manage your condition while finding recovery from addiction.

If you are pregnant and using marijuana don’t hesitate to seek help. Call us at 1-800-980-3927 to speak with an addiction program support specialist about finding the best program to fit your needs.
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References:

  1. American College of Obstetricians and Gynecologists. (2015). Committee Opinion: Marijuana Use During Pregnancy and Lactation.
  2. Sonon, K. E., Richardson, G. A., Cornelius, J. R., Kim, K. H., & Day, N. L. (2015). Prenatal marijuana exposure predicts marijuana use in young adulthood. Neurotoxicology and teratology, 47, 10-15.
  3. Hayatbakhsh, M. R., Flenady, V. J., Gibbons, K. S., Kingsbury, A. M., Hurrion, E., Mamun, A. A., & Najman, J. M. (2011). Birth outcomes associated with cannabis use before and during pregnancy. Pediatric research, 71(2), 215-219.
  4. World Health Organization. (2016). Cannabis.
  5. Warshak, C. R., Regan, J., Moore, B., Magner, K., Kritzer, S., & Van Hook, J. (2015). Association between marijuana use and adverse obstetrical and neonatal outcomes. Journal of Perinatology, 35(12), 991-995.
  6. Jaques, S. C., Kingsbury, A., Henshcke, P., Chomchai, C., Clews, S., Falconer, J., … & Oei, J. L. (2014). Cannabis, the pregnant woman and her child: weeding out the myths. Journal of Perinatology, 34(6), 417-424.
  7. Behnke, M., Smith, V. C., Levy, S., Ammerman, S. D., Gonzalez, P. K., Ryan, S. A., … & Cummings, J. J. (2013). Prenatal substance abuse: short-and long-term effects on the exposed fetus. Pediatrics, 131(3), e1009-e1024.
  8. Dreher, M. C., Nugent, K., & Hudgins, R. (1994). Prenatal marijuana exposure and neonatal outcomes in Jamaica: an ethnographic study. Pediatrics, 93(2), 254-260.
  9. Jutras-Aswad, D., DiNieri, J. A., Harkany, T., & Hurd, Y. L. (2009). Neurobiological consequences of maternal cannabis on human fetal development and its neuropsychiatric outcome. European archives of psychiatry and clinical neuroscience, 259(7), 395-412.
  10. Volkow, N. D., Baler, R. D., Compton, W. M., & Weiss, S. R. (2014). Adverse health effects of marijuana use. New England Journal of Medicine, 370(23), 2219-2227.
  11. Goldschmidt, L., Day, N. L., & Richardson, G. A. (2000). Effects of prenatal marijuana exposure on child behavior problems at age 10. Neurotoxicology and teratology, 22(3), 325-336.
  12. Warshak, C. R., Regan, J., Moore, B., Magner, K., Kritzer, S., & Van Hook, J. (2015). Association between marijuana use and adverse obstetrical and neonatal outcomes. Journal of Perinatology, 35(12), 991-995.
  13. Ko, J. Y., Farr, S. L., Tong, V. T., Creanga, A. A., & Callaghan, W. M. (2015). Prevalence and patterns of marijuana use among pregnant and nonpregnant women of reproductive age. American journal of obstetrics and gynecology,213(2), 201-e1.
  14. National Institutes of Health. (2016). Available Treatments for Marijuana Use Disorders.

Heroin’s Effects on Pregnancy

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Heroin’s Effects on Pregnancy

Heroin is an illegal and highly addictive substance that may be injected, smoked, or snorted. This powerful opiate drug can easily harm any user, and it can cause numerous problems for a pregnant mother and her developing baby. Unfortunately, heroin use is all too prevalent; the 2015 National Survey on Drug Use and Health report showed that 329,000 people in the US reported using heroin in the past month 1. This includes women of childbearing age. The survey found that approximately 79,000 women aged 15-44 in the US reported using heroin in the past month. 1.

Because unintended pregnancies are common in the United States, women may be using heroin and other substances without realizing that they are pregnant 2. Heroin can cause serious harm to a woman’s body, and it can also significantly harm her baby.

If you are a woman of reproductive age and you are either pregnant or not actively preventing pregnancy through birth control and using heroin, consider getting help. You deserve to be healthy and so does your child. Call 1-800-980-3927    

Effects of Heroin Use on the Mother

Heroin use during pregnancy is a major public health concern,  with the potential to result in serious maternal and neonatal health issues. Using a drug like heroin can eventually compel a person to prioritize the drug over important issues like hygiene and proper nutrition, which can give rise to numerous issues during pregnancy.

Heroin-addicted mothers also tend to have poor attendance rates at prenatal visits 8. Prenatal care is vital for any expectant mother, and may be even more essential for women using heroin due to the high risk for pregnancy complications, such as 3 4 5:

  • Antepartum hemorrhage (bleeding).
  • Low birth weight.
  • Higher neonatal mortality.
  • Hepatitis.
  • HIV.
  • Sexually transmitted infections (STIs).
  • Respiratory failure.
  • Preeclampsia.

Additionally, heroin is a dangerous drug because it is associated with serious physical, mental and social repercussions that negatively impact the mother and, consequently, the fetus or developing child. These include 3:

  • Malnutrition.
  • Poor dental hygiene.
  • Infections, such as HIV and hepatitis viruses.
  • Depression.
  • Self-harm.
  • Relationship problems.
  • Domestic violence.
  • Criminal activity.

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1-800-980-3927   Treatment Advisors Are On Call 24/7

Effects of Heroin on a Developing Fetus

Heroin can easily cross the placental barrier. This means that when a woman injects, inhales, or smokes heroin, the drug is passed along to the baby, presenting numerous risks and the strong possibility the baby will become dependent on the drug.

Taking drugs such as heroin can lead to a number of health issues related to pregnancy, including but not limited to 6:

  • Problems with the placenta: The placenta is an important part of pregnancy since it provides a steady supply of blood through the umbilical cord—rich in oxygen and nutrients. When a woman has problems with her placenta, her baby may become oxygen- or nutrient-deprived. Placental abruption, or the separation of the placenta from the uterus, can be can be very serious for both the mother and the baby.
  • Increased risk of preterm birth: “Preterm” is a term used to define babies who are born before 37 weeks of pregnancy are completed. There are categories of preterm birth, including extremely preterm (<28 weeks), very preterm (28 to <32 weeks), and moderate to late preterm (32 to 37 weeks) 7.
  • Low birth weight: Low birth weight is defined by the World Health Organization (WHO) as weight at birth less than 2,500 grams or 5.5 lbs. Low birth weight is associated with neonatal mortality, inhibited cognitive development, and chronic disease as the child grows up 10.

Heroin use can also be deadly to the developing fetus or the newborn baby. Aside from increased miscarriage risk due to complications like placental abruption, illicit drug use during pregnancy increases the risk of stillbirth (death of a baby in the womb after 20 weeks of pregnancy) by 2 to 3 times 13.

Illicit drug use also increases the chances of sudden infant death syndrome (SIDS, or crib death) 6,13. This refers to the unexplained death of a baby who is younger than 1 year old 11.

Neonatal Abstinence Syndrome (NAS)

When a woman uses an opioid like heroin during pregnancy it can cause her baby to develop neonatal abstinence syndrome (NAS). NAS is a set of behavioral and physical signs in the newborn that result from abruptly cutting off a baby’s opioid supply once the child is born. Studies show that anywhere from 48-94% of babies exposed in utero to heroin will experience withdrawal at birth 3.

  • How much heroin the mother used.
  • How well her body clears the drug from her system.
  • How long she used heroin.
  • Whether the baby was born full-term or premature.

Symptoms of NAS

Symptoms of NAS usually occur within the first 1-3 days after birth; however, they may appear up to a week after birth 12.

Characteristics of NAS include but are not limited to 12:

  • Excessive crying.
  • Mottled (blotchy) skin.
  • Fever.
  • High-pitched cry.
  • Irritability.
  • Slow weight gain.
  • Poor ability to breastfeed.
  • Tremors.
  • Diarrhea.
  • Vomiting.

In the most severe cases, NAS can cause seizures and death. When a baby is born with NAS, they will usually need to be hospitalized and treated with medication (typically, another opioid medication like morphine or methadone) to relieve the withdrawal symptoms 13. The medication is gradually tapered as the baby adjusts to not having heroin in their system.

Although the effects of heroin use in utero have been well documented, less is known about the long-term effects on the developing child. However, some studies show that exposure to heroin in utero is associated with the following characteristics later in life 14 15 16:

  • Behavioral disorders.
  • Difficulties with concentration and attention.
  • Hyperactivity.
  • Aggressiveness.
  • Lack of social inhibition.

If you are pregnant and use heroin, call your doctor to find out the best way to keep you and your baby safe. If you are interested in treating your substance use disorder, give us a call 1-800-980-3927   and a rehab placement specialist can help you.
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Quitting Heroin While Pregnant

When a woman quits opiates cold turkey while pregnant, her fetus goes through a period of withdrawal. The fetus is not able to tolerate the effects of withdrawal as well as the mother and this may result in the death of the fetus 17. Because of this risk, it is important to talk to your doctor before attempting to quit using heroin on your own.

Pregnancy offers a window of opportunity to enter treatment and live drug-free. Data collected by the Substance Abuse and Mental Health Services Administration (SAMHSA) found that pregnant women use lower amounts of drugs, such as heroin, during the third trimester than they do the first and second trimesters (2.4 percent vs. 9.0 and 4.8 percent) 1. This data suggests that by their last trimester, more women have stopped using harmful substances.

While therapeutic options may vary on an individual basis, many women quit using heroin during pregnancy through a combination of medication-assisted treatment and counseling.

Medication-Assisted Treatment During Pregnancy

Used since the 1970s, methadone is a time-tested method of medication-assisted treatment during pregnancy. Although methadone is the standard of care in most of the world and most doctors will prescribe it to women who are using heroin during pregnancy, it is important to note that methadone is still an opioid, and there are risks of using methadone when pregnant.

Credit: National Institute on Drug Abuse

Methadone can easily cross the placenta and enter the baby’s bloodstream, increasing the risk that the baby will be born with neonatal abstinence syndrome. Researchers are investigating the potential to use buprenorphine and naloxone (i.e., Suboxone) instead of methadone 18 19. Research is still emerging, and one study found that babies born to mothers who were treated with buprenorphine and naloxone had less incidence of NAS and shorter hospital stays 20.

It is important to talk to your health care provider about your options for treatment. Give us a call today at 1-800-980-3927 to speak with a rehab treatment specialist and learn more about your options.

References:

  1. Substance Abuse and Mental Health Services Administration. (2015). Results from the 2015 National Survey on Drug Use and Health: Detailed Tables (HHS Publication No. SMA 16-4984, NSDUH Series H-51).
  2. Centers for Disease Control and Prevention. (2015). Unintended Pregnancy Prevention.
  3. Namboodiri, V., George, S., Boulay, S., & Fair, M. (2010). Pregnant heroin addict: what about the baby?. BMJ case reports, 2010, bcr0920092246.
  4. Giordano, R., Cacciatore, A., Cignini, P., Vigna, R., & Romano, M. (2010). Antepartum Haemorrhage. Journal of Prenatal Medicine, 4(1), 12–16.
  5. Semba, R. D. (2010). Psychiatric Disorders in Pregnancy and the Postpartum: Principles and. Humana.
  6. March of Dimes. (2015). Heroin and pregnancy.
  7. World Health Organization. (2015). Preterm birth.
  8. World Health Organization. (2001). WHO Regional Strategy on Sexual and Reproductive Health.
  9. March of Dimes. (2015). Stillbirth.
  10. World Health Organization. (2004). Low birth weight.
  11. March of Dimes. (2015). Sudden Death Syndrome.
  12. National Institutes of Health. (2015). Neonatal abstinence syndrome.
  13. National Institute on Drug Abuse. (2015). Substance Use While Pregnant and Breastfeeding.
  14. Ornoy, A., Michailevskaya, V., Lukashov, I., Bar-Hamburger, R., & Harel, S. (1996). The developmental outcome of children born to heroin-dependent mothers, raised at home or adopted. Child abuse & neglect, 20(5), 385-396.
  15. Ornoy, A., Segal, J., Bar‐Hamburger, R., & Greenbaum, C. (2001). Developmental outcome of school‐age children born to mothers with heroin dependency: Importance of environmental factors. Developmental Medicine & Child Neurology, 43(10), 668-675.
  16. Messinger, D. S., Bauer, C. R., Das, A., Seifer, R., Lester, B. M., Lagasse, L. L., … & Langer, J. C. (2004). The maternal lifestyle study: cognitive, motor, and behavioral outcomes of cocaine-exposed and opiate-exposed infants through three years of age. Pediatrics, 113(6), 1677-1685.
  17. Chasnoff, I. J. (Ed.). (2012). Drug use in pregnancy: Mother and child. Springer Science & Business Media.
  18. Lund, I. O., Fischer, G., Welle-Strand, G. K., O’grady, K. E., Debelak, K., Morrone, W. R., & Jones, H. E. (2013). A comparison of buprenorphine+ naloxone to buprenorphine and methadone in the treatment of opioid dependence during pregnancy: maternal and neonatal outcomes. Substance abuse: research and treatment, 7, 61.
  19. Kraft, W. K., Dysart, K., Greenspan, J. S., Gibson, E., Kaltenbach, K., & Ehrlich, M. E. (2011). Revised dose schema of sublingual buprenorphine in the treatment of the neonatal opioid abstinence syndrome. Addiction, 106(3), 574-580.
  20. Wiegand, S., Stringer, E., Seashore, C., Garcia, K., Jones, H., Stuebe, A., & Thorp, J. (2014). 750: Buprenorphine/naloxone (B/N) and methadone (M) maintenance during pregnancy: a chart review and comparison of maternal and neonatal outcomes. American Journal of Obstetrics & Gynecology,210(1), S368-S369.

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Dangers of Drinking While Pregnant

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Dangers of Drinking While Pregnant

The Dangers of Alcohol During Pregnancy

When a woman uses drugs during pregnancy, it can result in a slew of negative health effects for her and her baby—alcohol is no exception. Drinking during pregnancy can lead to fetal alcohol spectrum disorders (FASDs) and a number of other birth defects.

Using alcohol during pregnancy is the leading preventable cause of developmental disabilities, and it is estimated that as many as 2-5% of first grade students in the United States might have FASDs 3.

If you are addicted to alcohol and you are pregnant or you are thinking about getting pregnant, it is not too late to get help. Give us a call today at 1-800-980-3927     to speak with a rehab placement specialist about helpful treatment options.

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Treatment Advisors Are On Call 24/7

 

Thinking About Getting Rehab?

Drinking alcohol during pregnancy is more common than you think: In a survey done by the CDC, 10.2% of pregnant women drank alcohol in the past 30 days and 3.1% of pregnant women reported binge drinking (drinking more than 4 drinks per occasion) during that time frame 3.

Pregnant women report binge drinking more frequently than nonpregnant women: Among binge drinkers, pregnant women reported binge drinking 4.6 times in the past 30 days compared to nonpregnant women who reported binge drinking 3.1 times in the past 30 days. Additionally, the survey found that, among binge drinkers, pregnant women consumed more than nonpregnant women with 7.5 versus 6.0 drinks 3.

Drinking alcohol during pregnancy is associated with high health care costs: The United States spends an estimated $5.5 billion dollars in health care and related costs related to drinking during pregnancy every year 9.

An estimated 3.3 million women ages 15 to 44 years old are at risk for unintentionally exposing their unborn child to alcohol: Many women drink alcohol while they are sexually active and not using birth control to prevent pregnancy 8. Additionally, over half of the pregnancies in the United States are unintended: an unintended pregnancy is either unplanned or planned but not monitored so that women continue drinking through the beginning of their pregnancy before discovering they are pregnant 10.

3 in 4 women do not stop drinking alcohol when they stop using birth control: When a woman wants to get pregnant she will usually stop taking birth control, yet according to a report by the CDC, 3 in 4 women reported that they still drank alcohol after going off their birth control. This is worrisome given that the majority of women do not know they are pregnant until they are 4-6 weeks pregnant, meaning their baby could be exposed to alcohol during this critical stage of development 10. Pregnant women are typically motivated to change their drinking behaviors to ensure that their child is born healthy: One survey found that 87% of women who drank prior to becoming pregnant quit during pregnancy, 6.6% reduced the amount they drank, and about 6.4% reported not changing the amount they drank 11.

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Effects of Alcohol on the Mother

Any amount of drinking is considered at-risk alcohol use during pregnancy.

Alcohol consumption among women of childbearing age in the United States is a public health issue. When a woman drinks during her pregnancy she increases the risk of harming her unborn baby as well as her own body.

According to the National Institute on Alcohol Abuse and Alcoholism, any amount of drinking is considered at-risk alcohol use during pregnancy. In consensus with this recommendation, the U.S. Surgeon General advises that pregnant women should not drink any alcohol while they are pregnant 1. Excessive alcohol consumption is a risk factor for miscarriage due to damage to the developing cells of the baby.

Aside from miscarriage risk, drinking during pregnancy is associated with negative health outcomes for the mother, that include both maternal psychosocial risks as well as physical risks of potential harms for both mother and developing fetus 1,2.

Physical Risks

  • Sexually transmitted infections (STIs) which, depending on the infection, may harm the pregnancy.
  • Injuries, such as falls, which may lead to miscarriage.
  • Seizures.
  • Malnutrition.
  • Cancer of the breast, liver, mouth, and esophagus.

Psychosocial Problems

  • Conflicts with a spouse or partner.
  • Work disability.
  • Anxiety.
  • Depression.
  • Sexual assault.
  • Child neglect or abuse.
  • Domestic violence.
  • Driving under the influence.
  • Trading sex for drugs.
  • Suicide.

For women who want to get pregnant, alcohol abuse can also harm fertility. If you or a loved one is currently pregnant or hoping to get pregnant and is abusing alcohol, it is important to talk to your doctor immediately. Your doctor can help you take the steps to reduce the possibility that your child is further exposed to alcohol in utero.

Effects of Alcohol on a Developing Fetus

Alcohol crosses the placenta and results in the fetus receiving nearly equal the concentration of alcohol as the mother 12. In addition, fetal metabolism of alcohol occurs more slowly than it does in an adult—the result being that fetal blood alcohol levels (BAC) can become more elevated than their mother’s BAC, and persist in that manner for a longer period of time 13.

Excess alcohol consumption can abruptly result in miscarriage. For many, however, the risks don’t end there. A developing baby, carried to term after in utero exposure to alcohol, is subject to a number of negative effects described below.

Credit: Centers for Disease Control and Prevention

 

Fetal Alcohol Spectrum Disorders (FASD)

When a fetus is exposed to alcohol it can disrupt their development and increase their risk of developing FASDs. FASDs is the umbrella term for a range of disorders caused by fetal alcohol exposure. FASDs include 14:

  • Fetal Alcohol Syndrome (FAS).
  • Partial Fetal Alcohol Syndrome (pFAS).
  • Alcohol-Related Neurodevelopmental Disorder (ARND).
  • Alcohol-Related Birth Defects (ARBD).

FASDs are completely preventable if the mother does not drink during pregnancy.

Credit: SAMHSA FASD Center for Excellence

The CDC estimates that up to 1 in 20 school children living in the United States may have FASDs 9. When a child is born with FASDs they can experience a range of unwanted problems, and these are outlined below 9.

  • Low birth weight.
  • Intrauterine growth retardation.
  • Problems with vital organs like the heart and kidneys.
  • Damage to the brain.

These physical issues can manifest as behavioral and intellectual disabilities as the child grows up and progresses through certain developmental milestones.

Intellectual Problems

  • Lower IQ.
  • Hyperactivity.
  • Attention problems.
  • Learning disabilities.
  • Impaired judgment and reasoning skills.

These types of disabilities can create lifelong problems for an individual. A person born with FASDs may face broader challenges for the rest of their life.
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Social Problems

  • Problems with social interactions.
  • Increased risk of using substances such as drugs and alcohol.
  • Difficulties keeping a job.
  • Problems with the law.

Fetal Alcohol Syndrome (FAS)

Fetal alcohol syndrome (FAS) is one of the most severe types of FASDs. FAS presents with specific facial abnormalities, including 14:

  • Narrow eye openings.
  • Smooth area between lip and the nose.
  • Thin upper lip.

In addition to facial dysmorphology, features of FAS also include:

  • Central nervous system (CNS) abnormalities, e.g., a small head circumference and/or CNS dysfunction.
  • Growth deficiencies either in utero or post-natal.

Research shows that a few factors play a major role in how severe the effects of alcohol are on a developing fetus. These risk factors include 4:

  • Amount: the number of drinks a pregnant woman has per occasion.
  • Rate: how often a woman drinks.
  • Timing: when the mother drinks. (When considering distinct points in time throughout fetal development that drinking occurs, the timing of alcohol use could have particular effects on the development of a specific brain region or physical feature.)

In addition to how often a woman drinks and how much she drinks, other factors may affect the risk of a child being born with FASDs. These risk factors include 4,5,6:

  • Diet.
  • History of multiple pregnancies.
  • Low body mass index (BMI).
  • Whether the mother smokes cigarettes and/or marijuana.
  • Older age.
  • Being in a family of heavy drinkers.
  • Inadequate prenatal care.
  • Social isolation.
  • Exposure to high levels of stress.
  • Genetics.
  • Poverty.
  • Homelessness.
  • Substance abuse by one’s partner.

Getting into treatment can help you learn healthy ways to address some of these risk factors. For example, women who are addicted to alcohol may choose alcohol over other things, such as eating a healthy diet during her pregnancy. In fact, many individuals addicted to alcohol are deficient in a number of essential nutrients—some of which may be crucial to a developing fetus 7. This may also make her more prone to becoming hypoglycemic or nutrient-deficient 8. Given that a mother’s eating habits during pregnancy can affect the severity of fetal alcohol impairment, it is important to address nutrition, in addition to all aspects of your health, during   addiction treatment.

Quitting Alcohol While Pregnant

If a pregnant woman attempts to withdraw from alcohol without medical help, she can place herself and her baby at risk. Women who are dependent on alcohol may need specialized counseling and, potentially, vigilant medical supervision while they withdraw. Accordingly, treatment should be managed by doctors and nurses who are experienced in treating pregnant women with substance abuse disorders. Depending on a woman’s level of alcohol use, her doctor may recommend specialized inpatient detoxification treatment or outpatient treatment.

Inpatient detoxification treatment may be recommended if a pregnant woman is 6:

  • Physiologically dependent on alcohol.
  • Drinking 5 days a week or more.
  • Actively drinking.
  • At risk for alcohol withdrawal, which can be dangerous to both mother and baby.

Withdrawing from alcohol during pregnancy is a threat to the brain of a developing fetus. One potential damaging effect is that withdrawal can activate the brain’s NMDA receptor. NDMA plays a major role in brain development, learning, and memory 15. When this receptor is activated excessively, which occurs during withdrawal, it can cause neuronal cell death in the baby 16.

Newborns can experience withdrawal after birth if their mothers have used alcohol or other substances during pregnancy. Not every baby born to a mother who used alcohol will experience withdrawal, and researchers are still examining why this is the case. However, many newborns who were exposed to alcohol in utero will experience symptoms that are mild or severe as they adjust to life outside the womb.

Signs of withdrawal in an infant include 17:

  • Hyperactivity.
  • Crying.
  • Irritability.
  • Trouble with feeding, such as having a weak suck.
  • Tremors.
  • Seizures.
  • Poor sleeping patterns.
  • Hyperphagia (increased appetite).
  • Diaphoresis (sweating).

Medical providers will assess your newborn’s withdrawal symptoms after birth in order to make a proper diagnosis. In some cases, your baby may need medication and/or frequent check-ups to help manage their withdrawal symptoms.

After the baby is born, many women who stopped drinking alcohol during pregnancy may begin to drink again. If this happens, it is important to tell your doctor during your next follow-up visit. Your doctor may recommend inpatient or outpatient treatment to help you resolve your addiction issues. Getting the help to become alcohol-free postpartum could significantly impact not only your health, but the health and wellbeing of your entire family.

Studies have shown that children raised in a household where the parent(s) abuse alcohol are increasingly prone to having adverse childhood experiences that negatively impact them throughout development and their entire lifetimes, such as abuse or neglect 18. Finally, if you unintentionally became pregnant, it may be an opportunity to talk to your doctor about long-term reversible contraception such as an IUD or other method of birth control to prevent future pregnancies.

Treatment for Alcohol Addiction

Inpatient programs usually last 30 to 90 days and individuals are required to live at the facility for the duration of the program. Inpatient programs will provide a combination of:

Depending on the facility, inpatient programs may offer other amenities such as individualized case management services as well as postpartum support. Some treatment centers, such as those offering dual diagnosis treatment, will be able to effectively address any concurrent mental health issues that may be present such as mood, anxiety, thought and affective disorders.

Outpatient programs offer a pregnant woman the flexibility of living at home while she receives care. In many cases, outpatient programs are less expensive than inpatient programs. Individuals who receive treatment at an outpatient program will often attend group therapy for several hours each week.

In addition to therapy and case management, doctors may prescribe certain medications during treatment to help a woman withdraw from alcohol safely. While these medications are sometimes prescribed, it is important to note that there is a limited amount of data on how safe the following medications are for a pregnant woman to take 19,20:

  • Naltrexone: Used during pregnancy because it does not have any known, harmful effects.
  • Disulfiram: Although this drug is sometimes used during pregnancy, it may cause harm to the fetus by increasing levels of acetaldehyde. Because of the potential danger with this drug, it is not used regularly in pregnancy.
  • Acamprosate: According to animal studies, this drug is a teratogen, which means it could negatively affect pregnancy. Today, there are not enough studies to conclude whether it is safe to take during pregnancy and will only be used if the benefit justifies the risk to the fetus 21.
  • Topiramate: Sometimes used as an off-label adjunct treatment for alcohol dependence, this drug has been found to be teratogen in animal studies. Its safety for use in human pregnancy is unknown 22.

Before considering going through withdrawal, detox, and/or rehab for alcohol use, it is best to first talk to your doctor about your current alcohol use. Your doctor can complete an assessment and direct you to the proper resources.

If you or a loved one is looking for treatment give us a call today at 1-800-980-3927  . We are available 24/7 to answer your questions and help you find a treatment center that’s right for you.
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References:

  1. American College of Obstetricians and Gynecologists. (2013). At-Risk Drinking and Alcohol Dependence: Obstetric and Gynecologic Implications.
  2. Knudsen, A. K., Skogen, J. C., Ystrom, E., Sivertsen, B., Tell, G. S., & Torgersen, L. (2014). Maternal pre-pregnancy risk drinking and toddler behavior problems: the Norwegian Mother and Child Cohort Study.European child & adolescent psychiatry, 23(10), 901-911.
  1. Tan, C. H., Denny, C. H., Cheal, N. E., Sniezek, J. E., & Kanny, D. (2015). Alcohol use and binge drinking among women of childbearing age—United States, 2011–2013. ‘ occurs during withdrawal, it risk for alcohol-exposed pregnancy. lcohol Use and Risks to Women’ occurs during withdrawal, it
  1. National Institutes of Health. (2015). Fetal Alcohol Exposure.
  1. May, P. A., & Phillip Gossage, J. (2011). Maternal risk factors for fetal alcohol spectrum disorders: not as simple as it might seem.Alcohol Research and Health, 34(1), 15.
  1. Bhuvaneswar, C. G., Chang, G., Epstein, L. A., & Stern, T. A. (2007). Alcohol use during pregnancy: prevalence and impact.Primary care companion to the Journal of clinical psychiatry, 9(6), 455.
  1. Young, J. K., Giesbrecht, H. E., Eskin, M. N., Aliani, M., & Suh, M. (2014). Nutrition implications for fetal alcohol spectrum disorder. Advances in Nutrition: An International Review Journal, 5(6), 675-692.
  1. Carter, R. C., Jacobson, J. L., Sokol, R. J., Avison, M. J., & Jacobson, S. W. (2013). Fetal Alcohol‐Related Growth Restriction from Birth through Young Adulthood and Moderating Effects of Maternal Prepregnancy Weight.Alcoholism: Clinical and Experimental Research,37(3), 452-462.
  2. Centers for Disease Control and Prevention. (2016). Alcohol and Pregnancy.
  1. Centers for Disease Control and Prevention. (2016). More than 3 million US women at risk for alcohol-exposed pregnancy.
  1. Kitsantas, P., Gaffney, K. F., Wu, H., & Kastello, J. C. (2014). Determinants of alcohol cessation, reduction and no reduction during pregnancy. Archives of gynecology and obstetrics, 289(4), 771-779.
  1. Nykjaer, C., Alwan, N. A., Greenwood, D. C., Simpson, N. A., Hay, A. W., White, K. L., & Cade, J. E. (2014). Maternal alcohol intake prior to and during pregnancy and risk of adverse birth outcomes: evidence from a British cohort.Journal of epidemiology and community health, jech-2013.
  1. National Institutes of Health. (2014). Alcohol and Pregnancy.
  2. National Institute on Alcohol Abuse and Alcoholism. (n.d.). Fetal Alcohol Exposure.
  1. Murawski, N. J., Moore, E. M., Thomas, J. D., & Riley, E. P. (2015). Advances in diagnosis and treatment of fetal alcohol spectrum disorders: from animal models to human studies.Alcohol research: current reviews, 37(1), 97.
  1. Thomas, J. D., & Riley, E. P. (1998). Fetal alcohol syndrome: does alcohol withdrawal play a role?.Alcohol Health & Research World, 22(1), 47-54.
  1. Hudak, M. L., Tan, R. C., Frattarelli, D. A., Galinkin, J. L., Green, T. P., Neville, K. A., … & Bhutani, V. K. (2012). Neonatal drug withdrawal.Pediatrics,129(2), e540-e560.
  1. Anda, R. F., Whitfield, C. L., Felitti, V. J., Chapman, D., Edwards, V. J., Dube, S. R., & Williamson, D. F. (2002). Adverse childhood experiences, alcoholic parents, and later risk of alcoholism and depression. Psychiatric services.
  2. (2016). Pharmacotherapy for alcohol use disorder.
  3. Rayburn, W. F., & Bogenschutz, M. P. (2004). Pharmacotherapy for pregnant women with addictions.American Journal of Obstetrics and Gynecology,191(6), 1885-1897.
  4. Mason, B. J., & Heyser, C. J. (2010). Acamprosate: a prototypic neuromodulator in the treatment of alcohol dependence.CNS & Neurological Disorders-Drug Targets (Formerly Current Drug Targets-CNS & Neurological Disorders), 9(1), 23-32.
  5. Hunt, S., Russell, A., Smithson, W. H., Parsons, L., Robertson, I., Waddell, R., … & Craig, J. (2008). Topiramate in pregnancy Preliminary experience from the UK Epilepsy and Pregnancy Register. Neurology, 71(4), 272-276.

Cocaine Use During Pregnancy

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Cocaine Use During Pregnancy

Cocaine usage during pregnancy has the potential to harm both mother and baby, and the effects may be long-lasting.

According to the 2015 National Survey on Drug Use and Health (NSDUH), roughly 1,000 pregnant women reported using cocaine in the past month 1. This usage is especially prevalent among young adults aged 18 to 25. In fact, according to a national survey, 1.7% of young adults between the ages of 18 to 25 admitted to using the drug in 2015 2.  In the United States, roughly half of all pregnancies are unplanned, and among women 19 years or younger, more than 4 out of 5 pregnancies are unintended 3. This means that a mother may use the drug before she even knows she is pregnant—placing the fetus at risk for exposure to the drug. In fact, women who use cocaine may have irregular menstrual cycles, which can delay the awareness of pregnancy 4.

Exposing a fetus to cocaine may lead to long-term health consequences, such as behavioral  problems and impaired language development. Prenatal exposure to the drug also increases the risk of adverse cognitive and neurodevelopmental issues in the baby 5.

Effects of Cocaine Use on an Expectant Mother

A pregnant woman’s health in large part shapes the health of her unborn child. Maternal cocaine abuse is associated with poverty, poor nutrition, and poor prenatal care, and due to the effects of the drug and the associated inadequate intake of healthy foods, it is common for users to have vitamin deficiencies 4—all of which may negatively affect the child in various ways.

Using substances like cocaine during pregnancy may also impact a mother’s likelihood of carrying her baby to full-term 5. “Full-term” is defined as birth between 37 and 41 weeks. The last few weeks of pregnancy are important stages in a baby’s brain development; a baby’s brain at 35 weeks is only two-thirds the weight of what it will be at 39 or 40 weeks 4. A shorter pregnancy could negatively affect a baby’s final growth spurt.

Video: Why Is Carrying to Full-Term So Important?


Credit: National Institute of Child Health and Human Development

The abuse of cocaine is also associated with a number of health issues for the mother that include psychiatric health issues, cardiovascular disease, respiratory problems, and blood-borne infections like hepatitis and HIV 2.

Other serious maternal health risks that may subsequently place the unborn baby in danger include the following 6:

  • Acute pulmonary edema.
  • Cardiac arrhythmia.
  • Increased blood pressure.
  • Seizures.
  • Sudden death.

Treatment is the best investment you can make for your health and the health of your family. If you or someone you know is pregnant and unable to stop using cocaine, give us a call today at 1-800-980-3927   . You can speak to a rehab placement specialist any time of day or night to learn about available recovery options.

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Effects on Pregnancy

Maternal cocaine use has been associated with poor outcomes during pregnancy. Problems that may arise as a result of this drug’s use within and around this delicate period include 5,7,8:

  • Problems associated with the placenta, including:
    • Placental abruption (separation of the placenta from the uterine wall).
    • Placental infarction (interruption of blood flow to the placenta).
    • Preeclampsia.
  • Impaired fetal growth:
    • Intrauterine growth restriction.
    • Low birth weight.
    • Small size for gestational age.
  • Ectopic pregnancy.
  • Spontaneous abortion.
  • Miscarriage.
  • Premature rupture of membranes.
  • Premature birth*.
  • Perinatal cerebral infarction.
  • Reduced head circumference.
  • Congenital malformations.
  • Stillbirth**.
  • Sudden infant death syndrome (SIDS).

*According to the World Health Organization (WHO), preterm birth is defined as a birth that takes place before 37 weeks of pregnancy. Preterm birth is the most common cause of death among children under 5 years of age, and many preterm children suffer from lifelong learning disabilities, as well as visual and hearing problems 9.

**One study of blood test results found that the use of a stimulant like cocaine was associated with 2.2 times greater risk of stillbirth 7. The trauma of experiencing a stillbirth can have long-term psychological effects on a mother and the family. Studies have noted that the maternal experience after stillbirth may be characterized by depression, post-traumatic stress disorder (PTSD), maternal anxiety, and unresolved mourning 10.

Prenatal Exposure and Miscarriage

The most common adverse outcome of pregnancy is a miscarriage (spontaneous abortion).  A number of studies have found that pregnant mothers who abuse cocaine are at risk for miscarriage due to the fact that usage in early pregnancy decreases blood flow 11. However, in the medical community, this remains controversial. In a meta-analysis of 20 scientific papers on substance use and pregnancy, researchers found that mothers who used it along with other drugs had an increased risk of miscarriage compared to drug-free mothers. However, when comparing women who only used cocaine with drug-free mothers, the effect was no longer present 5.

While the aforementioned studies examining cocaine and miscarriage show somewhat mixed results 12, the other potential risks introduced throughout pregnancy—such as those associated with placental problems—underscore an undeniable connection between maternal use and fetal endangerment.

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Effects on a Developing Child

One study found that children who were exposed to cocaine before birth had 2.8 times the risk of having a learning disability 13.

Cocaine affects the central nervous system (CNS). It is small in molecular weight and can cross the placenta, directly reaching the fetus. The direct impact of the drug on a developing fetus may lead to a number of congenital abnormalities (or birth defects), including 13:

  • Limb reduction defects (a limb fails to form properly).
  • Congenital heart diseases (CHDs).
  • Cleft palate.

Cocaine in utero may also cause neurodevelopmental problems for offspring, potentially contributing to 5,13:

  • Impaired adolescent functioning (poor school performance, behavior, brain structure).
  • Impaired perceptual reasoning and procedural learning.
  • Behavior problems.
  • Symptoms of oppositional defiant disorder.
  • Attention deficit hyperactivity disorder (ADHD).
  • Impaired memory and executive function.
  • Problems with language development.

Research has also found that using stimulant drugs, such as amphetamines and cocaine, is associated with increased odds of physical abuse of the child 14. This may be due to the fact that these drugs cause significant mental disturbances 14.

Researchers have also found that teens who were exposed to the drug in utero were twice as likely to use tobacco and marijuana at age 15 and to develop a substance use disorder at age compared to teens who did not experience in-utero cocaine exposure 17. These teens were also more likely to have 17:

  • Trouble problem-solving.
  • Less control over their emotions.
  • Difficulty handling stress.

If the child was mistreated, for example neglected or emotionally or physically abused, they were also more likely to suffer from the problems above. Researchers suggest that prenatal cocaine exposure may lower a child’s threshold for when they activate their stress circuits and may make them more vulnerable to stresses in their environment, including any mistreatment 17.

Teens exposed to the drug in-utero were also more likely to engage in aggressive behaviors at school, as well as steal or use tobacco or alcohol 17.

Long-term drug abuse can greatly impact the development of a child. Prenatally exposed children may be negatively impacted by living with a parent who is living in the ‘‘stress and chaos’’ of drug abuse. After a baby is born, their environment can play a major role in how they develop. If a child is raised in a stressful environment, it can decrease their chances of overcoming the effects of prenatal exposure to cocaine 15.

Getting Help for Cocaine Addiction

If you are abusing cocaine during your pregnancy, it is important that you seek medical care for your addiction. There is evidence that an early intervention can make a big difference in your child’s life.

Getting help for an addiction to this drug can greatly boost the health of your entire family in numerous ways and reduce the incidence of 16:

  • Postnatal drug exposure.
  • Chaotic lifestyles with rotating caregivers.
  • Ongoing paternal drug use.
  • Maternal depression.

There are a variety of treatment options available to help you stop using the drug and learn coping skills. Often, a parent who abuses illicit drugs like cocaine does so in order to cope with underlying stressors, such aspast trauma or abuse. Treatment can help you learn skills to help cope with these triggers without the use of cocaine or other drugs. Options for addiction treatment include:

  • Outpatient drug treatment: This option typically requires 8-12 hours a week of time spent visiting the treatment center. Treatment will consist of sessions on drug abuse education, individual and group counseling, and coping skills.
  • Inpatient drug treatment: This is a more intensive option with centers that offer 24/7 care and support. There are varying types of inpatient treatment that range from short-term stays to longer stays (30-90+ days).
  • Group-based therapy: Therapy provides you with the opportunity to learn about addiction so that you can better understand your addiction and ways to overcome it. In a group setting, you can learn and support others who are recovering from an addiction to cocaine. Group therapy is a common treatment approach offered in both outpatient and inpatient recovery programs.

By taking the steps to get treatment, you are creating a safe and healthy environment for your child. Research shows a positive association between mothers receiving drug treatment and 16:

  • Decreased substance use.
  • Reduced mental health symptoms.
  • Improved birth outcomes.
  • Employment.
  • Self-reported health status.
  • HIV risk reduction.

Engaging in drug treatment during and after pregnancy improves both your health and the health of your unborn child. Give us a call today to learn more about your options 1-800-980-3927.
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References:

  1. Center for Behavioral Health Statistics and Quality. (2016). Results from the 2015 National Survey on Drug Use and Health: Detailed Tables. Substance Abuse and Mental Health Services Administration, Rockville, MD.
  2. Center for Behavioral Health Statistics and Quality. (2016). Key substance use and mental health indicators in the United States: Results from the 2015 National Survey on Drug Use and Health (HHS Publication No. SMA 16-4984, NSDUH Series H-51).
  3. Centers for Disease Control and Prevention. (2015). Unintended Pregnancy Prevention.
  4. Lewis, M., & Bendersky, M. (1995). Mothers, babies, and cocaine: The role of toxins in development. Psychology Press.
  5. Cressman, A. M., Natekar, A., Kim, E., Koren, G., & Bozzo, P. (2014). MOTHERISK ROUNDS: Cocaine Abuse During Pregnancy. Journal of Obstetrics and Gynaecology Canada, 36(7), 628-631.
  6. Fox, C. H. (1994). Cocaine use in pregnancy. The Journal of the American Board of Family Practice, 7(3), 225-228.
  7. National Institutes of Health. (2013). Tobacco, drug use in pregnancy can double risk of stillbirth.
  8. Rassool, G. H., & Villar-Luis, M. (2006). Reproductive risks of alcohol and illicit drugs: an overview. Journal of Addictions Nursing, 17(4), 211-213.
  9. World Health Organization. (2015). Preterm birth.
  10. Hughes, P., Turton, P., Hopper, E., & Evans, C. D. H. (2002). Assessment of guidelines for good practice in psychosocial care of mothers after stillbirth: a cohort study. The Lancet, 360(9327), 114-118.
  11. Ness, R. B., Grisso, J. A., Hirschinger, N., Markovic, N., Shaw, L. M., Day, N. L., & Kline, J. (1999). Cocaine and tobacco use and the risk of spontaneous abortion. New England Journal of Medicine, 340(5), 333-339.
  12. WHITE, H. L., & BOUVIER, D. A. (2005). Caring for a patient having a miscarriage. Nursing2015, 35(7), 18-19.
  13. Viteri, O. A., Soto, E. E., Bahado-Singh, R. O., Christensen, C. W., Chauhan, S. P., & Sibai, B. M. (2015). Fetal Anomalies and Long-Term Effects Associated with Substance Abuse in Pregnancy: A Literature Review. American journal of perinatology, 32(05), 405-416.
  14. Taplin, S., Richmond, G., & McArthur, M. (2014). Identifying alcohol and other drug use during pregnancy: Outcomes for women, their partners and their children. ANCD Research Paper, 30.
  15. Berger, L. M., & Waldfogel, J. (2000). Prenatal Cocaine Exposure: Long‐Run Effects and Policy Implications. Social Service Review, 74(1), 28-54.
  16. Ashley, O. S., Marsden, M. E., & Brady, T. M. (2003). Effectiveness of substance abuse treatment programming for women: A review. The American journal of drug and alcohol abuse, 29(1), 19-53.
  17. Case Western Reserve University. (2017, May 3). Prenatal cocaine exposure increases risk of higher teen drug use. ScienceDaily.