Drug Abuse and Pregnancy

In 2016, over 6% of women interviewed stated that they had used illicit substances in the past month. Substance use and abuse can cause significant harm to the mother and the fetus. Every year nearly 2 million babies in America are exposed to tobacco, alcohol, and illicit drugs in utero ( Addiction resource, 2019). Nurses must know how to care for these women and babies.

It is important to define some terms. Substance use is the sporadic consumption of alcohol or drugs with no adverse consequences from that use. Abuse does not define frequency, but the user has experienced adverse consequences because of that use. Physical dependence means that the woman's body has adapted to the substance and will have withdrawal symptoms if she continues using it. Psychological dependence is a perceived sense of need for the substance by the user. Addiction is a primary, chronic disease of brain reward, motivation, and memory (Miller et al., 2019).

Screening for substance abuse is recommended during the initial prenatal visit and each trimester. The Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) opposes laws that result in incarceration or punitive legal actions against women because of a substance use disorder (SUD) in pregnancy and the postpartum period. (Optimizing Outcomes, 2019). Universal urine drug screening would find all women who have used illicit substances but is expensive to perform. Various validated screening tools can be used to determine if the woman abuses substances. The 4P's Plus Screen is a screening tool that asks questions about substance use, and any positive finding should trigger further assessment. This is a copyrighted screening tool. The CRAFFT substance abuse screen for adolescents and young adults is available for anyone to use. The National Institute on Drug Abuse (NIDA) quick screen may also screen women. There are other tools also available (Substance use, 2019).

Nurses and providers must know risk factors that may indicate that the woman has a history of drug use. Young, unmarried women with a low education level are more likely to use. Women who have started prenatal care late or have missed appointments may be using. Women with sudden behavior changes, relationship problems, poor work or job performance, and poor weight gain may be at risk. Women with high-risk sexual behaviors, a history of a mental health disorder, or a family history of or partner with substance abuse are at risk. Women who have an unexplained obstetric history such as demise, miscarriages, etc., and women who do not have custody of their other children also may have a history of using (Substance use, 2019).

Urine drug testing may be considered for women with a history of drug use, a positive screen, and poor prenatal care. Women with abruptio placenta, preterm labor, and unexplained fetal demise may also need drug testing (COP, 2017).

Women who use substances during pregnancy usually want help to provide the best care for their babies. It is important to help these women to get assistance. For opiate dependence, methadone or buprenorphine are safe during pregnancy and are treatment options for these women. These medications can also cause withdrawal in the newborn but are generally considered safer for pregnancy than illicit drugs. Women on high doses of benzodiazepines and alcohol may need a detoxification program to help them stop using. Any psychiatric diagnoses should be addressed to help these women with substance abuse problems (Substance use, 2019). A comprehensive drug rehab program reduces the risk of miscarriage, preterm delivery, congenital disabilities, and neonatal abstinence syndrome (Addiction resource, 2019).

Women with substance abuse need to feel safe with their providers, or they will not return. Nurses are trusted healthcare professionals who can positively impact as long as they are not judgmental when caring for these women. Treatment for drug abuse should be family-focused and non-stigmatizing (Optimizing Outcomes, 2019). Nurses need to be aware of screening tools and their institution and state's policy for drug testing and reporting. Each state may have different laws regarding testing and reporting, which the nurse must follow.

LS is a 22-year-old woman who presents to the OB clinic for her first prenatal visit. She thinks she is around 26 weeks pregnant. She is thin and looks malnourished. She says she did not have a car to get to prenatal visits sooner. Her obstetric history is questionable. She says she had 2 spontaneous miscarriages at approximately 7-8 weeks and one elective abortion when she was 16. She also states that she has had multiple partners and does not know who the baby's father is.

What do you think about this patient? Do you think she is using any illicit substances? How will you find out?

• This patient is young and appears to not be in ideal physical condition. Any type of substance abuse is possible. It is important to ask questions and use a screening tool. It is also important to question her gently and non-judgmental. The goal is to get her help and have her return for care. You do not want to scare her away from getting treatment or prenatal care. It is important to provide her with realistic resources that she can utilize.

• Addiction Resource, Pregnancy, and Drug Abuse: Understanding Addiction in Future Mothers. Addiction Resource. Accessed December 31, 2019. Visit Source.
• Committee on Obstetric Practice. Committee Opinion No. 711: Opioid Use and Opioid Use Disorder in Pregnancy. Obstet Gynecol 2017; 130:e81. Reaffirmed 2019.
• HHS A Collaborative Approach to the Treatment of Pregnant Women with Opioid Use Disorders. HHS Publication No. (SMA) 16-4978. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2016. Accessed December 31, 2019. Visit Source.
• Miller SC, Fiellin DA, Rosenthal RN, Saitz R. The ASAM Principles of Addiction Medicine. Philadelphia: Wolters Kluwer; 2019.
• Optimizing Outcomes for Women With Substance Use Disorders in Pregnancy and the Postpartum Period. Journal of Obstetric, Gynecologic & Neonatal Nursing. 2019;48(5):583-585. doi:10.1016/j.jogn.2019.06.001. Visit Source.
• Substance use by pregnant women - UpToDate. Updated Oct 9, 2019. Accessed December 31, 2019. Visit Source.
• Substance Use While Pregnant and Breastfeeding | National. Accessed December 31, 2019. Visit Source.