Addiction During Pregnancy—Drug Exposure In Utero

Addiction during pregnancy is an unfortunate and risky situation for both the pregnant woman and her child. When pregnant women are exposed to substance use, so are their babies, and exposure can cause lifelong problems for children. In utero exposure can also cause miscarriage, still birth and conditions that endanger the lives of newborn babies. Also, addicted pregnant women are at severe risk for health complications and even death in certain circumstances.

Addicted pregnant women have various and very difficult problems. Not only the health of their babies and themselves is critical, but pregnant addicted women must also deal with cultural stigma and shame. All people with addictions in our culture at large are subject to negative stereotyping, prejudice, and stigma, but for pregnant women, there is another overwhelming aspect of shame and stigma—that they are mothers.

Addicted women often feel they are held to a higher standard of conduct than addicted men, even though the illness is an equalizer across genders, socioeconomic statues, race, and any other demographic you can imagine. Addiction takes everyone to dire circumstances, but pregnant women are particularly stigmatized. Moral judgments are widely made about the illness itself, and still after many years of science-based research, many still feel that addiction is a moral failing rather than a disease. The moral stigma is broader and deeper for pregnant addicted women.

Shame and Stigma of Addiction During Pregnancy

Not only do others believe a great deal of misinformation about the nature of addiction, but addicted women themselves often believe these negative things and feel too ashamed to seek help. It is unfortunate because all addiction-informed prenatal care is beneficial for the woman’s safety and the baby’s. Shame and stigma can be paralyzing, and many women postpone getting addiction treatment or forego it altogether. Overall, pregnant addicted women face many difficult challenges on several fronts.

Common Drugs Used by Addicted Women during Pregnancy

Three drugs are very prevalently used by pregnant addicted women. These are cocaine, alcohol, and opiates. While all drug use is detrimental to babies in utero, and all substance abuse detrimental to mothers, we will explore these three most commonly used drugs here. While dramatically different substances, cocaine, alcohol, and opiates all pose similar and significant risks in the following ways:

  • Prenatal development can be significantly and negatively impacted.
  • There can be severe risks for the mother’s health during pregnancy and delivery.
  • Risks of miscarriage and stillbirth are notable.
  • Newborns require special medical care.
  • Children exposed to cocaine, alcohol, or opiates in utero are at high risk for life long problems.
  • Women who use during pregnancy are at risk for child protection agency intervention, including removal from the mother’s care shortly after birth.

Cocaine Addiction During Pregnancy

Cocaine crosses the placenta during pregnancy and directly enters the bloodstream of an unborn baby. Due to slow metabolism of cocaine by the fetus, the drug remains in the baby’s system much longer than it does in a user’s system. Consequently, the toxicity of one episode of use is more concentrated for a longer period for a child exposed in utero. This means that even a seemingly light dose, or one dose, can have far more effects upon a fetus than most expect. Research suggests that approximately 750,000 pregnant women use cocaine every year.

Cocaine use early in pregnancy has been shown to correlate with a high risk of miscarriage. However, fetal death is always a risk at any stage during pregnancy when cocaine is used. Cocaine related fetal death can result in several ways:

  • Placental abruption—the placenta provides life-sustaining nourishment to the unborn baby. During abruption, the placenta separates from the wall of the uterus, endangering the baby by oxygen and nutritional deprivation. It also endangers the mother through bleeding.
  • Hypoxia–hypoxia is a lack of oxygen that is caused by constricted blood vessels during cocaine use. Lack of oxygen to the fetus can cause organ damage and/or fetal death. The fetus loses oxygen whenever cocaine is used.
  • Fetal stroke—unborn babies exposed to cocaine can have a stroke in utero if the mother has a blood pressure crisis. The mother’s hypertension causes the fetal heart rate to increase.
  • Fetal developmental impairment—unborn babies can experience severe and pervasive developmental problems when exposed to cocaine. These can be life-threatening due to organ impairment.

Cocaine exposed babies can be born prematurely with low birth weight, undeveloped organs, smaller than normal head size, cerebral palsy, lack of responsiveness, poor reflexes, poor movement, and sensory difficulties. Newborns can also experience cocaine withdrawal symptoms (Neonatal Abstinence Syndrome or NAS), as well as feeding and sleep problems that require intensive medical attention.

Heroin Addiction During Pregnancy

Heroin, an opioid, also crosses the placenta, entering the bloodstream of the unborn baby. As a result, the babies of heroin addicted women are born dependent upon the drug and must have intensive medical attention to detox during NAS (Neonatal Abstinence Syndrome). It is estimated that a child is born addicted to opioids every 19 minutes in the U.S. The symptoms of NAS include: inconsolable and excessive crying

  • tremors
  • low birth weight and slow weight gain
  • tremors
  • seizures
  • diarrhea
  • vomiting
  • fever

Newborns can also die during withdrawal. Seeking care during pregnancy can dramatically increase the chances of a baby’s survival. However, it is important to fully inform healthcare providers of the addiction and the specifics of how much is used and how often. Some say that without simultaneous prenatal care and treatment for maternal heroin addiction, a baby is 4 times more likely to die either during pregnancy or after delivery.

Alcoholism During Pregnancy

As with cocaine and heroin, alcohol also passes through the placenta to directly enter the baby’s system. It is often said, in fact, whenever alcohol is consumed by a pregnant woman, her baby also consumes it. Like other toxic substances ingested by pregnant women, babies cannot metabolize alcohol quickly. Consequently, they are exposed to higher levels of alcohol and for longer periods of time than is the drinker. This exposure in utero can result in Fetal Alcohol Spectrum Disorder (FASD) which is a range of birth defects caused specifically by prenatal alcohol exposure. There is no safe amount of alcohol for consumption during pregnancy.

FASD, or Fetal Alcohol Spectrum Disorders, can result in the following birth defects and impairments:

  • Unusual facial features such as small eyes and ears, thin upper lip, unusual facial tissue, skin, and bone structure
  • Vision and/or hearing impairments
  • Small head and brain size
  • Organ defects
  • Bone defects
  • Defects in extremities and joints
  • Sleep and feeding difficulties

It is difficult to determine how many children are affected by FASD or any other drug related exposure, but one study of school aged children has suggested 6-9 out of every 1000 children in the U.S. have Fetal Alcohol Spectrum Disorder (FASD).

Childhood Issues and Needs for Babies Exposed In Utero

The troubles for children exposed to toxic substances in utero do not end in their infancy. Many have impairments they must live with throughout their lives. These include not only physical effects of drug exposure but also negative effects in other realms of growth and development, resulting in the need for special services and care. Some of the problems children who were exposed to drugs in utero have as they age include:

  • Physical disabilities resulting from birth defects
  • Neurological impairments
  • Developmental delays
  • Cognitive delays and retardation
  • Inadequate bonding
  • Emotional and psychological difficulties related to inadequate bonding
  • Emotional difficulty due to inability to regulate emotions
  • Delays in motor skill development
  • Language and speech disabilities
  • Learning disabilities
  • Conduct disturbances
  • Poor memory
  • Poor information processing
  • Poor coordination
  • Poor balance
  • Attention problems
  • Hyperactivity
  • Difficulty following directions
  • Difficulty staying on task
  • Impulsivity
  • Poor social skills

Children exposed to maternal addiction during pregnancy can have any number of issues and in various combinations. Their impairments and needs can range from mild, to moderate and severe. They can be helped to achieve higher levels of functioning and success with special services and care, however. Progress can be made in such areas as developing:

  • Language
  • Speech
  • Motor skills
  • Self-control
  • Self-soothing
  • Social interaction
  • Memory and cognition coping skills
  • Methods to cope with learning disabilities
  • Methods of coping with education settings
  • Methods of managing home life

Treatment for Addiction During Pregnancy

Although often overwhelming hopeless, women who are pregnant and addicted can take action that makes a significant difference in the health and survival of their babies, as well as themselves. Addiction informed medical care at any stage of pregnancy helps stop damage to babies, and makes pregnancy and delivery safer for the mother. Survival rates for both mother and child can be dramatically improved with the proper prenatal care obtained as soon as possible.

Addiction during pregnancy requires specialized treatment from a team of professionals that are trained specifically to treat such issues. Care should be well coordinated by a physician following prenatal care, and addiction specialists. Addiction treatment requires addiction specialists that can supervise safe withdrawal and detox of the mother while safeguarding the unborn child. Many inpatient rehabs are equipped to help pregnant women stop drug use and enter addiction recovery prior to delivery. There are also specialized programs after rehab that pregnant women and women with newborns can attend. The mother’s addiction recovery best ensures immediate and long-term safety for the baby.

Addiction during pregnancy inevitably calls into question the child’s safety on multiple levels prenatally, but also after birth. Child protection agencies are informed of infants born with evidence of having been exposed to addictive substances in utero. Healthcare professionals are legally mandated to make such reports. It is common for ensuing court involvement to mandate addiction treatment, and even follow up with structured programs for addicted mothers. Often mother and child are temporarily separated until the mother is in recovery and stable.