There Is Hope: Substance Use Disorder (SUD) During Pregnancy

In the United States, one of the most stigmatized and abused populations includes people with substance use disorder (SUD). The judgment and bias against this population only seem to increase if individuals become pregnant. Being demonized for a chronic and progressive illness and being charged with a felony for a positive drug screen while being pregnant are morally wrong.

People become fearful for their safety and the safety of their children, including their unborn child. When people are fearful and unwelcome by the medical community, they avoid the services that they desperately need. This is unnecessarily detrimental to the health of the parent and baby. When people with SUD receive comprehensive, combined, integrated care during their pregnancy, the outcome for the entire family improves dramatically.

Barriers to Treatment

The pregnant population suffers if they have SUD because healthcare workers, family, friends, and loved ones’ attitude creates a barrier to prenatal care and other supportive services related to their SUD. When people use disrespectful, stigmatizing words toward pregnant people with SUD, the pregnant person usually feels judged and devalued. These feelings of alienation can be particularly strong if the person using the disrespectful, stigmatizing language is medical personnel.

When this happens, the consequence results in an individual experiencing isolation, a lack of support, poor prenatal care, or no prenatal care at all.

Common barriers to treatment include:

• Stigma
• Fear
• Shame
• Punishment
• Judgment
• Lack of transportation
• Cost
• Lack of availability
• The bias of medical and treatment providers
• Distrust of the healthcare system

Health Challenges

SUD can compound health problems for pregnant people and their babies. These challenges can be present during pregnancy, birth, and post-partum. The risk of various complications and co-occurring mental health issues due to substance use during pregnancy cannot be overstated.

The health challenges for the baby include:

• Premature birth
• Low birth weight
• Sudden Infant Death Syndrome (SIDS)
• Miscarriage
• Organ abnormalities
• Abnormal development
• Stillbirth
• Congenital defects
• Poor cognition
• Learning disabilities and poor school performance
• Emotional and behavioral problems
• Psychiatric disorders
• High risk for SUD later in life

The health challenges for the pregnant person include:

• Anemia
• Eclampsia
• Heart problems, heart attack, or heart failure
• Sepsis
• Diabetes
• Higher risk of postpartum mental health issues
• Domestic violence
• Overdose, isolation increases the likelihood of using alone which increases the risk of overdose
• Death

Specific Treatment Goals During Pregnancy

People with SUD need extra support to create and participate in a care plan which combines and addresses all of the co-occurring conditions present. There is a strong need for more substance abuse treatment facilities to offer programs that are designed for pregnant clients and address their specific needs. Some treatment goals that address the additional stress that pregnancy adds include:

• Providing access to assistance programs that help with nutrition, domestic violence, clothes, transportation, and a safe place to live
• Prenatal services that are integrated with treatment plans which are located all in the same place
• Providing assistance navigating health and social systems, including dealing with child welfare agencies
• Medication-Assisted Treatment (MAT)
• Focus on parent/child relationships and parent training
• Paying special attention to post-traumatic stress due to pregnancy and birth
• Immediate access to help for postpartum depression
• Family therapy

Benefits of Comprehensive Treatment While Pregnant

Treatment plans for SUD, pregnancy, and mental health can and should be managed concurrently. Treatment plans should be managed by all providers working together in a coordinated way. Health care and treatment should be made far more accessible and supportive. People most at risk have a very improved outcome and success in recovery when they receive comprehensive, coordinated care. These benefits are:

• Improved nutrition
• Consistency in care
• Earlier prenatal care
• Continuation of consistent post-natal care
• Better psychosocial support
• Harm reduction
• Peer support
• Pediatric care is supported and included

When a person is pregnant and suffers from SUD, with or without another co-occurring mental health condition, it is imperative that they have access to early universal screening, testing, and care in order to create a positive outcome. Offering access to both treatment of their conditions and prenatal care early in pregnancy improves the outcome for both parent and infant.

Contraceptive services should be routinely included in treatment for all people who can get pregnant in order to minimize the risks of unplanned pregnancy. Obstetric care should be offered by health care providers who have engaged in extra training in addiction medicine so that their role supports all aspects of their patient’s care. Pediatricians similarly should have advanced training and understanding of addiction medicine so that the infant receives care from an educated provider for neonatal abstinence syndrome.

What is clear is that a coordinated multidisciplinary approach to pregnancy and SUD, as well as any other co-occurring mental health conditions, provides the best outlook and chances for pregnant people and their babies.