Substance abuse in Pregnancy 

Evidence 

https://ranzcog.edu.au/wp-content/uploads/2022/05/Substance-use-in-pregnancy.pdf 

‘Substance use is associated not only with adverse pregnancy outcomes, but with a cascade of health, legal, social, and financial problems that adversely affect the welfare of the mother and child. For these reasons, broad psychosocial assessment is necessary to understand the reasons for the woman's substance use, helping allows these to be addressed.’ 

Education 

Effects of Drugs on Mother and Baby 

During pregnancy, the exchange of oxygen and nutrients in the blood happens through the placenta from the mother to the baby and any substance that is carried through the mother’s blood, including alcohol, illegal drugs, or prescription medications, can possibly affect the baby. Substance abuse may harm the baby in one or more ways. The unborn baby is very sensitive to drugs and can’t eliminate drugs as effectively as an adult, resulting in the drugs building up to extremely high levels in the baby’s system and may also cause permanent damage to the baby. Sometimes these problems are not known until the baby is born and as time passes when the baby gets older, problems may surface that were not obvious at birth. 

Here are some of the specific consequences of drug use during pregnancy: 

• Low birth weight places an infant at a higher risk for illness, intellectual disability, and even death. 
• Premature birth increases the risk multiple problems of lung, eye, and learning problems in the infant. Also, birth defects can often occur due to drug use this; include seizure, stroke, and intellectual and learning disabilities. 

• Birth defects & stillbirth 
• Sudden unexpected death of the infant (SUDI) 
• Substance use before pregnancy and during pregnancy also puts babies at risk for developing neonatal abstinence syndrome (NAS). NAS is a syndrome of drug withdrawal symptoms in babies of women who are physically dependent on the drug during pregnancy some symptoms for the baby to have include: neurological excitability, gastrointestinal dysfunction, autonomic signs, poor weight gain, neuromuscular abnormalities and occasionally seizures. Some information says that these symptoms are more common in infants born to mothers of opioid-dependant women. 

There are obvious contraindications for drug use during pregnancy and breastfeeding and the more common one’s are as follows:  

• MDMA 
• Heroin 
• Methamphetamine 
• Opioids /Narcotics

These are more common drugs that are harmful to the unborn baby or while you breastfeed. 

Tobacco while Pregnant and Breastfeeding 

If you smoke the best thing is to limit and quit although keep in mind that some quitting methods may not be suitable while you're pregnant — ask your health professional for advice on what is best for you and your baby or call the Quitline 13 78 48. 

If you can’t stop smoking right now these are some safety measures that will help: 

• Breastfeed before smoking 

• Smoke outside, limit as much as possible secondary exposure the baby 
• Wear clothes while smoking which can be removed after smoking 
• Carers who smoke should also wash their hands and clean their teeth before breastfeeding 
• Be aware that babies exposed to tobacco smoke in utero and after birth are more at risk of SUDI and respiratory difficulties 
• Never co-sleep

Cannabis while Pregnant and Breastfeeding 

Research shows that 3-16% percent of pregnant females use this drug. According to available studies, after birth, the baby may have poor growth, be at risk for childhood leukemia, and experience neurobehavioral problems, such as irritability, tremors or be prone to high-pitched crying. 

• Abstinence is the safest option when pregnant because it not known how much is passed on to the baby through the breastmilk 
• Some effects to the baby may include sedation, growth delay, poor muscle tone and poor sucking  
• May reduce milk supply 
• Babies born to women that are solely addicted to cannabis could have a delayed onset of withdrawal symptoms for up to 10 days after birth

Alcohol while Pregnant and Breastfeeding 

Alcohol can cause a condition known as fetal alcohol syndrome (FAS), characterized by abnormal facial features, slowed fetal growth, and dysfunctions of the central nervous system (brain and spinal cord). Damage to the central nervous system can lead to a baby growing up to have a low IQ or a behavioural disorder, such as attention deficit hyperactivity disorder (ADHD).  

The following factors are important to consider: 

• The concentration of alcohol in your blood is the concentration of alcohol in your milk 
• Alcohol gets into your breastmilk from your blood, moving freely from the blood to the breastmilk (and back out again) 

• Alcohol will be in your breastmilk 30–60 minutes after you start drinking 
• The strength and amount of alcohol in your drink 
• What and how much you’ve eaten 
• How much you weigh 
• How quickly you are drinking 
• As a general rule, it takes 2 hours for an average woman to get rid of the alcohol from 1 standard alcoholic drink and therefore 4 hours for 2 drinks, 6 hours for 3 drinks and so on. The time is taken from the start of drinking. The Feed Safe app can help you work out these times more accurately 
• Only time will reduce the amount of alcohol in the milk in your breasts

Feed Safe App suggested by the Australian Breastfeeding Association. This app will help make safe choices while drinking alcoholic drinks and breastfeeding. 

https://www.breastfeeding.asn.au/resources/alcohol-and-breastfeeding 

Empowerment 

Treatment Questions 

• Is there help for pregnant women who what stop using drugs? 
• Who can I talk to about this? 
• I’m afraid I will get into trouble, or they may take my baby away can you tell me what is the process is if I disclose my drug use?

Pregnant women with substance use disorders may be apprehensive to get the help they need because of shame and fear of the judgemental remarks of others, or not understanding how to access services that are acceptable. But help is available for any drug or alcohol problem at hospitals and clinics. There are services that can give you support and provide you with the appropriate resources to help you stop using drugs or alcohol. You can look online for information on support groups in your area, such as Alcoholics Anonymous, Narcotics Anonymous, and Cocaine Anonymous. There are also drug treatment centres, social and family service agencies, and alcoholism and drug abuse counsellors. 

There is a need to address the stigma associated with substance use in pregnancy so that women can be supported and find the right treatment and have the best possible health for themselves and their babies. It’s important to not judge women in this situation and help direct them to the special help they need.  

If you have a problem with alcohol or other drugs use this can often make you feel judged and ashamed. This can put a barrier to getting urgent health needs met and this might stop you from getting the right antenatal care. There is support for you if you have a substance abuse problem please reach-out to any of the listings below.   

Useful Links 

Alcoholics Anonymous (AA) 1300 222 222 

Narcotics Anonymous (NA) 1300 652 820 

Every Moment Matters  

https://everymomentmatters.org.au/support 

Smoking and Pregnant  

https://www.quit.org.au/articles/how-to-quit-when-pregnant/ 

Australian Government – Department of Health 

https://www.health.gov.au/resources/pregnancy-care-guidelines/part-c-lifestyle-considerations/substance-use 

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