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Women's Health Education Program (WHEP) Blog Substance Use Disorder During Pregnancy

Growing Fetus

This article includes discussion of substance use that may be challenging for some readers.

October 21, 2022
By Riddhi Deshpande, Drexel University College of Medicine

Substance use during pregnancy is a public health concern as it can harm both the mother and the fetus. It is estimated that 8.5% of all pregnant women in the U.S. use substances during the pregnancy (Smith, 2020). Substance use during pregnancy is associated with an increased risk of low birth weight, birth defects, neonatal mortality and long-term developmental issues (Louw, 2018 and Oni, 2021). Because of the possible health risks of using substances during pregnancy, physicians should have an understanding of this issue. It is especially important for physicians to understand factors that discourage versus encourage patients to seek treatment for substance use disorder during pregnancy in order to provide effective care.

Studies suggest that pregnant women are less likely to successfully complete a substance use disorder treatment program than nonpregnant women (Smith, 2020). However, it is important to note that patients who are referred to a treatment program have a significantly greater chance of completion compared to patients who are self-referred to treatment programs. Therefore, it is important that treatment services be easily accessible to pregnant women and that the referral process empowers these women to seek treatment.

Women using substances during pregnancy may have limited access to health care due to unfavorable social determinants of health, such as lack of formal employment, financial strain, and unsecured housing. A qualitative study using focus groups found that stressors such as abuse and financial strain were predictive of continued substance use during pregnancy, while feelings of self-efficacy were associated with substance use discontinuation (Latuskie, 2019) Those who do seek treatment may face stigmatization or may find that pregnancy itself is a barrier to obtaining treatment as some programs do not treat pregnant women. One study suggested that one of the most significant barriers to accessing treatment was the fear of losing custody of their children, while another study cited lack of medical understanding of substance use consequences as a major barrier (Frazer, 2019, Latuskie, 2019, and Oni, 2021). To avoid stigmatization or criminalization, some pregnant women adopted measures to avoid detection by forgoing necessary medical care and isolating from family. Those who did disclose substance use during previous experiences in health care noted negative experiences that deterred them from discussing substance use during pregnancy. However, those who were referred to a specialized treatment program designed for pregnant women found the services helpful in receiving non-judgmental education about substance use consequences, obtaining treatment, and navigating requirements set by child protective services.

Physicians should be aware that several factors, such as non-judgmental education, trauma-informed care and patient empowerment, can encourage pregnant women with substance use disorders to seek treatment.

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  • Frazer, Z., McConnell, K., & Jansson, L. M. (2019). Treatment for substance use disorders in pregnant women: Motivators and barriers. Drug and alcohol dependence, 205, 107652.
  • Latuskie, K. A., Andrews, N., Motz, M., Leibson, T., Austin, Z., Ito, S., & Pepler, D. J. (2019). Reasons for substance use continuation and discontinuation during pregnancy: A qualitative study. Women and birth : journal of the Australian College of Midwives, 32(1), e57–e64.
  • Louw K. A. (2018). Substance use in pregnancy: The medical challenge. Obstetric medicine, 11(2), 54–66.
  • Oni, H. T., Drake, J. A., Dietze, P., Higgs, P., & Islam, M. M. (2021). Barriers to women's disclosure of and treatment for substance use during pregnancy: A qualitative study. Women and birth : journal of the Australian College of Midwives, S1871-5192(21)00202-X. Advance online publication.
  • Smith W. T. (2020). Women with a substance use disorder: Treatment completion, pregnancy, and compulsory treatment. Journal of substance abuse treatment, 116, 108045.

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