Substance use disorder is widespread across America and the wider world. It is a complex, chronic condition, and the consequences can be even more severe when a woman becomes pregnant. 4.5% of pregnant women report using illicit drugs during pregnancy, while scientists estimate that the true number may be between 11-24%.[1][2]
Untreated substance use during pregnancy can be harmful to the mother and the fetus, but specialized treatment can minimize those risks.
Here’s everything you need to know about addiction treatment and rehab during pregnancy.
- Drug and alcohol addictions can be especially dangerous to anyone who is pregnant and can harm the fetus.
- Coordinated prenatal treatment plans offer extended support and can include detox or pharmacotherapy, as well as parenting training.
- Having strong social support and finding a treatment program that meets your needs are key to recovery.
The risks of substance use during pregnancy
Much of the research into the risks of substance use during pregnancy concerns the harm it can cause to the fetus, but many of these conditions can also be life-threatening for the pregnant woman as well. One example is placental abruption, where the placenta separates from the wall of the uterus.
Here are some of the most common drugs and how they can affect the pregnant woman, fetus, or newborn baby. [3][4]
| Substance | Effect |
|---|---|
| Alcohol |
|
| Nicotine |
|
| Cannabis |
|
| Stimulants |
|
| Opioids |
|
Other risks can include an increased risk of sudden infant death syndrome (SIDS) and possible diseases associated with drug use, such as HIV.[2]
Specialized treatment options for pregnant women
Specialized treatment options for pregnant women address the unique challenges of substance use disorder (SUD) during pregnancy, ensuring both maternal and fetal well-being. These approaches combine behavioral therapies, medication-assisted treatment, and comprehensive prenatal care to improve outcomes for both mother and baby.
Behavioral therapy
Behavioral therapies for addiction focus on helping people with SUD to change their behavior. Cognitive behavioral therapy (CBT) explores links between thoughts, feelings, and behaviors, offering alternative strategies to deal with situations that would normally lead to substance use.
Motivational interviewing allows people with SUD to explore their reasons for stopping using substances and enhance their motivation to quit. Both of these techniques have been shown to be effective during pregnancy.[7][8]
Pharmacotherapy
Medications can be used to help pregnant women deal with the symptoms of withdrawal or as an alternative to full detox. These medications can be associated with some risks during pregnancy, but those risks are less serious than the risks of continued substance use.
Alcohol withdrawal can be dangerous, but continued alcohol use during pregnancy can harm the fetus. Benzodiazepines, especially long-acting ones, can offer a smoother, safer withdrawal. Medical practitioners may recommend avoiding these too close to labor, however.[3]
Rapid opioid withdrawal can lead to preterm labor, with associated health risks for the baby. The risk of relapse for opioid addiction is also higher after detox than when supported with medication (pharmacotherapy). For these reasons, the American Society of Addiction Medicine, the American College of Obstetricians and Gynecologists, and the World Health Organization all recommend pharmacotherapy for pregnant patients with opioid use disorder (OUD).[6] Both methadone and buprenorphine can lead to neonatal abstinence syndrome (NAS), where the baby experiences some withdrawal symptoms after birth, but this can be managed by medical practitioners.
Comprehensive care
Comprehensive care providers for addiction treatment during pregnancy aim to offer all the services required as part of their treatment program. This ensures that prenatal care, obstetrics, and other needs can all be met. This increases the chance of a woman completing the program and having a healthy baby.
Detox and pregnancy
Detox isn’t the same as treatment for SUD. It’s the process of managing substance withdrawal and minimizing dangerous withdrawal symptoms.[5] This is usually considered an ideal first step to SUD treatment. For someone who is pregnant, however, detox might not always be the best choice for them and their baby, depending on the substances they have been using.[6]
In cases of opioid addiction, full detox might not be the most appropriate course of action. Instead of stopping substance use, pregnant women might be advised to transition to medications for opioid disorders. These medications include methadone and buprenorphine.[6]
For alcohol abuse, detox is highly recommended to avoid fetal alcohol syndrome, but medications can be used to ease the symptoms.
Medical supervision is essential for anyone with a SUD who wishes to detox while pregnant.
The importance of prenatal care during treatment
SUD treatment and rehab during pregnancy are trying to create positive outcomes for both the mother and the baby. Prenatal care, especially comprehensive, multidisciplinary care, is associated with better outcomes for both.[2]
Prenatal care during SUD treatment can include:
- Gynecology
- Obstetrics
- Pediatrics
- Parenting skills training
- Family therapy
- Birthing classes
- Family planning
- Occupational support
- Lactation support
- Nutritional support
- CPR classes, due to higher rates of Sudden Infant Death Syndrome (SIDS)
- Relapse prevention
Challenges in seeking treatment while pregnant
Finding high-quality treatment for addiction while pregnant can be difficult. Many clinics are designed with adult men in mind, and some actively exclude pregnant women because of the complexities involved in their care.[2]
The overwhelming majority of clinical trials for medications specifically exclude pregnant women, meaning that we don’t know the effects of many drugs (including some of those used to treat addiction) on the health of these women or the fetus.[3] As a result, some doctors and medical practitioners are reluctant to offer medications to someone who is pregnant.
Pregnant women often face additional barriers to seeking addiction care, including: [2]
- Lack of transport to addiction centers, especially if having to travel out of state
- Lack of childcare for any existing children
- Lack of obstetrics care at treatment facilities
- Feelings of being stigmatized or shamed by medical professionals for their continued substance use
- Lack of focus on women’s needs
Family and social support for pregnant women in recovery
A strong social support network can be extremely beneficial to women in recovery from SUD. Close friends and family members can offer support in a variety of different ways. These include: [9]
- Providing information, such as teaching them coping skills or offering sobriety support
- Providing emotional support through encouragement, praise, and positivity
- Providing concrete support through helping with money, housing, childcare, or handling healthcare admin
Caring for someone who is dealing with SUD can be challenging. Look for resources designed to support families of people with substance use disorders. You may also want to talk to your doctor or healthcare provider about any additional support that might be available to you.
Choosing the right rehab for pregnant women
Choosing the right rehab center is a personal decision. There’s no single set of criteria that every pregnant woman will want or need. The right rehab center or treatment option is the one that’s right for you and your circumstances.
Here are some questions you might want to ask:
- Do you have a history of trauma? If so, is the treatment option you’re considering trauma-informed?
- Do you believe that inpatient or outpatient care would best suit your needs? Is the treatment option compatible with this?
- Do you have effective prenatal care outside of addiction treatment, including obstetrics? If not, are these aspects of care incorporated into your treatment?
- What needs do you anticipate having after treatment or after the birth? Is this treatment able to meet those needs?
- How far are you willing or able to travel for treatment?
- How much does this treatment option cost, and can you afford it?
It’s often helpful to compare several different treatment options to get a better sense of which ones will meet your needs. The Recovered Rehab Directory lets you search for providers in your area.
