Drug and Alcohol Use in Pregnancy

Research into drug and alcohol use during pregnancy is constantly evolving. And although the specifics change, the essential message remains the same. We don’t truly know what a safe level of drug or alcohol use is. 

Until we know more, the recommendations are clear about pregnant mothers avoiding all alcohol or drug use during their pregnancy.

Every mother and her growing baby are unique. What is a toxic or potentially dangerous level of a drug or alcohol for one pregnant mother may not be so risky for another.  The only way to confirm individual risk profiles is to experiment with dosages – this of course, is impossible.

The Dangers of Drug and Alcohol Misuse During Pregnancy

What we know to be true:

  • Both can have a negative impact on a mother and her growing baby.
  • Exposure to either alcohol and/or drugs the first trimester (3 months) of pregnancy can affect a baby’s development.
  • A growing foetus cannot metabolise alcohol or drugs in the same way an adult can. Their organs are immature and particularly sensitive to chemical substances.
  • Pregnancy changes the way a mother’s body reacts to drugs and alcohol. This means that some drugs are more harmful during pregnancy.

What Drugs are Harmful?

Alcohol, cigarettes and drugs such as marijuana, opiates, benzodiazepines and some antidepressant medications, cocaine, heroin and amphetamines are all known to have harmful effects on a developing baby.

Even some prescription medications can be dangerous when taken during pregnancy. In the first trimester when the baby’s organs are forming, particular drugs can be Teratogenic  e.g.  cause birth defects.  

What are the Specific Risks of Drug and Alcohol Use During Pregnancy?

Risk level changes depending on the level of alcohol or drugs being used. Some mothers already have pregnancy complications such as hypertension (increased blood pressure) or gestational diabetes. These conditions also change the way her body responds to alcohol and/or drugs.

There is also an increased risk of:

  • Pregnancy loss – miscarriage and stillbirth.
  • The baby being a low birth weight for their gestational age.
  • The baby having complications when they are born. Breathing, temperature regulation, maintaining a healthy blood sugar level and feeding difficulties are all more common.
  • Premature birth. Babies who are born early are at more risk of a range of complications.
  • Birth defects including seizures, learning difficulties and seizures.
  • The baby becoming drug dependent. This means that when they are born they experience withdrawals and need sedation.

Pregnancy and Addiction – What Happens to a Mother and Baby

Addiction is a complex problem and like most complicated situations, there is no one simple solution.  In many cases, addiction is a symptom of bigger issues going on in someone’s life. Their    use of alcohol or drugs can be a way to cope with their emotional pain or trauma.

Finding the cause for addiction and doing something about it can take an enormous amount of motivation and energy. Some women claim that being pregnant and having their baby ‘saved’ them.  

Mothers who use Substances During Pregnancy

Are more at risk of:

  • Accidents
  • Overdosing
  • Having poor nutrition
  • Having inadequate or unsafe housing
  • Mental health issues
  • Disease and illness
  • Infections
  • Death

Prioritising their baby’s needs gave them the drive they needed to seek help.

Neonatal Abstinence Syndrome (NAS)

Some drugs, including opioids, can cause the baby to experience withdrawal symptoms when they are born.  This condition is called Neonatal Abstinence Syndrome (NAS).  Caring for these babies is a complex process because they are at greater risk of having seizures and breathing problems.

Depending on the severity of their withdrawals, babies may need morphine to support their body’s reaction to a sudden withdrawal from alcohol and/or drugs.   If substances have been taken regularly, especially in the third trimester, the baby is more likely to experience withdrawal symptoms after they are born.  A special scoring tool – Finnegan Score measures a baby’s withdrawal symptoms.

Babies with NAS are also prone to breathing and feeding difficulties as well as other, long-term health problems.   

Down the Track

Complications of drug and alcohol use during pregnancy are not solely restricted to the early years. Babies who’ve been exposed to these substances are at more risk of problems with their growth, development and learning.  This is because of brain changes which happen as a result of being exposed to   substances at crucial times in their brain formation.

If alcohol and drug use has been excessive, it can be dangerous to stop suddenly.  The general advice is for pregnant mothers to be monitored carefully and for treatment programs to be tailored specifically to their needs.

Detoxification programs are run by specialist drug and alcohol units. Similarly, most large maternity hospitals have access to best practice guidelines for managing a mother’s withdrawals.

As well as the physical management of withdrawals from drug and alcohol use, psychological support is crucial

Popular options include:

  • Cognitive behaviour therapy (CBT)
  • Counselling and support
  • Group therapy
  • “Step” Programs

Where to Get Help

Most large maternity hospitals have specialist units which are designed to care for pregnant mothers who use drugs and/or alcohol.  The first step in getting help is to talk with your maternity care provider. Know for sure that you aren’t the first to ask for help and you won’t be the last.

If you have problems bringing up the topic:

  • Write your concerns on a piece of paper and hand it to your maternity care provider at your next appointment.
  • Take a trusted friend or family member with you. Ask them to speak on your behalf if you’re unable to do this yourself.   
  • Ask your partner to go to appointments with you and to be an advocate. If you are struggling to talk, give your advocate permission to speak on your behalf.
  • Hand your maternity care provider a leaflet or printed off information about drug and alcohol use during pregnancy. Sometimes you don’t need to say much to get the message across.
  • Show your maternity care provider evidence of your drug use. Track marks, bruises, scratches – all give clues to an experienced person.
  • Check the hospitals website and make direct contact with the drug and alcohol support service. They will respect your privacy and maintain confidentiality until you give permission to share information with your healthcare providers.
  • Ask your drug and alcohol support person (if you have one) to go to your appointments with you. Take a copy of your treatment plan (if you have one) so that everyone’s clear on your management.
  • Ask your GP or healthcare practitioner to make contact with the maternity hospital where you’ll be having your baby.
For more information:

Better Health - Drugs, medication and birth defects

COPE - Alcohol and Drugs in Pregnancy

Written by: Jane Barry, Midwife and Child Health Nurse

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