Drug and Alcohol Use in Pregnancy and When Breastfeeding

Research into drug and alcohol use during pregnancy and when breastfeeding 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. 

The current recommendations are clear about pregnant and breastfeeding mothers to avoid using any alcohol or (unprescribed) drugs.

During pregnancy and when breastfeeding

What we know to be true about drugs and alcohol:

1. Both can have a negative impact on a mother and her growing baby.
2. Exposure to either alcohol and/or drugs the first trimester (3 months) of pregnancy can affect a baby’s development.
3. A growing fetus cannot metabolise alcohol or drugs in the same way an adult can. Their organs are immature and particularly sensitive to chemical substances.
4. A baby’s liver cannot metabolise drugs or alcohol. Their blood alcohol level is the same as the mothers if she drinks.
5. 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 and types of alcoholic drinks 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. Any drink which contains alcohol poses a risk of harm to the developing baby, either during pregnancy or when they are breastfeeding. Beer, wine and spirits are all equally risky.

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

What are the specific risks of using drugs and/or alcohol when pregnant or breastfeeding?

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:

1. Pregnancy loss – miscarriage and stillbirth.
2. The baby being a low birth weight for their gestational age.
3. The baby having complications when they are born. Breathing, temperature regulation, maintaining a healthy blood sugar level and feeding difficulties are all more common.
4. Premature birth. Babies who are born early are at more risk of a range of complications.
5. Birth defects including seizures, learning difficulties and seizures.
6. 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 condition 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:

1. Accidents
2. Overdosing
3. Having poor nutrition
4. Having inadequate or unsafe housing
5. Mental health issues
6. Disease and illness
7. Infections
8. 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.   

As the child gets older

Complications of drug and alcohol use during pregnancy are not solely restricted to the early years. Mothers who drink alcohol during pregnancy are at risk of having a baby with FASD (Fetal Alcohol Spectrum Disorder). This is a disability which impacts on the baby’s brain and body. 

Babies who’ve been exposed to drugs and alcohol 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.

Treatment options include:

1. Cognitive behaviour therapy (CBT) and ‘talking’ therapies
2. Counselling and support
3. Group therapy
4. “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 struggle to talk about your drug or alcohol use:

Write your concerns on a piece of paper and hand it to your maternity care provider at your next appointment.

1. Take a trusted friend or family member with you. Ask them to speak on your behalf if you’re unable to do this yourself.   
2. 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.
3. Hand your maternity care provider printed information about drug and alcohol use during pregnancy. Sometimes you don’t need to say much to get the message across.
4. Show your maternity care provider evidence of your drug use. Track marks, bruises, scratches – all give clues to an experienced person.
5. 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.
6. 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.
7. Ask your GP or healthcare practitioner to make contact with the maternity hospital where you’ll be having your baby.

About the Author:

Written for Nourish Baby by Jane Barry. Jane has qualifications in general, paediatric, immunisation, midwifery and child health nursing. She holds a Bachelor Degree in Applied Science (Nursing) and has almost 35 years specialist experience in child health nursing. She is a member of a number of professionally affiliated organisations including AHPRA, The Australasian Medical Writer’s Association and Australian College of Children and Young People’s Nurses.

For more information:

Better Health - Drugs, medication and birth defects

COPE - Alcohol and Drugs in Pregnancy

References

Alcohol during pregnancy and breastfeeding | Australian Government Department of Health

Australian Breastfeeding Association |

Breastfeeding and Drugs (health.qld.gov.au)

Smoking, alcohol and drug use during pregnancy and breastfeeding - Patient Information Brochures - Mater Group

Substance use during pregnancy - care of the mother and newborn | Safer Care Victoria (bettersafercare.vic.gov.au)