August 6, 2024
A growing public health concern, as well as a criminal one, substance use during pregnancy not only impacts the health of a fetus but that of the mother, and risks potential arrest, conviction, or the removal of a child.
In the United States, around 5% of woman use one or more addictive substances during pregnancy, including tobacco, alcohol, and prescription and illegal drugs, with substance abuse resulting in significantly detrimental social and maternal health outcomes if not managed accordingly.
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In an ideal world, all women planning for pregnancy would be screened for substance use, with those who test positive being referred for additional treatment and support. Typically, pregnancy may be a younger woman’s first time engaging with health services, which can be a motivator to stop or find help to stop using substances, but long-standing stigma from the public and healthcare professionals and risk of prosecution, can influence a mother’s desire to seek help, as well as bias the treatment provided by healthcare professionals, impeding mothers’ access to evidence-based treatments.
Figures from the 2012 National Survey of Drug Use published by the Substance Abuse and Mental Health Administration state that nearly 9.4% of pregnant women aged 15-44 years reported drinking alcohol, 17.6% reported smoking tobacco, and 5% reported using illicit drugs. Other reviews have shown that 2.5% of all pregnant women, and close to a fifth of those with Medicaid insurance, filled at least one opioid prescription during pregnancy.
The silver lining, albeit small, is that the use of these substances does tend to decrease throughout pregnancy as most women try to cut back. But for those who continue use, this ordinarily includes one or more of the following:
Tobacco use during pregnancy contributes to several complex maternal health concerns, significantly heightening the risk of prematurity, fetal growth restriction, birth defects, decreased birth weight, and sudden unexplained infant death.
Like tobacco, the perception of the safety of alcohol due to its legal status can also be misleading. Alcohol consumption during pregnancy, no matter how little is consumed, poses even more severe risks such as fetal alcohol syndrome (FAS). Despite its legality, alcohol is a potent teratogen, and FAS is a leading cause of preventable intellectual disability in the United States.
While legal in many states, despite its status as a federally banned substance, Marijuana has been shown to be associated with stillbirth, low birth weight, and preterm birth. Though direct evidence is lacking, there are concerns about poorer cognitive outcomes in children exposed to marijuana in utero, which has led the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics to advise against its use due to potential neurodevelopmental impacts.
With more illicit drug us, the risks of poor outcomes extend further. Cocaine use during pregnancy is highly linked to pre-eclampsia, pulmonary edema, low birth weight, and prematurity, while amphetamines present even more severe dangers, including maternal hypertension, placental abruption, fetal demise, and neonatal death. Similarly, opioids can cause neonatal opioid withdrawal syndrome, leading to prolonged hospitalization and developmental issues for the newborn.
The estimated lifetime cost of care for an infant exposed to a substance-using mother in the US range from around $750,000 - $1,400,000. Thus, careful consideration of maternal and neonatal treatments is of utmost importance, not only to reduce the financial burden on the healthcare system but to increase the chances of a better health outcome for both mother and child.
Data from the late 90s showed that intensive multi-professional care saves an average of $4,644 per mother-infant pair. Appropriate opioid treatments can drastically reduce hospital stays and costs, with combined treatments costing $33,344 compared to $69,200 for opium alone. Specialized maternal care, such as residential programs, therefore results in healthier infants and is more cost-effective.
Implementing universal screening for substance use during pregnancy is essential for early intervention and better health outcomes. The World Health Organization, Substance Abuse and Mental Health Services Administration, American College of Obstetricians and Gynecologists, and United States Preventive Services Task Force all recommend routine screening. Research shows that this approach helps identify those needing substance use-specific services and addresses social determinants of health, ultimately improving outcomes and reducing healthcare costs.
But the criminalization substance use during pregnancy is deterring mothers from seeking prenatal care, with eighteen states classifying substance use during pregnancy as child abuse. Pregnant individuals of color often face compounded stigma, making their challenges even greater, with substance-abusing women of color being subject to more surveillance, conviction, and child removal.
A growing number of experts, including maternal specialists, federal health officials and addiction services, are calling for changes to the laws in an effort to remove the intense anxiety surrounding the threat of reporting to child protective services, which impacts a mother’s decision as to whether to accept anti-addiction treatment.
Medications for use disorder can decrease risk of overdose deaths, improve pregnancy outcomes and increase the likelihood of carrying to term. Studies have shown that self-report screening early and periodically during pregnancy leads to decreased substance use and reduced morphine treatment for newborns. Healthcare providers should thus ask about substance use in a person-centered manner to establish better communication and trust with their patients to encourage honest disclosure and reduce stigma.
Mother Goose Health is facilitating effective prenatal care for mothers struggling with substance use by removing stigma, building trusting relationships with mothers, and delivering seamless access to essential services.
Recognizing the critical need for early and routine screenings, Mother Goose Health offers a comprehensive platform that integrates all aspects of maternity care, ensuring timely intervention and continuous support.
The Mother Goose app provides 24/7 direct chat support with a mother’s care manager, with whom they can build a trusting relationship throughout the course of their pregnancy and in the year following birth. This provides a safe, non-judgemental space to ask questions, share concerns and encourages open discussions about substance use early, fostering a more compassionate, supportive environment.
Additionally, the app also allows mothers to upload vital health data directly, bypassing the potential stigma of face-to-face doctor visits, including regular blood pressure checks, which addresses some of the significant risks associated with illicit drug use during pregnancy. By facilitating these screenings and offering personalized support, Mother Goose Health helps in the early identification of high-risk pregnancies, significantly reducing the incidence of preterm births and associated NICU stays.
Furthermore, Mother Goose Health’s network provides access to remote, online mental health and recovery support to help to address addiction and associated mental health challenges.
This innovative approach has led to a 55% lower preterm birth rate among its users compared to those not using the platform. By providing continuous, compassionate care and utilizing a high-quality network of providers, Mother Goose Health is revolutionizing maternal healthcare, improving outcomes, and reducing costs.