19 - Management of drug misuse in pregnancy

Summary

Summary Use of both licit and illicit drugs can lead to a range of medical, psychiatric and social problems, and the situation becomes further complicated if the user is pregnant. Prescribed and non-prescribed substances can affect a pregnancy, and substances are seldom used in isolation. This chapter focuses on the use of illicit drugs (including prescribed drugs used illicitly) during pregnancy and describes some of the issues in managing such cases. The impact of substance use on the foetus, the mother and the new-born child is considered, and the importance of multidisciplinary working in this area is highlighted. Space precludes a detailed account of the issues surrounding the use of legal substances such as alcohol and tobacco during pregnancy, but they also have a significant impact in this group (see chapters 6 and 8).

It is difficult accurately to estimate the prevalence of high-risk drug use during pregnancy for a variety of reasons: feelings of shame, denial and stigma experienced by the drug user, lack of awareness among professionals in antenatal services, the presence of comorbid psychiatric disorders, and sociocultural barriers that prevent a thorough assessment. However, we know that about one-third of drug users in treatment in the UK are female, and over 90% of these women are of childbearing age (15–39 years). A number of large surveys of drug use in different populations conducted in the USA provide a further insight. For example, the National Pregnancy and Health Survey gathered self-report data from a sample of 2613 women whose babies were delivered in 52 urban and rural hospitals during 1992 (National Institute of Drug Abuse, 1996). Over 5% of those who gave birth during the study period had used illicit drugs while they were pregnant, with 2.9% using cannabis and 1.1% using cocaine at some point in their pregnancy (compared with 20% smoking tobacco and 18.5% drinking alcohol). A further report combined 2 years of US National Household Survey data (1994 and 1995) for women and girls 15–44 years old and found that 9.3% reported current use of illicit drugs, with 2.3% doing so while pregnant. The problem is therefore a significant one, particularly as it has implications for both mother and child.