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Relapsing During Pregnancy

Many things are possible with pregnancy for any woman who is expecting. That group includes mothers in recovery from substance use disorders. However, for them, there is an extra concern: the possibility of a relapse.

Relapse is always an outcome for any person in recovery, as well as those who are actively using. Add a baby to that mix, and two lives are threatened. 

An unplanned pregnancy is concerning as it can make women unprepared for cravings that make it easy for them to relapse. Willpower can give in to cravings, derailing any efforts to stay sober.

How Drugs, Alcohol Can Affect Prenatal Babies

Addictive substances are harmful to both mom and baby, so they should be avoided. 

“Using drugs, alcohol, or tobacco during pregnancy exposes not just the woman but also her developing fetus to the substance and can have potentially deleterious and even long-term effects on exposed children,” writes the National Institute on Drug Abuse.

From the very start, a mother’s choices directly affect her unborn child, even if she is not aware that she is pregnant. Everything she eats and drinks comes into contact with the child via the placenta. This life-sustaining organ is how the fetus receives oxygen, food, and nutrients for its proper development. 

If alcohol, drugs, and other harmful substances are used, those, too, can pass through the placenta and negatively affect the fetus. Substance use only heightens the risks that come with pregnancy in the first place. Such use can be life-altering for the baby. It can complicate life before and after birth.

“The most frequently used substance in pregnancy is tobacco, followed by alcohol, cannabis and other illicit substances,” according to this study. Designer street drugs, such as ecstasy and bath salts, inhalants, psychedelics, methamphetamines, and nicotine are on the “avoid these drugs” list. 

The study goes on to say that polysubstance abuse is common in pregnancy. This is when people use two more drugs at the same time. They do so to get a stronger high or use one drug to offset the effects of another. For example, one may use a sedative medication like Xanax to come down from a cocaine high. 

Having a mental health disorder along with a substance use disorder can complicate a pregnancy,  the study says. Dually diagnosed people who have problems with drugs and alcohol are likely to be attempting to manage life with a disorder, such as depression, anxiety, or post-traumatic stress disorder (PTSD). Specialized addiction treatment that addresses both disorders together at the same time is necessary in cases such as these.

Other harmful factors to a woman’s pregnancy include environmental stressors and problems in prenatal care. Having limited or no prenatal care is also an issue. According to the study, all of these can result in harmful outcomes for the mother and baby.

The use of opiates, marijuana, and cocaine during one’s pregnancy can make infants drowsy, anxious, or irritable. It doesn’t take long for these effects to unfold. According to one study, newborns can experience severe withdrawal symptoms within 24 to 72 hours after birth. This happens because their brains and nervous systems are attempting to adjust to the lack of chemicals they had become used to having in their systems while in the womb.

Pregnant women should also take care when using prescription medications and over-the-counter medications. These, too, are potent chemicals, and they can harm pregnant women. 

The Merck Manual reports that “more than 50% of pregnant women take prescription or nonprescription (over-the-counter) drugs or use social drugs (such as tobacco and alcohol) or illicit drugs at some time during pregnancy, and use of drugs during pregnancy is increasing.” 

Harmful substances that are used during pregnancy can increase the likelihood of the following complications:

  • Placenta issues
  • DVT (deep vein thrombosis) – A condition that develops when blood clots form deep ina vein in the lower leg, thigh, pelvis or arm)
  • Antepartum hemorrhage – This is bleeding from the birth canal pre-birth

Other conditions that can result from pregnant women using addictive substances are:

  • Infant mortality
  • Low birth weight 
  • Stillbirth 
  • Sudden Infant Death Syndrome (SIDS)
  • Preterm or early birth
  • Respiratory difficulties
  • Delayed fetal growth

What Happens to Babies Born Dependent on Substances?

The problems for babies born to mothers who used during pregnancy only worsen as their lives begin. Withdrawal from addictive substances is just the beginning of what could be a lifetime of challenges. As their bodies detox from substances during what is called Neonatal Abstinence Syndrome, they can experience:

  • Fever
  • Seizures
  • Tremors
  • Vomiting
  • Lack of appetite
  • Irritability
  • Sleep problems
  • Diarrhea

Babies who overcome drug withdrawal still have other challenges to overcome. Many go on to have learning problems, developmental delays, physical disabilities, and behavioral issues. 

Treatment Options

Pregnant mothers who find themselves in a relapse situation should receive addiction treatment services immediately. While many in this situation avoid getting help, it is best to find a treatment facility that can help them become sober and receive medical services geared toward recovery.

Medical treatment can help avoid further harm to the woman’s health, and it can reduce the chances of her losing her baby. Treatment could boost the baby’s chances of avoiding withdrawal symptoms, developmental disabilities, and other problems.

There are specialized facilities that treat pregnant women who have substance use disorders. A comprehensive treatment facility that provides a staff that is skilled in meeting the needs of pregnant women in recovery, including those who have relapsed, is ideal.

Programs that offer gender-specific services could better address the unique needs that come with pregnancy. These include breastfeeding support and nutritional guidance that encourages healthful eating and overall wellness. These programs also educate women about pregnancy, prenatal care and postnatal care, parenting, and early childhood development. 

Treatment programs should also prepare expecting mothers in recovery with the tools they need for motherhood. For those working to recover from a relapse, having a relapse prevention plan that factors in pregnancy and life after the baby is born can be effective. Women in this group need to know how to manage their lives without substances, and part of that is recognizing triggers and what to do should they arise. 

Recovery is a unique journey to all who take it, so treatment programs won’t look the same for everyone. Still, a facility that offers long-term residential or outpatient programs can help pregnant mothers in recovery ensure that they have the time they need to address their substance dependence or addiction and see to it that their physical and psychological needs are met.

The National Institute on Drug Abuse highlights what pregnant women in recovery should aim for in treatment.

Overcoming substance addiction for the long-term is the goal. Aim to make this relapse your last. Keep in mind that relapse is a part of addiction recovery. According to NIDA, relapse rates are between 40 to 60 percent, which is similar to relapse rates for other chronic illnesses such as hypertension and asthma.  

Having a plan in place to prevent this outcome will serve you well if you follow it. Adjust it as needed. A therapist or counselor can help you work on relapse prevention skills, as well as skills that help you cope with triggers and other situations that, in the past, led to substance use.

Common forms of behavioral therapy are used in addiction treatment, and these can help pregnant mothers as well. Cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) are the most widely used behavioral therapies. Both help people address flawed thought patterns and replace them with patterns that promote a healthy outlook that leads to positive outcomes.

Medication-Assisted Treatment (MAT) is available for people who chronically relapse after using opiate medications or heroin. MAT programs use FDA-approved prescription medications such as Suboxone or methadone to help people taper off their opiate use. This approach is paired with behavioral health therapy and counseling to treat substance use disorders, particularly those involving opioids, alcohol, depressants, and smoking addiction.

According to the Substance Abuse and Mental Health Services Administration, MAT has been shown to be effective. There have been reports of improved patient survival, increased treatment retention, and decreased illicit opioid use. 

The approach also has been credited with improving birth outcomes among women who are managing substance use disorders during pregnancy. However, it’s important to note that participation in MAT therapy often involves long-term chemical dependence on medication. Consult a physician for the best guidance on whether a MAT program is right for you.

Sources

NIDA. “What Are the Unique Needs of Pregnant Women With Substance Use Disorders?” National Institute on Drug Abuse. Retrieved from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-second-edition/frequently-asked-questions/what-are-unique-needs-pregnant-women

“Pregnancy Complications.”Womenshealth.gov, 19 Apr. 2019. Retrieved from https://www.womenshealth.gov/pregnancy/youre-pregnant-now-what/pregnancy-complications

Logan, Beth A., Mark S. Brown, and Marie J. Hayes. “Neonatal Abstinence Syndrome: Treatment and Pediatric Outcomes.” Clinical obstetrics and gynecology 56.1 (2013): 186–192. PMC. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3589586/

Merck Manual. “Drug Use During Pregnancy.” Retrieved from https://www.merckmanuals.com/home/women-s-health-issues/drug-use-during-pregnancy/drug-use-during-pregnancy

National Institute on Drug Abuse. (2018, July). Treatment and Recovery. Retrieved from https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery

Forray, Ariadna. “Substance Use during Pregnancy.”F1000Research, F1000Research, 13 May 2016. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4870985/

Substance Abuse and Mental Health Services Administration. (2019, May 7). Medication and Counseling Treatment. Retrieved from https://www.samhsa.gov/medication-assisted-treatment/treatment#medications-used-in-mat

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