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Management of Substance Abuse in Pregnancy: Maternal and Neonatal Aspects

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Psychopharmacology and Pregnancy

Abstract

In Europe, the USA and Australia the prevalence of smoking during pregnancy ranges between 10 and 27 %. Drinking alcohol is reported by 8.5–19.5 % of pregnant women, with a potentially significant number of unreported cases. Additionally, there are as many as 60,000–100,000 pregnant women using illicit drugs per year, with a high percentage of poly-drug users. Substance-dependent women have a high incidence of co-morbid psychiatric disorders, with DSM-IV axis I affective and post-traumatic stress as well as axis II personality disorders being the most frequent co-morbidities. Due to serious consequences of licit and illicit substance use during pregnancy as well as undetected/untreated psychiatric co-morbidities, the primary focus must be on adequate diagnostic assessment. Treatment, tailored individually to the kind of substance dependence and under consideration of evidence-based treatment options available as early as possible during pregnancy, leads to better pregnancy outcomes and fewer birth complications. Neonates born to mothers who are chronic illicit drug users or provided maternal medication-assisted treatment frequently develop a Neonatal Abstinence Syndrome (NAS). Pharmacological NAS treatment should be provided based on principles of accurate assessment and diagnosis, with non-pharmacological measures such as rooming-in being vital supportive interventions. The economic burden of substance dependence during pregnancy and related follow-up costs are significant. To lower societal costs and increase the quality of life of both mothers and children, international treatment standards, building on previous recommendations, must be established and implemented.

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Authors and Affiliations

  1. Center for Public Health, Medical University of Vienna, Vienna, Austria

    Laura Brandt & Anna K. Leifheit

  2. Finnegan Consulting, LLC, Avalon, NJ, USA

    Loretta P. Finnegan

  3. Office of Research on Women’s Health, National Institutes of Health, Bethesda, MD, USA

    Loretta P. Finnegan

  4. Department of Psychiatry and Psychotherapy & Center for Public Health, Medical University of Vienna, Vienna, Austria

    Gabriele Fischer

Authors
  1. Laura Brandt
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  2. Anna K. Leifheit
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  3. Loretta P. Finnegan
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  4. Gabriele Fischer
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Correspondence to Laura Brandt .

Editor information

Editors and Affiliations

  1. Perinatal Mental Health, Mercy Hospital for Women, Heidelberg, Australia

    Megan Galbally

  2. Perinatal Mental Health, Mercy Hospital for Women, Heidelberg, Australia

    Martien Snellen

  3. School of Psychology, Deakin University, Victoria, Australia

    Andrew Lewis

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Brandt, L., Leifheit, A.K., Finnegan, L.P., Fischer, G. (2014). Management of Substance Abuse in Pregnancy: Maternal and Neonatal Aspects. In: Galbally, M., Snellen, M., Lewis, A. (eds) Psychopharmacology and Pregnancy. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-54562-7_12

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