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Substance misuse in pregnant women

Grace Chang, MD, MPH
Section Editor
Charles J Lockwood, MD, MHCM
Deputy Editor
Kristen Eckler, MD, FACOG


The obstetrical provider is in a key position for screening, early diagnosis, counseling, and initiating treatment of pregnant women who use illicit drugs (marijuana/hashish, cocaine, heroin, hallucinogens, inhalants, methamphetamine, prescription psychotherapeutics used non-medically) [1]. Both the gravida and her family benefit from factual, nonjudgmental information about the maternal and fetal risks of substance use and from counseling about options for cessation. However, substance users may not seek prenatal care because of fear, guilt and shame, as well as concerns about medical and legal intervention [2]. Opioid users may not even realize that they are pregnant if they are not planning pregnancy and misinterpret the early signs of pregnancy as opioid withdrawal symptoms (eg, nausea, vomiting, cramping). Unintended pregnancy is common in these women; in one study, 86 percent of pregnant opioid-using women reported their pregnancy was unintended [3].

Pregnant women are typically highly motivated to modify their behavior in order to help their unborn child. In a national survey from the United States, the mean rate of pregnancy-related abstinence among users of illicit drugs was 57 percent [4]. Unfortunately, many of these women resumed substance use during the year after giving birth, although not to the level of nonpregnant women who were not recent mothers.


The following terms are used to distinguish different patterns of drug use for diagnosis and treatment (see "Clinical assessment of substance use disorders"):

Use – Sporadic consumption of alcohol or drugs with no adverse consequences of that consumption.

Abuse – Although the frequency of consumption of alcohol or drugs may vary, some adverse consequences of that use are experienced by the user.

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Literature review current through: Nov 2017. | This topic last updated: Oct 04, 2017.
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