Substance Use and Pregnancy: Danger Ahead

Substance Use Pregnancy

The problem of substance use during pregnancy cannot be ignored. Research shows that use of tobacco, alcohol, and illicit drugs during pregnancy can have severe consequences for infants. Research also shows that despite these consequences, about 16 percent of women continue to smoke during pregnancy, eight to nine percent continue to drink alcohol, and almost six percent use illicit drugs.

“An adult may be able to handle substances like alcohol, tobacco, or drugs, but these substances can wreak havoc on a defenseless, developing fetus. Even small amounts of these substances can harm the unborn baby and imperil a pregnancy,” says Kecia Gaither, MD, Director of Perinatal Services at Lincoln Medical and Mental Health Center in Bronx, New York.

Women and Babies at Risk

Women make up 40 percent of Americans who meet the criteria for a substance use disorder. The highest risk is for women between the ages of 18 to 29, their peak reproductive years. The most commonly abused substances are nicotine and alcohol, followed by marijuana and cocaine. For about half of these women, more than one substance is being used.

According to the National Institute on Drug Abuse, use of tobacco, marijuana, alcohol, or a prescription pain reliever during pregnancy more than doubles the risk for stillbirth. Stillbirth is a baby being born dead after 24 weeks of pregnancy. “That is why women who, smoke, drink, or take drugs need to seek advice and support before, during, and after pregnancy,” says Dr. Gaither.


Use of tobacco not only increases the risk of stillbirth, it also increases the risk of miscarriage, ectopic pregnancy, low birthweight, premature separation of the placenta (placental abruption), and preterm birth. “When a mother smokes, her baby smokes. Both nicotine and carbon monoxide pass through the placenta to the baby. This is a devastating one-two punch,” says Gaither. Even a few cigarettes per day reduces the blood supply and the amount of oxygen going to a baby. Second-hand smoke is also very dangerous. It also doubles the risk of stillbirth.


“Prenatal exposure to alcohol is the leading preventable cause of birth defects in the United States,” says Gaither. The many negative effects of alcohol on a baby are grouped together under the term fetal alcohol spectrum disorders (FASDs). No type of alcohol or amount of alcohol is safe when it comes FASDs. All women who may become pregnant or are pregnant should avoid alcohol completely. Effects of FASDs on a baby can include:

  • Small head size
  • Short stature
  • Clumsiness
  • Hyperactivity
  • Poor attention span
  • Delayed speech and language
  • Learning disabilities
  • Low IQ
  • Visual defects or hearing defects
  • Heart, kidney, or bone defects

Illicit Drugs 

The list of drugs that can pose a serious health risk to an unborn baby is long. It includes marijuana, cocaine, amphetamines, tranquilizers, and narcotics (opioids). Marijuana is the most common drug, but opioids (including heroin and prescription painkillers) are the most dangerous and fastest growing. All these drugs are dangerous:

  • Marijuana can cause preterm labor, poor fetal growth, miscarriage, stillbirth, developmental delays, and learning problems.
  • Cocaine can cause premature labor, stillbirth, miscarriage, and birth defects.
  • Amphetamines can cause heart defects, miscarriage, and preterm labor.
  • Tranquilizers can cause birth defects and babies that have withdrawal symptoms at birth.
  • Opioids can cause sudden infant death syndrome, breathing problems, small head size, and neonatal abstinence syndrome (NAS).

When a woman abuses an opioid drug, her body can go into withdrawal if the drug is stopped suddenly. Withdrawal can be very dangerous for a pregnant woman because it can trigger premature labor. If withdrawal is a possibility, it is safer to maintain a pregnant woman on an opioid maintenance drug than to stop an opioid during pregnancy. This reduces the risk of relapse and the risk of withdrawal.

A baby born to a woman on opioids may have withdrawal symptoms at the time of birth. This is NAS. When doctors are aware of opioid use, NAS can be safely treated. “When a pregnant mother becomes addicted to opioids, her baby also becomes addicted. We are seeing a rise in prescription opioids but heroin is still a major problem. When heroin is injected, there is the danger of HIV, hepatitis, and heart valve infection in the mother. All of these problems can be devastating for her and her baby,” says Gaither.

To learn more about opioid abuse treatment during pregnancy and treatment of NAS, check out Jessica Siller’s very interesting blog here.

Hope for Women With Substance Use 

The good news is that for most women, pregnancy is an opportunity to abstain from substance use and get help. Women who get help can and do have normal pregnancies. Even better, many women continue to get help after pregnancy. Studies show that pregnancy can be a strong motivation for recovery. In one study, 96 percent of heavy alcohol drinkers, 78 percent of marijuana smokers, and 73 percent of cocaine users were able to abstain during pregnancy. “In many cases the maternal instinct is stronger than the urge to use,” says Gaither.

Substance use and pregnancy is a very dangerous combination. The effects can be truly devastating. If you are pregnant or you may become pregnant, and you are struggling with a substance use problem, the time to ask for help is now. Treatment does work. You can have your baby safely. Having a new life to care for along with the support and coping skills you get during pregnancy can be the motivation you need to have a future free from the danger of substance use.

Christopher Iliades
Dr. Chris Iliades is a medical doctor with 20 years of experience in clinical medicine and clinical research. Chris has been a full time medical writer and journalist since 2004. His byline appears in over 1,000 articles online including EverydayHealth, The Clinical Advisor, and Healthgrades. He has also written for print media including Cruising World Magazine, MD News, and The Johns Hopkins Children's Center Magazine. Chris lives with his wife and close to his three children and four grandchildren in the Boston area.

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