Maternal Substance Use: Consequences, Identification and Interventions

Abstract

Alcohol, tobacco, and cannabis are the substances most frequently used during pregnancy, and opioid-exposed pregnancies have increased fourfold. The purpose of this review is to describe the prevalence and consequences of prenatal exposure to alcohol, tobacco, cannabis, and opioids. Currently available screening questionnaires for prenatal substance use are summarized and contrasted with the measures available for prenatal alcohol use. Because screening for prenatal alcohol and substance use is but the prelude to efforts to mitigate the potential adverse consequences, attempts for the modification of these consequences are briefly reviewed. In addition, areas of future research related to the criminalization of prenatal substance use, which may inhibit both inquiry and disclosure, are discussed. Indeed, the full potential of effective interventions has yet to be realized.

Maternal Exposure and Neonatal Effects of Drugs of Abuse

“…The use of cannabis by pregnant women (aged 18‐44 years) has significantly increased, from ≈3% to 7% in the last 20 years, with an even higher exposure rate in pregnant adolescents, up to 15% 84 . There remain significant gaps in understanding the mechanisms of action and the consequences of prenatal and perinatal cannabis use and subsequent neonatal health outcomes 84 . Gunn et al assessed maternal, fetal, and neonatal outcomes up to 6 weeks postpartum after exposure to cannabis 85 .…”

“…It is difficult to precisely discern the pharmacology associated with cannabis that may cause harmful effects because in most cases the pregnant woman is also exposed to tobacco and alcohol and other confounding factors 84 . To date, there is no definitive evidence demonstrating safe exposure to cannabis during the prenatal and perinatal periods.…”

Heterogeneity in prenatal substance use screening despite universal screening recommendations: findings from the Pregnancy Risk Assessment Monitoring System, 2016–2018

“…11 A number of prenatal substance use screening tools exist, showing good validity, sensitivity, and specificity. [12][13][14] State policies around prenatal substance use may influence screening, including laws classifying prenatal substance use as child abuse or neglect, laws mandating reporting or testing of prenatal substance use, and laws granting targeted treatment funding or priority treatment access to care for pregnant individuals with SUDs. [15][16][17] No studies to date have examined the correlation between these policies and prenatal substance use screening.…”

From the Editors

“…In “Maternal Substance Use: Consequences, Identification, and Interventions,” Chang reviews prevalence and addresses the importance of early identification and intervention for substance use among pregnant women, with emphasis on alcohol, tobacco, cannabis, and opioid exposure. 18 She reviews strengths and shortcomings of available screening tools specific to pregnant women, legal and social barriers to implementation of universal screening, and available prevention intervention strategies, particularly for fetal alcohol spectrum disorders. 18 …”

“… 18 She reviews strengths and shortcomings of available screening tools specific to pregnant women, legal and social barriers to implementation of universal screening, and available prevention intervention strategies, particularly for fetal alcohol spectrum disorders. 18 …”