The Protective Effect of Pregnancy on Risk for Drug Abuse: A Population, Co-Relative, Co-Spouse, and Within-Individual Analysis

Abstract

Objective To determine whether pregnancy is an intrinsic motivator for drug abuse (DA) cessation. Method We conducted, in Swedish females born 1980–1990 who gave birth at ages 20–35 (N=149,512), prospective cohort, co-relative, co-spouse, and within-person analyses of registration for DA during pregnancy. DA was assessed from medical, criminal and pharmacy registries. Results In the population, rates of DA were lower during pregnancy (unadjusted OR=0.67, 95% CIs 0.60–0.74). Compared to population results, the negative association between pregnancy and DA was moderately stronger in cousins (OR=0.49, 0.39–0.62) and substantially stronger in siblings (OR=0.35, 0.24–0.51) discordant for pregnancy. The estimated OR for DA in pregnancy-discordant monozygotic twins was even stronger: 0.17 (0.10–0.31). Within-individuals, the OR for DA while pregnant compared to an equivalent pre-pregnancy interval was similar to that seen in pregnancy-discordant monozygotic twins: 0.22 (0.19–0.26). Compared to cohabiting fathers, mothers had a greater reduction in risk for DA during pregnancy (OR=0.40, 0.34–0.47). Pregnancy was more protective in those with low parental education and without a cohabiting actively drug abusing father. Compared to pre-pregnancy baseline, within-individual analyses indicate risk for DA is also substantially reduced post-partum e.g. day 0–242 OR=0.13 (0.11–0.16). Conclusions Risk for DA in women is substantially reduced during pregnancy. Multiple analyses suggest that this association is largely causal, suggesting that pregnancy is indeed a strong intrinsic motivator for DA cessation. Similar strong protective effects may be present immediately post-partum. Our results have implications for our etiologic models of DA and especially for contingency management programs seeking to reduce DA risk.

Protective Effects of Pregnancy on Risk of Alcohol Use Disorder

“…Even as past 30-day alcohol consumption and binge drinking have increased among non-pregnant US women, the same behaviors have decreased among pregnant women (7). As noted in the context of prenatal illicit substance use (8), women who misuse substances may be more likely to have an unplanned pregnancy (9,10), which would result in a positive association between pregnancy and alcohol misuse. However, the drive to protect one's offspring from the adverse effects of alcohol is likely a counteracting factor, resulting in a negative association between pregnancy and alcohol misuse.…”

Obstetric patients’ perspectives on functional magnetic neuroimaging research in pregnant women

“…In summary, considering the prevalence and magnitude of positive health behavior changes observed among expectant mothers (Kendler et al 2017;Solomon and Quinn 2004), combined with the need for more effective interventions on health behavior change (Riddle 2015), we recommend further research on the feasibility of fMRI research in healthy pregnant women. Maternal behavior is the most proximal (and modifiable) determinant of a child's rearing environment, beginning at conception.…”

“…In the context of the urgent need to develop more effective and durable treatments for substance use disorders (Volkow 2014), it is ironic that pregnancy exerts a more robust (temporary) protective effect on women's drug use than any intervention to date, independent of psychosocial and familial factors (Kendler et al 2017), including intentions to raise the affected child (Massey et al 2011;Massey et al 2012). Yet, due in part to the relative paucity of studies involving pregnant women, it remains unclear why.…”

Postnatal depression: recognition and diagnosis

“…Health professionals often feel helpless and hopeless about the care of these women, and yet, as a group increasingly represented within these maternal death enquiries, they are a group for whom improvements in care are essential to prevent future deaths. The risk of drug misuse in women is substantially reduced during pregnancy and multiple analyses suggest that this association is largely causal, implying that pregnancy is indeed a strong intrinsic motivator for drug abuse cessation (Kendler, Ohlsson et al 2017). Pregnancy therefore represents a time of opportunity which should not be ignored.…”