Pregnant women with opioid use disorders often face a number of challenges during their pregnancies: limited options for drug treatment, shame and stigma from family, friends and providers and concern for the effects of drug on their babies. Women are often more concerned about the risks of drugs on their babies than themselves. These risks include preterm birth, low birth weight or neonatal abstinence syndrome, a treatable condition that some infants develop after exposure to drugs or other substance in utero. But the most serious complication many of these babies may face is beginning life without a mother.
"Maternal death is a growing problem among pregnant and postpartum women with opioid use disorders" said Marcela Smid, MD, a maternal-fetal specialist with Ï㽶ÊÓƵ of Utah Health. "When looking at the complications opioids may cause for infants, the most important thing for those babies is for their mothers not to die."
The most critical period for mothers with a dependence or addiction to opioids is not when she is pregnant, but rather when she is post-partum. This is when the likelihood of a drug caused death is increased.. "The mother may have tried to decrease, or stop, her drug use during pregnancy and having a new baby," said Smid. "That stress, coupled with the stress of having a new baby, or dealing with post-partum depression can lead to misuse, overdose, and possibly death."
It is important for pregnant and postpartum women using opioids to get help as soon as possible in order to avoid health complications. That help could either be in the form of her primary care physician, or a specialist like Smid, who runs Ï㽶ÊÓƵ of Utah Health's SUPeRAD (Substance Use & Pregnancy - Recovery, Addiction, and Dependence) Prenatal Specialty Clinic. "We are a clinic for pregnant and post-partum women who are actively using any substance or are in recovery for any addiction," Smid said. "We not only provide health care, but we also connect with women with resources like peer support, social workers, and addiction consultants."
When a mom to be seeks treatment for opioid use the first thing that must be determined is if the mom is dependent on the drugs or addicted. There is a difference. Anyone who takes opioids for a prolonged period of time will become dependent on them and develop withdrawal symptoms. Those who are addicted not only have a physical response to the drugs, but also a psychological response. "Those women with addiction also are dealing with some sort of negative consequence that is out of their control," said Smid. "It could be financial in that they are spending money they don't have for drugs, or legal in that they have been arrested, or emotional in the ways the drug use is impacting their relationships."
For pregnant women who are dependent on opioids but not addicted to them, a specialist can help navigate them through the risks and benefits of taking or stopping opioids. Are they being used for chronic pain? If so, can that pain be managed in other ways? "We can suggest supportive measures like physical therapy, exercise, or acupuncture," said Smid. "There also may be cases where completely stopping the opioids is not the best option and we develop a plan to maximize benefits and reduce risks for mom and baby."
For pregnant women with addiction, medications such as methadone or suboxone and supportive behavioral therapy are the best evidence-based approach. In addition to dealing with the physical impacts of withdrawal, women with addictions face the challenges of mental and emotional impacts. "We use behavioral therapy to help women understand how they've used drugs as a short term coping strategy," said Smid. "We help them develop other, long term, coping mechanisms to use instead."
Both addiction and psychical dependence to opioids or other drugs are treatable medical conditions, just like diabetes and high blood pressure. It is possible to overcome an addiction or a dependence on opioids. Motherhood and a new baby are excellent reasons to do it. "Pregnant women are incredibly powerful. We help women harness their own power to address addiction or dependence and help themselves and their babies," said Smid. "At SUPeRAD, our job is to create a safe and non-judgemental space for pregnant and postpartum women to address addiction and dependence issues. When women are ready, we are here for them."