By Jennifer Loera, RN
Clinical Navigator - Maternal Opiate Medical Support (MOMS) Program, Blanchard Valley Health System

Engaging in as much prenatal care as possible is the single most important thing a pregnant woman can do, even if care is not sought until late. Pregnant women with substance use disorder (SUD) frequently face tremendous stigma and judgment when seeking medical care. Experience with judgment and stigma can often make it difficult to seek prenatal care, mental health care, and community support services. 

Providers should utilize a trauma-informed care approach when working with substance-using pregnant patients to combat stigma. This includes harm reduction and motivational interviewing. Focusing primarily on building trust, enhancing self-efficacy, and strengthening personal skills and resources promotes optimal health and well-being of the mother-baby dyad. 

Identification of substance use during pregnancy allows for interventions for improving maternal and fetal health. Substance use disorders are defined by cognitive, behavioral, and physiological symptoms with continued substance use despite it causing significant social or interpersonal problems. Conditions such as psychiatric disorders, trauma, and physical/sexual/emotional abuse occur frequently in individuals with SUD. The interconnection between these issues and substance use should be addressed in caring for these patients by linking them to community services, appropriate treatment, and medications. Constructing multidisciplinary wrap-around care has shown successful outcomes for mother-baby dyads. 

Opioid use during pregnancy can have serious negative health outcomes for pregnant women and developing babies. Neonatal Abstinence Syndrome (NAS) is a group of withdrawal symptoms that most commonly occur in newborns due to exposure to opioids during pregnancy. Not all babies who are exposed to opioids will need to be pharmacologically treated for withdrawal symptoms. If you are pregnant and using opioid medications, the Centers for Disease Control and Prevention recommends you talk to your provider to help you understand all of the risks and make the safest choice for you and your pregnancy. Treatment for opioid use disorder (OUD) with methadone, buprenorphine, or a buprenorphine-naloxone combination medication is recommended and safe during pregnancy and when breastfeeding. It is considered the first-line gold standard of care treatment for patients during pregnancy. Recent evidence suggests that naltrexone (Vivitrol®) is safe to continue during pregnancy when the patient is already receiving it for OUD treatment.  

Stimulant use during pregnancy is becoming more common. Pregnant women using stimulants during pregnancy are at increased risk of adverse perinatal, neonatal, and childhood outcomes. While it is rare, it is possible to die from methamphetamine or cocaine use due to stress on the heart and circulatory system. Stimulants can cause decreased blood flow to the placenta and increase blood pressure, which increases the risk of preeclampsia, a dangerous condition in pregnancy that can cause seizures, heart attack, stroke, and pulmonary edema (fluid in the lungs). Stimulants can be linked to preterm premature rupture of membranes (PPROM), which occurs when the sac that contains the amniotic fluid breaks before 37 weeks of pregnancy. Currently, there are no FDA-approved medications for the treatment of stimulant use disorder. Many patients find that group or individual therapy is helpful, and contingency management behavioral therapy has shown success in the treatment of patients with stimulant use and other substance disorders. 

Many healthcare systems/providers offer a collaborative team to support the health, safety, and well-being of infants and the recovery of pregnant women with opioid and stimulant use disorders. This team works together to establish an individualized support plan for each patient to ensure a safe and stable environment for the mother and infant. 

Care is often coordinated between obstetric providers, outpatient medication-assisted treatment specialists, outpatient mental health providers, the labor and delivery department, and a special care nursery unit. If you have questions, please ask your provider (or provider’s office) to be put in touch with an affiliated or nearby clinical navigator.