Minimize Substance Use During Pregnancy - Revision history

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	Drug, alcohol, and even tobacco use during pregnancy have lasting and sometimes detrimental effects on mothers and unborn babies. Prenatal use of substances cause the infant to be born with very serious health problems and can lead to stillbirths. In some cases, it can cause infant withdrawal symptoms, or dependency. Alcohol use during pregnancy can lead to what is known as Fetal Alcohol Syndrome (FAS), characterized by low birth weight, cognitive deficits, increased risk of birth defects, and behavioral problems later in life.		Drug, alcohol, and even tobacco use during pregnancy have lasting and sometimes detrimental effects on mothers and unborn babies. Prenatal use of substances cause the infant to be born with very serious health problems and can lead to stillbirths. In some cases, it can cause infant withdrawal symptoms, or dependency. The unintended pregnancy rate among pregnant people with SUD is approximately 80%. <ref>https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/08/opioid-use-and-opioid-use-disorder-in-pregnancy#:~:text=Unintended%20pregnancy%20rates%20among%20women,than%20in%20the%20general%20population.</ref> 40% of pregnant people who drank alcohol during pregnancy reported co-using other substances, including tobacco, cannabis, cocaine, and heroin. <ref>England LJ, Bennett C, Denny CH, et al. (2020) Alcohol Use and Co-Use of Other Substances Among Pregnant Females Aged 12-44 Years - United States, 2015-2018. MMWR Morbidity and Mortality Weekly Report 69(31):1009-1014.</ref> Recently, the number of pregnant people using opioids has rapidly increased, in keeping with the increase observed in the general population. <ref>https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/08/opioid-use-and-opioid-use-disorder-in-pregnancy</ref> Pregnant people with substance use disorder face multiple challenges and obstacles. Lack of access to medical care, ineffective collaboration among social service systems, stigma, and fear of punishment further compound their challenges. <ref>https://store.samhsa.gov/sites/default/files/d7/priv/sma15-4426.pdf</ref>

	The unintended pregnancy rate among pregnant people with SUD is approximately 80%. <ref>https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/08/opioid-use-and-opioid-use-disorder-in-pregnancy#:~:text=Unintended%20pregnancy%20rates%20among%20women,than%20in%20the%20general%20population.</ref> 40% of pregnant people who drank alcohol during pregnancy reported co-using other substances, including tobacco, cannabis, cocaine, and heroin. <ref>England LJ, Bennett C, Denny CH, et al. (2020) Alcohol Use and Co-Use of Other Substances Among Pregnant Females Aged 12-44 Years - United States, 2015-2018. MMWR Morbidity and Mortality Weekly Report 69(31):1009-1014.</ref> Recently, the number of pregnant people using opioids has rapidly increased, in keeping with the increase observed in the general population. <ref>https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/08/opioid-use-and-opioid-use-disorder-in-pregnancy</ref> Pregnant people with substance use disorder face multiple challenges and obstacles. Lack of access to medical care, ineffective collaboration among social service systems, stigma, and fear of punishment further compound their challenges. <ref>https://store.samhsa.gov/sites/default/files/d7/priv/sma15-4426.pdf</ref>

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 *physical issues (vascular complications, infections, bodily trauma), and
 *reduced frequency of prenatal care.
 Postnatal impacts on the mother and baby extend beyond physio-social consequences. Mothers who use substances throughout pregnancy are at an increased risk of having the child removed from their care after birth.  <ref>https://healthandjusticejournal.biomedcentral.com/articles/10.1186/s40352-015-0015-5</ref> <ref>https://www.vumc.org/childhealthpolicy/news-events/many-states-prosecute-pregnant-women-drug-use-new-research-says-thats-bad-idea</ref> These child removals have been shown to lead to an increase in maternal drug use and mental health complications, especially in Black and Indigenous people. <ref>https://www.nationalpartnership.org/our-work/health/moms-and-babies/substance-use-disorder-hurts-moms-and-babies.html</ref> Those who do retain custody of their infants and continue substance use are at risk of atypical maternal-infant bonding and attachment, which is linked to adverse child outcomes. <ref>https://www.frontiersin.org/articles/10.3389/fpubh.2019.00045/full</ref>

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	'''SAFE Project''' offers "Addiction and Mental Health Resources for Women," which includes a series of resources for support during pregnancy. <ref>https://www.safeproject.us/resource/women/</ref>		'''SAFE Project''' offers "Addiction and Mental Health Resources for Women," which includes a series of resources for support during pregnancy. <ref>https://www.safeproject.us/resource/women/</ref>

			'''Colorado Department of Public Health''' developed an informational brief on the topic of substance use among women of reproductive age. The goal of the department is to identify women between the ages of 18 and 44 and provide interventions that prevent substance use, including prescription drugs and marijuana. <ref>https://www.tobaccofreeco.org/wp-content/uploads/2019/02/Substance-Use-Among-Women-of-Reproductive-Age-in-Colorado.pdf</ref>

	'''Pregnancy Justice,''' previously known as National Advocates for Pregnant Women (NAPW), works to secure the human and civil rights, health, and welfare of all people, focusing particularly on pregnant and parenting people, and those who are most likely to be targeted for state control and punishment because of gender, color, income, or and drug use. <ref>https://www.pregnancyjusticeus.org/</ref>		'''Pregnancy Justice,''' previously known as National Advocates for Pregnant Women (NAPW), works to secure the human and civil rights, health, and welfare of all people, focusing particularly on pregnant and parenting people, and those who are most likely to be targeted for state control and punishment because of gender, color, income, or and drug use. <ref>https://www.pregnancyjusticeus.org/</ref>

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			'''The Prevention of Substance-Exposed Pregnancies Collaborative''' is a group of organizations that work together with the common goal of reducing the number of people who use substances during pregnancy. <ref>https://health.usf.edu/publichealth/chiles/fpqc/~/media/D61B2A15C6E54AAB85627A153D8DAF77.ashx</ref> Organizations from multiple states, including Oregon, California, Ohio, Colorado, Florida, and Maryland developed multiple strategies for medical and public health officials to implement in order to accomplish their mission of preventing substance exposure to those of reproductive age, pregnant people, and their unborn children.

	'''Her Way Home''' provides non-judgmental health care and social supports for pregnant and parenting people who have a history of substance use and who may also be affected by mental health issues, violence, and trauma. <ref>https://www.samhsa.gov/sites/default/files/family_treatment_paper508v.pdf</ref>		'''Her Way Home''' provides non-judgmental health care and social supports for pregnant and parenting people who have a history of substance use and who may also be affected by mental health issues, violence, and trauma. <ref>https://www.samhsa.gov/sites/default/files/family_treatment_paper508v.pdf</ref>

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			'''Her Way Home''' provides non-judgmental health care and social supports for pregnant and parenting people who have a history of substance use and who may also be affected by mental health issues, violence, and trauma. <ref>https://www.samhsa.gov/sites/default/files/family_treatment_paper508v.pdf</ref>

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	'''Pregnancy Justice,''' previously known as National Advocates for Pregnant Women (NAPW), works to secure the human and civil rights, health, and welfare of all people, focusing particularly on pregnant and parenting people, and those who are most likely to be targeted for state control and punishment because of gender, color, income, or and drug use. <ref>https://www.pregnancyjusticeus.org/</ref>		'''Pregnancy Justice,''' previously known as National Advocates for Pregnant Women (NAPW), works to secure the human and civil rights, health, and welfare of all people, focusing particularly on pregnant and parenting people, and those who are most likely to be targeted for state control and punishment because of gender, color, income, or and drug use. <ref>https://www.pregnancyjusticeus.org/</ref>

	'''Her Way Home''' provides non-judgmental health care and social supports for pregnant and parenting people who have a history of substance use and who may also be affected by mental health issues, violence, and trauma. <ref>https://www.samhsa.gov/sites/default/files/family_treatment_paper508v.pdf</ref>

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	'''Center for Addiction and Pregnancy (CAP),''' at The Johns Hopkins Bayview Medical Center, offers an innovative approach to help mothers and infants deal with the physical, emotional, and social problems caused by addiction. CAP is an outpatient program with an available overnight housing unit for patients requiring a recovery-oriented domicile. It provides a comprehensive, coordinated, and multidisciplinary approach to drug-dependent mothers and their drug-affected babies. <ref>https://www.hopkinsmedicine.org/psychiatry/patient-information/bayview/substance-abuse/comprehensive-addiction-pregnancy</ref>

	'''Massachusetts.''' Project RESPECT (Recovery, Empowerment, Social Services, Prenatal care, Education, Community and Treatment) is a high-risk obstetrical and addiction recovery medical home at Boston Medical Center and the Boston University School of Medicine. Project RESPECT provides a unique service of comprehensive obstetric and substance use disorder treatment for pregnant people and their newborns. <ref>https://www.bmc.org/obstetrics/pregnancy/addiction</ref>

	'''New Jersey.''' The Child Protection Substance Abuse Initiative (CPSAI) is a program that targets parents engaged in the Division of Child Protection and Permanence. Although only 9% of the participants completed treatment, CPSAI is examining individual factors associated with successful treatment and continuing to facilitate treatment engagement for parents being evaluated by the child welfare system.
	~~<ref>https://www.recoveryanswers.org/research-post/using-the-child-welfare-system-to-engage-parents-with-substance-use-disorders/</ref>~~

	'''North Carolina.''' Project CARA is housed at MAHEC Ob/Gyn Specialists. It has supported over 800 women with substance use disorders since 2014. MAHEC first offered integrated substance use treatment services with obstetrical visits in the late 1990s. The Project CARA team has built on this early foundation to provide comprehensive substance use care using current evidence-based practices. <ref>https://mahec.net/patient-information/ob-gyn-care/project-cara-welcome</ref>

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	'''Her Way Home''' provides non-judgmental health care and social supports for pregnant and parenting people who have a history of substance use and who may also be affected by mental health issues, violence, and trauma. <ref>https://www.samhsa.gov/sites/default/files/family_treatment_paper508v.pdf</ref>		'''Her Way Home''' provides non-judgmental health care and social supports for pregnant and parenting people who have a history of substance use and who may also be affected by mental health issues, violence, and trauma. <ref>https://www.samhsa.gov/sites/default/files/family_treatment_paper508v.pdf</ref>

	~~'''Drug Treatment and Referral Services:'''~~

	*The American Psychological Association''' <ref>https://www.apa.org/pi/women/resources/treatment-resources-pregnant-women.pdf</ref>

	*National Partnership for Women and Families: Maternity Care in the United States: We Can – and Must – Do Better <ref>https://www.nationalpartnership.org/our-work/resources/health-care/maternity-care-in-the-united.pdf</ref>

	*Maternal, Infant and Early Childhood Home Visiting Program Funding <ref>https://mchb.hrsa.gov/maternal-child-health-initiatives/home-visiting-overview</ref>

	*Healthy Safe Children <ref>https://healthysafechildren.org/trending-topics</ref>

	*Obstetric-Fetal Pharmacology Research Centers <ref>https://www.utmb.edu/nichd-oprc/</ref>

	*Alliance for Innovation on Maternal Health (AIM) <ref> https://www.acog.org/practice-management/patient-safety-and-quality/partnerships/alliance-for-innovation-on-maternal-health-aim</ref>

	* Recovery Research Institute <ref> https://www.recoveryanswers.org/research-post/ob-gyns-say-opioid-use-disorders-pregnancy-provide-opportunities-life-changing-interventions/</ref>

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	'''~~SAFE Project:~~'''		'''SAMHSA''' provides a fact sheet titled "Pregnancy Planning for Women Being Treated for Opioid Use Disorder." <ref>https://store.samhsa.gov/sites/default/files/d7/priv/pre_pregnancy_factsheet_041919_508.pdf</ref>
	*'''"Have A Safety Plan"''' is a ~~SAFE Project resource that instructs drug users on how to create a safety plan to prevent overdoses.<ref>https://www.safeproject.us/safety-plan/</ref>~~
	*See the wiki titled "~~Expand Motivational Interviewing for Pregnant People"~~ for ~~more detailed information on the evidence-based practice of motivational interviewing and how it inspires change~~ for ~~those who are pregnant and struggle with substance use issues~~.<ref>https://~~www~~.~~yoursafesolutions~~.us/~~wiki~~/~~Expand_Motivational_Interviewing_for_Pregnant_People~~/</ref>

	'''~~SAMHSA~~''' ~~provides a fact sheet titled~~ "~~Pregnancy Planning~~ for Women ~~Being Treated~~ for ~~Opioid Use Disorder~~." <ref>https://~~store~~.~~samhsa~~.~~gov/sites/default/files~~/d7/~~priv~~/~~pre_pregnancy_factsheet_041919_508.pdf~~</ref>		'''SAFE Project''' offers "Addiction and Mental Health Resources for Women," which includes a series of resources for support during pregnancy. <ref>https://www.safeproject.us/resource/women/</ref>

	'''Pregnancy Justice,''' previously known as National Advocates for Pregnant Women (NAPW), works to secure the human and civil rights, health, and welfare of all people, focusing particularly on pregnant and parenting people, and those who are most likely to be targeted for state control and punishment because of gender, color, income, or and drug use. <ref>https://www.pregnancyjusticeus.org/</ref>		'''Pregnancy Justice,''' previously known as National Advocates for Pregnant Women (NAPW), works to secure the human and civil rights, health, and welfare of all people, focusing particularly on pregnant and parenting people, and those who are most likely to be targeted for state control and punishment because of gender, color, income, or and drug use. <ref>https://www.pregnancyjusticeus.org/</ref>

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	Studies suggest that pregnant people have a unique opportunity to embrace treatment and recovery options. <ref>https://www.cdc.gov/pregnancy/polysubstance-use-in-pregnancy.html</ref> However, they face significant barriers. Quitting substance use, especially when an individual has SUD, can be difficult, and they might find quitting complicated by the fear that asking for help could lead to potential social and even legal consequences. Reporting requirements and administrative policies of service agencies may lead to mandatory involvement with child protective services, loss of child custody, or other legal consequences. Limited child care options may deter mothers from seeking treatment. Likewise, pregnant people in treatment may need help with handling the burdens of work, home, and other family responsibilities. <ref>https://www.hcup-us.ahrq.gov/reports/statbriefs/sb254-Delivery-Hospitalizations-Substance-Use-Clinical-Outcomes-2016.pdf</ref>		Studies suggest that pregnant people have a unique opportunity to embrace treatment and recovery options. <ref>https://www.cdc.gov/pregnancy/polysubstance-use-in-pregnancy.html</ref> However, they face significant barriers. Quitting substance use, especially when an individual has SUD, can be difficult, and they might find quitting complicated by the fear that asking for help could lead to potential social and even legal consequences. Reporting requirements and administrative policies of service agencies may lead to mandatory involvement with child protective services, loss of child custody, or other legal consequences. Limited child care options may deter mothers from seeking treatment. Likewise, pregnant people in treatment may need help with handling the burdens of work, home, and other family responsibilities. <ref>https://www.hcup-us.ahrq.gov/reports/statbriefs/sb254-Delivery-Hospitalizations-Substance-Use-Clinical-Outcomes-2016.pdf</ref>

	Stigma is a large barrier to treatment and recovery. The societal stigma toward women who use substances tends to be greater than that toward men, and the stigma amplifies significantly for pregnant drug users. Women's ascribed role and the expectations placed on them influences societal perceptions and reactions toward women with SUDs. ~~Women~~ who use alcohol and illicit drugs ~~regularly~~ feel shame and guilt, and they ~~also~~ often suffer from low levels of self-esteem and self-efficacy. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5151516/</ref> Women with substance use issues often have high levels of comorbid mental health disorders. In 2019, there were 34.3M adult women who had a mental illness and/or SUD. <ref>https://www.samhsa.gov/data/data-we-collect/nsduh-national-survey-drug-use-and-health</ref>		Stigma is a large barrier to treatment and recovery. The societal stigma toward women who use substances tends to be greater than that toward men, and the stigma amplifies significantly for pregnant drug users. Women's ascribed role and the expectations placed on them influences societal perceptions and reactions toward women with SUDs. Women who use alcohol and illicit drugs feel shame and guilt regularly, and they often suffer from low levels of self-esteem and self-efficacy. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5151516/</ref> Women with substance use issues often have high levels of comorbid mental health disorders. In 2019, there were 34.3M adult women who had a mental illness and/or SUD. <ref>https://www.samhsa.gov/data/data-we-collect/nsduh-national-survey-drug-use-and-health</ref>

	Substance use disorders can manifest differently in women than in men. <ref>https://www.drugabuse.gov/publications/drugfacts/substance-use-in-women</ref> In the past, women were not included in most clinical research. <ref>https://www.drugabuse.gov/publications/research-reports/substance-use-in-women/importance-including-women-in-research</ref> Women may experience varying levels of discrimination in both healthcare and criminal justice systems that affect their substance use and may affect their recovery. Pregnant people using substances, particularly people of color and those in lower socioeconomic brackets, deal with increased surveillance and may face consequences, such as arrest and child removal. <ref>https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=23</ref> Some people use substances to cope with these stresses of discrimination. People dealing with SUD who struggle financially may have to deal with low-income unstable housing, lack of access to transportation and medical care, as well as poor nutrition. Less access to health care, and difficulty in funding treatment due to a lack of health insurance, can result in later referral for substance use treatment. Since residential treatment facilities are limited, pregnant people have reported several barriers to treatment and healthcare, including insufficient treatment options and difficulty locating and entering treatment.		Substance use disorders can manifest differently in women than in men. <ref>https://www.drugabuse.gov/publications/drugfacts/substance-use-in-women</ref> In the past, women were not included in most clinical research. <ref>https://www.drugabuse.gov/publications/research-reports/substance-use-in-women/importance-including-women-in-research</ref> Women may experience varying levels of discrimination in both healthcare and criminal justice systems that affect their substance use and may affect their recovery. Pregnant people using substances, particularly people of color and those in lower socioeconomic brackets, deal with increased surveillance and may face consequences, such as arrest and child removal. <ref>https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=23</ref> Some people use substances to cope with these stresses of discrimination. People dealing with SUD who struggle financially may have to deal with low-income unstable housing, lack of access to transportation and medical care, as well as poor nutrition. Less access to health care, and difficulty in funding treatment due to a lack of health insurance, can result in later referral for substance use treatment. Since residential treatment facilities are limited, pregnant people have reported several barriers to treatment and healthcare, including insufficient treatment options and difficulty locating and entering treatment.