Good Practices
The Use of Drugs during Pregnancy
The use of alcohol, drugs and tobacco during pregnancy can threaten the health of both the mother and her baby. It is therefore good to know that with appropriate care many female adolescents who use drugs before becoming pregnant stop using at the start or during the early stages of pregnancy. In a 1998 study, Rabb found that almost all teenage women attending public prenatal clinics used at least one substance (usually cigarettes or alcohol) in the six months prior to becoming pregnant but that the majority discontinued use during their first trimester.
Research conducted in Australia also suggests that many pregnant adolescent girls stop using drugs before or during early pregnancy when receiving care in obstetric hospitals (Quinlivan and Evans, 2002). This research involved 456 teenage antenatal patients who were interviewed and asked to complete questionnaires to establish their pattern of non-prescription drug use before and during pregnancy. The results indicated that many of these girls were former drug users who stopped using drugs when they found that they were pregnant.
Education can contribute to the prevention of unplanned adolescent pregnancies (Paine-Andrews, et al, 1996) and reduce the use of psychoactive substances among adolescents who become pregnant (Sarvela and Ford, 1993). Educational and other programmes are therefore needed to prevent adolescent girls from using psychoactive substances during pregnancy and to help those who do.
Adolescents who do continue to use drugs during pregnancy often have a variety of social and psychological problems, such as conduct disorders (Zoccolillo, et al, 1997), depression, physical health problems, problematic family and peer relationships, poor social skills, limited education and vocational achievements, and poor use of leisure time (Scafidi, et al, 1997). A history of physical and sexual abuse is also common (Martin, et al, 1999). If unresolved, or compounded by poverty and the consequence of being a single mother with a drug habit, these problems can contribute to prostitution, drug dealing, welfare dependence and child neglect (Waters, Roberts and Morgen, 1997). Appropriate interventions can, however, benefit this population.
The previously noted study from Australia (Quinlivan and Evans, 2002) also involved about 90 girls who used marijuana throughout their pregnancies. About a third of these also used other drugs. Those who used illegal drugs were more likely to also use cigarettes and alcohol and to have other social and psychiatric problems. Those using multiple drugs were more likely to have infections. While those using drugs were more likely to experience threatened pre-term labour, there were no effects on birth weight, birth weight ratios or pre-term birth. The authors concluded, "Good antenatal care may be able to ameliorate many adverse pregnancy outcomes in teenagers who use illegal drugs throughout pregnancy". However, they also cautioned that "High levels of coexisting psychosocial morbidity are a concern for future mother-crafting".
Field, et al, (1998) found that female adolescents who used drugs during their pregnancies - and their children - benefited from a three-month programme that offered educational, vocational and parenting classes; social and drug rehabilitation; and infant daycare while the mothers attended a half-day school. Upon enrolment in the programme, both the mothers who had used drugs during their pregnancies and their children had inferior scores on a variety of behavioural and biochemical measurements when compared with a control group of mothers - and their infants - who did not use drugs during pregnancy. However, three months after the programme these mothers and their infants were similar to the others in their interactions, and by six months, they looked similar on virtually every commonly used measure. At 12 months, and in comparison with a control group, the drug-exposed infants whose mothers had been in the rehabilitation programme had superior scores on measures of social communication and mental health, as well as significantly greater head circumference and fewer pediatric complications. Their mothers also reduced their use of drugs, had fewer additional pregnancies and increased their participation in school or in the workforce.
So, it is important that education and treatment programmes that target adolescents at-risk for pregnancy and substance abuse need to be developed and supported. However, many issues need further research. Research that mainly involved pregnant adults who use drugs (Nishimot and Roberts, 2001; Haller, et al, 2003) suggests that the following issues should be given special attention with respect to adolescents:
- Matching clients to treatment.
- Increasing treatment enrolment and participation.
- Determining the role, if any, of legal and other forms of coercion in treatment engagement and compliance.
Males also have an obvious role to play in this issue, so programmes and research involving adolescent and adult men who get young girls pregnant are also needed. There is evidence that male adolescents who get girls pregnant have higher than expected rates of cocaine use and other 'risk' behaviours, such as multiple sexual partners, drinking and driving, and being injured in fights (Spingarn and DuRant, 1996). These characteristics may be especially prominent among men who impregnate girls who use drugs. These men, therefore, need educational and other programmes that target their sexual and drug use behaviours.
References
Haller, D.L., Miles, D.R. and Dawson, K.S. (2003). Factors influencing treatment enrollment by pregnant substance abusers. American Journal of Drug and Alcohol Abuse, 29: 117-131.
Field, T.M., Scarfidi, F., Pickens, J., et al (1998). Polydrug-using adolescent mothers and their infants receiving early intervention. Adolescence, 33: 117-143.
Martin S.L., Clark K.A., Lynch S.R., Kupper L.L. (1999). Violence in the lives of pregnant teenage women: associations with multiple substance use. American Journal of Drug Alcohol Abuse, 25: 425-440.
Nishimoto, R., and Roberts, A. (2001) Coercion and drug treatment for postpartum women. American Journal of Drug and Alcohol Abuse, 21: 161-181.
Paine-Andrews, A., Vincent, M.L., Fawcett, S. B., et al (1996). Replicating a community initiative for preventing adolescent pregnancy from South Carolina to Kansas. Family & Community Health, 19: 14-30.
Quinlivan J.A. and Evans S.F. (2002). The impact of continuing illegal drug use on teenage pregnancy outcomes - a prospective cohort study. International Journal of Obstetrics and Gynecology, 109: 1148-1153.
Raab M. (1998). Most teenagers who obtain prenatal care at public clinics discontinue substance use early in pregnancy. Family Planning Perspectives, 30: 198-199.
Sarvela, P. D. and Ford, T.D. (1993). An evaluation of a substance abuse education program for Mississippi Delta pregnant adolescents. Journal of School Health, 63: 147-152.
Scafidi, F.A., Field, T., Prodromidis, M. and Rahdert, E. (1997) Psychosocial stressors of drug-abusing disadvantaged adolescent mothers. Adolescence, 32: 93-100.
Spingarn, R.W., DuRant, R.H. (1996). Male adolescents involved in pregnancy: Associated health risk and problem behaviors. Pediatrics, 98: 262-268.
Waters, J., Roberts, A.R. and Morgen, K. (1997). High-risk pregnancies: teenagers, poverty and drug abuse. Journal of Drug Issues, 27: 541-562.
Zoccolillo M., Meyers J. and Assiter S. (1997) Conduct disorder, substance dependence, and adolescent motherhood. American Journal of Orthopsychiatry, 67: 152-157.
Prepared by:
Alan Ogborne, PhD,
Canadian Centre on Substance Abuse
Email:
alan.ogborne@sympatico.ca
Gary Roberts, Senior Associate
Director, Best Practices and Training
Canadian Centre on Substance Abuse
Phone: 613-235-4048-225/613-829-3152(home)
Fax: 613-235-8101/613-829-3307(home)
Email:
groberts@ccsa.ca
Web:
http://www.ccsa.ca