Get 20M+ Full-Text Papers For Less Than $1.50/day. Subscribe now for You or Your Team.

Learn More →

Maternal Substance Use: Consequences, Identification, and Interventions

Maternal Substance Use: Consequences, Identification, and Interventions FOCUS ON Alcohol Res. 2020;40(2):06 • https://doi.org/10.35946/arcr.v40.2.06 Published online [TK] Maternal Substance Use: Consequences, Identification, and Interventions 1,2 Grace Chang U.S. Department of Veterans Aa ff irs Boston Healthcare System, Boston, Massachusetts Harvard Medical School, Department of Psychiatry, Boston, Massachusetts Alcohol, tobacco, and cannabis are the substances most frequently used during pregnancy, and opioid-exposed pregnancies have increased fourfold. The purpose of this review is to describe the prevalence and consequences of prenatal exposure to alcohol, tobacco, cannabis, and opioids. Currently available screening questionnaires for prenatal substance use are summarized and contrasted with the measures available for prenatal alcohol use. Because screening for prenatal alcohol and substance use is but the prelude to efforts to mitigate the potential adverse consequences, attempts for the modification of these consequences are briefly reviewed. In addition, areas of future research related to the criminalization of prenatal substance use, which may inhibit both inquiry and disclosure, are discussed. Indeed, the full potential of effective interventions has yet to be realized. KEY WORDS: prenatal alcohol substance use; screening and intervention INTRODUCTION Prenata e lxposure to alcohol and other substances are summarized and contrasted with the measures has become increasingly common. The substances available for prenatal alcohol use. Because used most frequently during pregnancy are alcohs oc lr , eening for prenatal alcohol and substance use is tobacco, and cannabis. Moreover, between 1999 but the prelude to eo ff rts to mitigate the potential and 2014, the number of women with opioid use adverse consequences, attempts for the modic fi ation The disorder during labor and delivery quadrupled. of these consequences are also briefly reviewed. purpose of this review is to describe the prevalence It should be noted that this review article is not and consequences of prenatal exposure to alcohol in , tended to be a systematic review of the world tobacco, cannabis, and opioids. Currently availabll ei terature on either prenatal substance use or its screening questionnaires for prenatal substance up se r evention. Rather, it is a narrative literature review Alcohol Research: Current Reviews 1 Vol 40 No 2 | 2020 that is meant to be illustrative and to stimulate intellectual disability or low IQ; poor reasoning areas of future research because the full potentia a ln d judgment skills; sleep and sucking problems as of ee ff ctive interventions has yet to be realized. a baby; vision or hearing problems; and problems with the heart, kidneys, or bones. A recent multisite study using active case THE CONSEQUENCES OF ascertainment methods estimated that the PRENATAL SUBSTANCE USE prevalence of FASD among first graders ranged The consequences of prenatal substance use die ff r This is concerning because these from 1% to 5%. depending on the specic fi substances used. The disorders are associated with life-long disabilities. most commonly used substances include alcohol, However, early intervention treatment services can tobacco, cannabis, and opioids. improve a child’s development and function. There is continuing uncertainty about the Prenatal Alcohol Use and ee ff cts of low and low-to-moderate levels of For example, a Its Consequences alcohol intake during pregnancy. The estimated percentage of prenatal alcohol use recent cohort study reported craniofacial changes is approximately 15%, with past month use being with almost any level of prenatal alcohol intake, 2,3 A Centers for Disease approximately 13%. but the clinical signica fi nce of these changes is not Factors that may inu fl ence the ee ff cts of Control and Prevention surc vo ey nducte d from known. 2015 to 2017 found that nearly 4% of pregnant prenatal alcohol use include patterns of maternal women had engaged in binge drinking in the drinking, maternal and fetal genetics, as well as Alcohol use during pregnancy prior 30 days. socioeconomic and ethnic factors. Because there is is a highly preventable cause of birth defects no proven “safe” level of alcohol exposure during Despite the and developmental disabilities. pregnancy, the most prudent advice for pregnant recognition of the teratogenic properties of women is to abstain from drinking. alcohol, many women continue to disregard Prenatal Tobacco Use and advisories on avoiding alcohol during pregnancy. There is no known safe level of alcohol use Its Consequences Cigarette smoking in the antepartum period is while pregnant because there is no exact dose- response relationship between the amount of common. Past month use of tobacco products alcohol consumed during the prenatal period among pregnant women was approximately 15% and the extent of damage caused by alcohol in according to the 2017 National Survey on Drug 7 13 Thus, an infant born to a mother who Tobacco products include the fetus. Use and Health report. drank alcohol while pregnant may be normal the use of alternative forms of nicotine, such as or may manifest alcohol-related birth defects e-cigarettes and vaping, which until recently, have (e.g., problems with the heart, kidneys, bones, been perceived to be less harmful. For example, or hearing), alcohol-related neurodevelopmental in 2015, as many as 7% of women with a recent disorders (e.g., intellectual disabilities or problem ls iv e birth in Oklahoma and Texas reported using with behavior and learning), or fetal alcohol an electronic vapor product shortly before, during, Data specific to the ee ff cts spectrum disorders (FASD), which includes a wide or after pregnancy. range of ee ff cts, from mild to severe. An individualo f prenatal use of electronic vapor products are with FASD might have abnormal facial features; sparse. However, the Centers for Disease Control small head size; shorter than average height; lowa nd Prevention has issued interim guidance that body weight; poor coordination; hyperactive electronic cigarette products should never be behavior; dic ffi ulty with attention; poor memory; used by pregnant women or adults who do not dic ffi ulties in school, especially with mathematics; currently use tobacco products as it investigates learning disabilities; speech and language delays; Alcohol Research: Current Reviews 2 Vol 40 No 2 | 2020 the more than 200 cases of severe pulmonary the meta-analysis was underpowered to stratify disease associated with their use. for all secondary outcomes of interest. Another The use of any tobacco product during systematic review and meta-analysis from the pregnancy is associated with adverse maternal, same time frame found that pregnant women fetal, and neonatal outcomes. Examples of the who used marijuana had increased odds of being adverse consequences of tobacco use may begin anemic and that infants exposed to cannabis in with subfertility and delay in conception among utero had decreased birth weight and were more The women who smoke and extend to pregnancy likely to require neonatal intensive care. outcomes, which include increased risk of researchers from this review acknowledged that spontaneous pregnancy loss, placental abruptionb , ecause many cannabis users often use tobacco preterm premature rupture of membranes, placen at na d alcohol as well, discerning a cannabis-only previa, preterm labor and delivery, low birth ee ff ct was not possible. A population-based weight, and ectopic pregnancy. Prenatal cigarettc e ohort study of 661,617 women in Ontario, smoking may exert ee ff cts beyond pregnancy Canada, showed that the percentage of preterm as well and is associated with increased risks of births among self-reported cannabis users was asthma, infantile colic, and childhood obesity. 12% compared to 6% among nonusers, with this increase persisting even after adjusting for Prenatal Cannabis Use and Until there is definitive confounding factors. Its Consequences evidence demonstrating the safety of prenatal Past month cannabis use among pregnant women marijuana use, concerns that marijuana may ages 18 to 44 increased between 2002 and 2017 interfere with neurodevelopment as well as have Among pregnant from approximately 3% to 7%. other ee ff cts have resulted in the American adolescents, past month use (15%) was even College of Obstetricians and Gynecologists A recent cross-sectional study using data higher. (ACOG) advising women who are pregnant or from 367,403 pregnancies among 276,991 women thinking about pregnancy to avoid using marijuana in Northern California found that self-reported and other cannabinoids. daily, weekly, and monthly cannabis use before Prenatal Opioid Use and and during pregnancy increased between 2009 and 2017. The greatest increases were for daily use, Its Consequences Opioid use among pregnant women increased reaching 25% among those who used in the year before pregnancy and 21% among those who used fourfold between 1999 and 2014 and is present in 19 26 Explanations for the increases Women who during pregnancy. approximately 3% of pregnancies. in prenatal use include increasing acceptance use opioids during pregnancy are a diverse group of cannabis use and decreasing perceptions of because opioid use may occur in the context of cannabis-related harms. medical care, opioid misuse, or untreated opioid The association between prenatal cannabis use use disorder. Prenatal opioid use can have a far-reaching and maternal, perinatal, and neonatal outcomes A 2016 systematic review and meta- is unclear. clinical impact on infant outcomes. Infants with analysis concluded that maternal marijuana prenatal opioid exposure are typically born use during pregnancy was not an independent smaller and may have neonatal opioid withdrawal risk factor for adverse neonatal outcomes, such syndrome (NOWS). Infants with NOWS experience as low birth weight or preterm delivery, after withdrawal from opioids and require additional Characteristics of NOWS, also adjusting for confounding factors like tobacco medical care. However, limitations to the generalizability use. known as neonatal abstinence syndrome (NAS), of this meta-analysis include the relatively few include disturbances in gastrointestinal, autonomic, women in the risk-adjusted group, indicating that and central nervous systems, leading to irritability, Alcohol Research: Current Reviews 3 Vol 40 No 2 | 2020 high-pitched crying, poor sleep, and uncoordinated higher social risk, male sex, and lower quality sucking ree fl xes that lead to poor feeding. In 2014, caregiving environments. A systematic review and meta-analysis a baby was born with NOWS in the United States 29,30 every 15 minutes. synthesized data from 41 studies on the The full impact of opioid exposure during neurodevelopment of prenatal methadone-exposed pregnancy on fetal, infant, and childhood children. The analysis included 1,441 children outcomes, however, is still unknown. Explanationw s hose mothers were prescribed methadone during include the possibility of exposure to other pregnancy and 842 children whose mothers did Methadone-exposed substances as well as concomitant maternal, not receive methadone. medical, psychological, and socioeconomic issues. children appeared to be at increased risk for There is a growing body of evidence about the neurodevelopmental impairment, with lower association of opioids with specific birth defects, scores on the Mental Development Index and such as congenital heart defects, neural tube Psychomotor Development Index, as well as defects, and clubfoot. atypical visual evoked potentials, strabismus, For pregnant women with opioid use disorder, and nystagmus. However, these findings about substitution treatment with opioid agonists, such ais m pairment may be biased, with the studies not methadone and buprenorphine, imparts importanta ccounting for factors other than methadone. benet fi s particularly when compared to continued Indeed, results from this meta-analysis confirm illicit drug use. Advantages include more stable the need for more research and the many factors maternal drug levels, reduced withdrawal and dr tu hg a- t can impact pregnancy outcome. seeking behavior, and improved self-care, which should lead to a better pregnancy outcome because SCREENING FOR PRENATAL of reduced risk for fetal distress, miscarriage, SUBSTANCE USE growth restriction, and preterm birth. Compared to data on buprenorphine-maintained E arly universal screening of pregnant women for pregnancies, more longitudinal data on methadone a-lcohol use, substance use, or both is recommended exposed pregnancies are available. In a prospective by ACOG because alcohol and substance use is longitudinal study, 68 methadone-exposed not typically disclosed spontaneously by patients. children and 88 nonmethadone-exposed children ACOG recommends clinicians use validated were evaluated at 2.0 and 4.5 years for executive questionnaires or have a conversation with functioning and later emotional behavioral patients but does not endorse using routine urine 33 35,36 The methadone- Moreover, a positive screening and emotional adjustment. toxicology tests. exposed children had worse inhibitory control questionnaire does not result in a diagnosis. Rather, than the nonexposed children, when taking such a result is an opportunity for a patient and maternal education and prenatal benzodiazepine h er clinician to review health practices and make use into account. Another study used a school changes, if appropriate. readiness framework to assess the health and Screening for Prenatal Alcohol Use neurodevelopmental outcomes of a regional There is no known safe level of alcohol cohort of 100 methadone-exposed children and Alcohol is 110 randomly identie fi d nonmethadone-exposed consumption during pregnancy. children who were studied from birth to 4.5 years.a teratogen; in other words, it is capable of Children born to opioid-dependent mothers had interfering with fetal development, resulting in higher rates of delay and impairment across all birth defects. Although the consequences of light outcome domains, with multiple domain problemsa lcohol use among women, defined as consuming being common. Impaired school readiness was up to 32 g of alcohol per week, on pregnancy associated with greater maternal substance use, outcomes remain unsettled in the absence of Alcohol Research: Current Reviews 4 Vol 40 No 2 | 2020 suc ffi ient evidence, the potential for harm cannot Several recent studies have evaluated the Hence, ACOG has recommended be ruled out. accuracy of various screening tools for prenatal that all women seeking obstetric–gynecologic cas rubs e tance use. In one prospective cross-sectional be screened for alcohol use annually and within study conducted in Baltimore, MD, with 500 the first trimester of pregnancy. pregnant women, stratie fi d by trimester and use of Screening questionnaires for prenatal alcohol u ps re e natal care, researchers administered three index The have been well studied. For example, a systematic tests and compared them to reference tests. review of brief screening questionnaires to identifyt hree index tests were the proprietary 4P’s Plus problem drinking during pregnancy evaluated NIDA Quick Screen–ASSIST), and the SURP-P. seven instruments given to 6,724 participants. The reference tests were urine and hair testing, The measures included the TWEAK (Tolerance, which captured substance use up to the past 90 days. Worried, Eye-Opener, Amnesia, K/Cut Dow n); Alcohol use was not evaluated. The researchers the T-ACE (Tolerance [number of drinks], found that there were die ff rences in validity indices Annoyance, Cut Down, Eye-Opener); CAGE (i.e., sensitivity, specificity, positive predictive value, (Cut Down, Annoyed, Guilty, Eye-Opener), NET and negative predictive value) by age and race, (Normal Drinker, Eye-Opener, Tolerance); AUDIT but not by trimester, for all screening tools. The were highly sensitive across (Alcohol Use Disorder Identica fi tion Test); AUDIT-C SURP-P and 4P’s Plus (AUDIT Alcohol Consumption Questions), and all trimesters, races, and age groups. SMAST (Short Michigan Alcoholism Screening Another prospective cross-sectional screening Test). The screening questionnaires were accuracy study compared v fi e screening compared with a structured interview to ascertain in struments on their ability to identify illicit drinking status as a reference standard. The drug, opioid, and alcohol use under privacy T-ACE, AUDIT-C, and TWEAK were the three expectations consistent with current practice. questionnaires identie fi d to be the most promising The participants included 1,220 pregnant women screening tools for identifying risk drinking in who were receiving care in Boston, MA; Detroit, pregnant women. However, the sensitivity and MI; or New Haven, CT. The women were specificity of these three questionnaires outside the socioeconomically diverse and had a mean age of United States is unknown. 29 years. The study used a reference standard of substance use in three classes (i.e., illicit drugs, Screening for Prenatal Substance Use opioids, and alcohol); results were considered Screening instruments for prenatal alcohol positive if use was evident via a 30-day calendar The illicit use have been well studied, whereas screening recall or urine toxicology analysis. instruments for substances other than alcohol drug use reference standard included marijuana, 26,40 The World have been less well developed. cocaine, heroin, amphetamines, barbiturates, and Health Organization (WHO) guidelines for the hallucinogens. The v fi e screening instruments for identica fi tion and management of substance use substance use in pregnancy were the SURP-P; and substance use disorder during pregnancy CRAFFT, a v fi e-item screener with items related list the Substance Use Risk Profile-Pregnancy to car, relax, alone, forget, friends, and trouble; 41 © 42 the proprietary 4P’s Plu , s (SURP-P) scale, 5Ps, with items on parents, peers, partner, and the National Institute on Drug Abuse (NIDA) pregnancy, past (i.e., an adaptation of the 4P’s ); Wayne Indirect Drug Use Screener Quick Screen–Modie fi d Alcohol, Smoking, and Plus Substance Involvement Screening Test (ASSIST) (WIDUS); and NIDA Quick Screen–ASSIST. as potential screening measures for pregnant None of the five measures showed both high women, even though not all of these instruments sensitivity and high specificity, and the area had been evaluated among that population at the under the curve was low for nearly all measures, time of its recommendation. Alcohol Research: Current Reviews 5 Vol 40 No 2 | 2020 indicating that none could be recommended for CRAFFT (AUROC=0.75, 95% CI [0.72, 0.79]) applied practice with pregnant women. and SURP-P (AUROC=0.74, 95% CI [0.71, A companion study compared the same v fi e 0.78]) had the highest AUROCs for identifying measures in the identica fi tion of substance use substance use disorder, including alcohol. In disorder, including alcohol, cannabis, opioids, contrast, the NIDA Quick Screen had the lowest and stimulants, among the 1,220 pregnant AUROC (AUROC=0.62, 95% CI [0.59, 0.65]) Participants completed the Mini women. for identifying substance use disorder, including International Neuropsychiatric Interview alcohol. Overall, the tested measures were more 7.0.2, a short, structured diagnostic interview accurate in identifying alcohol use disorder than to identify substance use disorder, including substance use disorder (e.g., for identifying alcohol alcohol; cannabis; stimulants, such as cocaine or use disorder, the AUROCs for the CRAFFT and amphetamines; and opioids, such as heroin and the SURP-P were 0.78 and 0.77, respectively). Substance nonmedical use of prescription drugs. Barriers to Early Identification use disorder is distinct from substance use and represents a more signica fi nt and persistent patterby n Screening Pregnant women with substance use disorder of consumption that may increase the risk of adverse infant outcomes as well as indicate that are at increased risk for adverse health and the pregnant woman may need evaluation and social outcomes, making early identification 49 50 Of the 1,220 Because substance use is substantially referral for specialty treatment. crucial. women in this study, more than 15% satise fi d underreported, even among women who participate diagnostic criteria for substance use disorder and regularly in urine drug screens, use of validated more than 30% reported having used alcohol questionnaires to identify prenatal alcohol and 26,51 or other substances in the past month. There substance use has been recommended. There are, however, at least two barriers was little overlap between the women who had substance use disorder and the women who had to these recommendations. First, as discussed used alcohol or other substances within the past in the preceding section, current screening month. Nearly 10% of the women satise fi d criteria questionnaires have been found to be inadequate for alcohol use disorder, as defined in the fifth measures. According to a 2010 survey of edition of thD e iagnostic and Statistical Manual obstetrician-gynecologists, 58% did not use of Mental Disorders, and 9.0% satise fi d criteria for a validated screening tool to assess alcohol substance use disorder. Specica fi lly, cannabis use risk despite there being several validated tools It is likely that even fewer will disorder was the most common substance disorder available. diagnosed (8%). Approximately 3% satise fi d use a screening tool for prenatal substance criteria for more than one disorder. use, particularly as such tools are less well There were considerable variations by site. developed. A second barrier includes the punitive For example, alcohol use disorder was the most consequences stemming from state laws regarding common in Boston (15%) but infrequent in New prenatal substance use, which can result in patients Haven (5%). In contrast, substance use disorder not wanting to disclose and physicians not wanting 53-55 Hence, was the most common in Detroit (17%) but less to learn about their patients’ behaviors. frequent in Boston (3%). Measures of merit in addition to patients’ previous fears about (i.e., sensitivity, specificity, accuracy, and area stigmatization because of use, disclosure could An example of a punitive under the receiver operating curve [AUROC]) now pose a legal risk. were calculated with 95% cond fi ence intervals policy includes treating substance use during [CI] for the NIDA Quick Screen, CRAFFT, pregnancy as child abuse or neglect. This policy SURP-P, WIDUS, and 5Ps, using substance may arise from a desire to discourage women from use disorder as the criterion standard. The using substances while pregnant, to encourage Alcohol Research: Current Reviews 6 Vol 40 No 2 | 2020 women to seek treatment, and to ensure the safety and middle-income countries had not. However, of the neonate. the WHO noted that much of the evidence The association between states with punitive underlying the ee ff ctiveness of screening and brief or reporting policies related to substance use interventions during pregnancy originated from in pregnancy and rates of NAS was recently a time when reporting standards and measures evaluated in a study of 4,567,963 births from of bias were not in consistent use. Nonetheless, 8 U.S. states in varying years between 2003 the evidence indicated that asking women about States without punitive or reporting and 2014. alcohol and other substance use in a detailed and policies were compared with states that had such comprehensive way may increase their awareness policies, before and after policy enactment. The of the risks associated with these practices and main outcome measure was the rate of NAS. State psro mpt them to modify their behavior. that criminalized substance use during pregnancy Psychosocial Interventions for (e.g., grounds for civil commitment, child abuse, or neglect) had significantly higher rates of NAS in P renatal Alcohol Use In late 2018, the U.S. Preventive Services Task the 1st full year after enactment and more than 1 full year after enactment. In contrast, there waF s o nr o ce (USPSTF) renewed its recommendation for association with neonatal abstinence rates in stat se cs reening adults ages 18 year or older, including with policies requiring reporting of suspected pregnant women, for unhealthy alcohol use and prenatal substance use. A possible explanation providing persons engaged in risky or hazardous for this die ff rence includes the extent to which drinking with brief behavioral counseling pregnant women disengage from health care interventions to reduce unhealthy alcohol use (i.e., services when punitive measures are enforced, a grade B recommendation meaning that there is whereas reporting policies may not dissuade high certainty that the net benefit is moderate, or pregnant women from engaging with health moderate certainty that the net benefit is moderate The USPSTF bounds the harms care services, resulting in greater conversations to substantial). between physicians and their patients. However, of screening and brief behavioral counseling neither the punitive nor the reporting approach interventions for unhealthy alcohol use in adults resulted in reduced rates of NAS, which was the as small to none, based on the likely minimal presumed, desired outcome of these policies. risks of completing screening questionnaires, the noninvasive nature of the interventions, and the absence of reported harms in the evidence of the AFTER SCR EENING: behavioral interventions. INTERVENTION The USPSTF makes three special comments Because screening for prenatal alcohol and with regards to pregnant women. First, any alcohol substance use is but the prelude to eo ff rts to use by pregnant women is unhealthy. Second, mitigate the potential adverse consequences, validated alcohol screening tools for pregnant brief intervention and referral to treatment, if women are available, including the T-ACE and Brief indicated, have also been recommended. TWEAK. Third, brief counseling interventions interventions and psychosocial interventions have among pregnant women have increased the been examined by investigators and organizations likelihood that women remain abstinent from such as the WHO, which sought to develop alcohol use during pregnancy. evidence-based global guidelines for identifying Most interventions for FASD have been and managing substance use and substance use reported in North America, which has lower Global guidelines were disorder in pregnancy. FASD prevalence compared to Europe and Context-related desired because although several high-income other sites around the world. countries had developed national guidelines, lowd - ie ff rences may impact on the ee ff ctiveness of Alcohol Research: Current Reviews 7 Vol 40 No 2 | 2020 the interventions. For example, in a systematic The first systematic review included four review of prevention interventions to reduce articles published between 2002 and 2013. It prenatal alcohol exposure and FASD in began with 3,792 unique potential publications, indigenous communities, reviewers evaluated but the vast majority did not meet a priori quality studies conducted from 1989 to 2017. A total of criteria. Limited, but promising, evidence of brief 10 studies from an initial sample of 712 articles interventions reducing illicit drug use among were included if inclusion criteria were met. postpartum women was found. The second systematic review was completed Comparisons of study ee ff cts were made dic ffi ult by heterogenous study designs, target populations b, y researchers from the Cochrane Collaboration. and interventions. The reviewers concluded that They sought to evaluate the evidence on the ee ff ct there was minimal evidence to support the belief of psychosocial interventions, such as contingency that interventions intended to reduce the risk of management (CM) and motivational interviewing- prenatal alcohol exposure or FASD in indigenous based (MIB) techniques compared to that of populations have been ee ff ctive. usual care for pregnant women in outpatient illicit This group reviewed drug treatment programs. Psychosocial Interventions for 14 studies, with 1,298 pregnant women who Prenatal Cigarette Smoking received either CM or MIB techniques in addition Psychosocial interventions for supporting women to other comprehensive care. The women in the to stop smoking during pregnancy were assessed control group received usual care that included by the Cochrane Pregnancy and Childbirth pharmacological management, counseling, prenatal This review included 102 randomized Group. care, transportation, and/or childcare. There controlled trials, with 120 intervention arms. Da w te a re no die ff rences in retention or abstinence from 88 randomized controlled trials, involvinb ge havior between CM/MIB techniques and usual more than 28,000 women, were analyzed. comprehensive care. The quality of evidence from Intervention strategies included counseling, healt th h ese studies was assessed to be low to moderate. education, feedback, incentives, social support, and exercise. Nearly all studies were conducted in SUMMARY high-income countries. Results from the review Prenatal exposure to alcohol, tobacco, and yielded moderate- to high-quality evidence that psychosocial interventions increased the marijuana has become increasingly common. In proportion of pregnant women who had stopped addition, there has been a fourfold increase in the smoking by late pregnancy (35%), with a 17% number of opioid-exposed pregnancies. Prenatal reduction in infants born with low birth weight,e xposure to alcohol and other substances may have and a 22% reduction in neonatal intensive care an adverse impact on a developing fetus. Since admissions. There did not appear to be any adverse pregnant women may be reluctant to disclose psychological ee ff cts from the interventions. their use or may not appreciate the potential for harm, early identica fi tion is desirable. However, Psychosocial Interventions to Reduce identica fi tion is currently limited by the lack of Other Prenatal Substance Use adequate screening tools and the fear of legal and Screening, brief intervention, and referral to other sanctions, which may limit both inquiry and treatment in the perinatal period have been disclosure. Although ee ff ctive interventions for recommended for prenatal substance use. prenatal alcohol, cigarette, and other substances Subsequent to this recommendation, at least are available, these interventions rely on two systematic reviews of the evidence for identica fi tion and behavioral counseling. It is likely psychosocial interventions have been completed. that the full potential of ee ff ctive interventions cannot yet be realized in the current setting. Alcohol Research: Current Reviews 8 Vol 40 No 2 | 2020 Financial disclosure use—Interim guidance. MMWR Morb Mortal Wkly Rep. The author receives royalty payments from UpToDate. 2019;68(36):787-790. http://doi.org/10.15585/mmwr.mm6836e2 . 14. Committee on Underserved Women, Committee on Obstetric Practice. Committee Opinion Number 721: Smoking cessation Publisher’s note during pregnancy Obstet . Gynecol. 2017;130(4):e200-e204. Opinions expressed in contributed articles do not necessarily http://doi.org/10.1097/AOG.0000000000002353 . reflect the views of the National Institute on Alcohol Abuse and 15. Volkow ND, Han B, Compton WM, et al. Self-reported medical Alcoholism, National Institutes of Health. The U.S. government does and non-medical cannabis use among pregnant women in not endorse or favor any specic fi commercial product or commodity. Trade or proprietary names appearing in this publication are used the United States. JAMA. 2019;322(2):167-169. http://doi. only because they are considered essential in the context of the org/10.1001/jama.2019.7982 . studies reported herein. 16. Salas-Wright CP, Vaughn MG, Ugalde J, et al. Substance use and teen pregnancy in the United States: Evidence from NSDUH 2002-2012. Addict Behav. 2015;45:218-225. http://doi. References org/10.1016/j.addbeh.2015.01.039 . 1. Haight SC, Ko JY, Tong VT, et al. Opioid use disorder 17. Young-Wolff KC, Sarovar V, Tucker LY, et al. Self-reported documented at delivery hospitalization—United States, 1999- daily, weekly, and monthly cannabis use among women before 2014. MMWR Morb Mortal Wkly Rep. 2018;67(31):845-849. and during pregnancy JAMA . Netw Open. 2019;2(7):e196471. http://doi.org/10.15585/mmwr.mm6731a1 . http://doi.org/10.1001/jamanetworkopen.2019.6471 . 2. Denny CH, Acero CS, Naimi TS, et al. Consumption of alcohol 18. Hill KP. Medical use of cannabis in 2019. JAMA. August 2019. beverages and binge drinking among pregnant women aged 18-44 http://doi.org/10.1001/jama.2019.11868 . years—United States, 2015-2017. MMWR Morb Mortal Wkly Rep. 19. Silverstein M, Howell EA, Zuckerman B. Cannabis use in 2019;68 (16):365-368. http://doi.org/10.15585/mmwr.mm6816a1 . pregnancy: A tale of 2 concerns. JAMA. 2019;322(2):121-122. 3. Terplan M, Cheng D, Chisholm MS. The relationship between http://doi.org/10.1001/jama.2019.8860 . pregnancy intention and alcohol use behavior: An analysis of 20. Conner SN, Bedell V, Lipsey K, et al. Maternal marijuana use and PRAMS data. J Subst Abuse Treat. 2014;46(4):506-510. http:// adverse neonatal outcomes. Obstet Gynecol. 2016;128(4):713- doi.org/10.1016/j.jsat.2013.11.001 . 723. http://doi.org/10.1097/AOG.0000000000001649 . 4. Warren KR. A review of the history of attitudes toward drinking 21. Gunn JKL, Rosales CB, Center KE, et al. Prenatal exposure to in pregnancyAlcohol . Clin Exp Res. 2015;39(7):1110-1117. cannabis and maternal and child health outcomes: A systematic http://doi.org/10.1111/acer.12757 . review and meta-analysis. BMJ Open. 2016;6(4):e009986. http:// 5. Feldman HS, Jones KL, Lindsay S, et al. Prenatal alcohol exposure doi.org/10.1136/bmjopen-2015-009986 . patterns and alcohol-related birth defects and growth deficiencies: 22. Corsi DJ, Walsh L, Weiss D, et al. Association between self- A prospective study Alcohol . Clin Exp Res. 2012;36(4):670-676. reported prenatal cannabis use and maternal, perinatal, and http://doi.org/10.1111/j.1530-0277.2011.01664.x. neonatal outcomes. JAMA. 2019;322(2):145-152. http://doi. 6. Centers for Disease Control and Prevention. Fetal Alcohol org/10.1001/jama.2019.8734 . Spectrum Disorders (FASDs). Basics About FASDs. https://www. 23. Volkow ND, Compton WE, Wargo EM. The risks of marijuana cdc.gov/ncbddd/fasd/facts.html . Accessed January 30, 2020. use during pregnancy JAMA . . 2017;317(2):129-130. http://doi. 7. May PA, Chambers CD, Kalberg WO, et al. Prevalence of org/10.1001/jama.2016.18612 . fetal alcohol spectrum disorders in 4 US communities. JAMA. 24. Haight SC, Ko JY, Tong VT, et al. Opioid use disorder 2018;319(5):474-482. http://doi.org/10.1001/jama.2017.21896 . documented at delivery hospitalization—United States, 1999- 8. Chang G. Alcohol Intake and Pregnancy. May 2019. https:// 2014. MMWR Morb Mortal Wkly Rep. 2018;67(31):845-849. www.uptodate.com/contents/alcohol-intake-and-pregnancy . http://doi.org/10.15585/mmwr.mm6731a1 . Accessed January 30, 2020. 25. Committee on Obstetric Practice. Committee Opinion No. 711: 9. Muggli E, Matthews H, Penington A, et al. Association between Opioid use and opioid use disorder in pregnancy Obstet . Gynecol. prenatal alcohol exposure and craniofacial shape of children at 12 2017;130(2):e81-e94. http://doi.org/10.15585/mmwr.mm6731a1 . months of age. JAMA Pediatr. 2017;171(8):771-780. http://doi. 26. Ecker J, Abuhamad A, Hill W, et al. Substance use disorders org/10.1001/jamapediatrics.2017.0778 . in pregnancy: Clinical, ethical, and research imperatives of the 10. Mamluk L, Edwards HB, Savovic J, et al. Low alcohol opioid epidemic: A report of a joint workshop of the Society for consumption and pregnancy and childhood outcomes: Time Maternal-Fetal Medicine, American College of Obstetricians and to change guidelines indicating apparently “safe” levels of Gynecologists, and American Society of Addiction Medicine. Am alcohol during pregnancy? A systematic review and meta- J Obstet Gynecol. 2019;221(1):B5-B28. http://doi.org/10.1016/j. analysis. BMJ Open. 2017;7(7):e015410. http://doi.org/10.1136/ ajog.2019.03.022. bmjopen-2016-015410. 27. Honein MA, Boyle C, Redfield RR. Public health surveillance 11. McCance-Katz EFNational . Survey on Drug Use and Health: of prenatal opioid exposure in mothers and infants. Pediatrics. 2018. Rockville, MD: Substance Abuse and Mental Health 2019;143(3):e20183801. http://doi.org/10.1542/peds.2018-3801 . Services Administration; August 2019. https://www.samhsa.gov/ data/report/dr-elinore-f-mccance-katz-webcast-slides-national- 28. Sanlorenzo LA, Stark AR, Patrick SW. Neonatal abstinence survey-drug-use-and-health-2018 . Accessed January 30, 2020. syndrome: An update. Curr Opin Pediatr. 2018;30(2):182-186. 12. Kapaya M, D’Angelo DV, Tong VT, et al. Use of electronic vapor http://doi.org/10.1097/MOP.0000000000000589 . products before, during, and after pregnancy among women with 29. Yazdy MM, Desai RJ, Brogly SB. Prescription opioids in a recent live birth—Oklahoma and Texas, 2015. MMWR Morbid pregnancy and birth outcomes: A review of the literature. J Pediatr Mortal Wkly Rep. 2019;68(8):189-194. http://doi.org/10.15585/ Genet. 2015;4(2):56-70. http://doi.org/10.1055/s-0035-1556740 . mmwr.mm6808a1 . 30. Konijnenberg C, Melinder A. Prenatal exposure to methadone 13. Schier JG, Meiman JG, Layden J, et al. Severe pulmonary and buprenorphine: A review of the potential effects on cognitive disease associated with electronic-cigarette–product development. Child Neuropsychol. 2011;17(5):495-519. http:// doi.org/10.1080/09297049.2011.553591. Alcohol Research: Current Reviews 9 Vol 40 No 2 | 2020 31. Levine TA, Woodward LJ. Early inhibitory control and working47. Edwards AC, Ohlsson H, Svikis DS, et al. Protective memory abilities of children prenatally exposed to methadone. effects of pregnancy on risk of alcohol use disorder Am. . J. Early Hum Dev. 2018; 116:68-75. http://doi.org/10.1016/j. Psychiatry. 2019;176(2):138-145. http://doi.org/10.1176/appi. earlhumdev.2017.11.010 . ajp.2018.18050632. 32. Lee SJ, Pritchard VE, Austin NC, et al. Health and 48. Kozhimannil KB, Dowd WN, Ali MM, et al. Substance use neurodevelopment of children born to opioid-dependent mothers disorder treatment admissions and state-level prenatal substance at school entry J . Dev Behav Pediatr. 2020;41(1):48-57. http:// use policies: Evidence from a national treatment database. doi.org/10.1097/DBP.0000000000000711. Addict Behav. 2019;90:272-277. http://doi.org/10.1016/j. 33. Monnelly VJ, Hamilton R, Chappell FM, et al. Childhood addbeh.2018.11.019. neurodevelopment after prescription of maintenance methadone 49. Garg M, Garrison L, Leeman L, et al. Validity of self-reported drug for opioid dependency in pregnancy: A systematic review and use information among pregnant women. Matern Child Health J. meta-analysis. Dev Med Child Neurol. 2019;61(7):750-760. 2016;20(1):41-47. http://doi.org/10.1007/s10995-015-1799-6 . http://doi.org/10.1111/dmcn.141.17 50. Anderson BL, Dan EP, Floyd RL, et al. Knowledge, opinions, 34. American College of Obstetricians and Gynecologists, and practice patterns of obstetrician-gynecologists regarding their Committee on Ethics. Committee Opinion No. 633: Alcohol patients’ use of alcohol. J Addict Med. 2010;4(2):114-121. http:// Abuse and Other Substance Use Disorders: Ethical Issues in doi.org/10.1097/ADM.0b013e3181b95015. Obstetric and Gynecologic Practice. June 2015. https:// 51. Flavin J, Paltrow LM. Punishing pregnant drug-using women: www.acog.org/-/media/project/acog/acogorg/clinical/files/ Defying law, medicine, and common sense. J Addict Dis. committee-opinion/articles/2015/06/alcohol-abuse-and-other- 2010;29(2):231-244. https://doi.org/10.1080/10550881003684830. substance-use-disorders-ethical-issues-in-obstetric-and- 52. Guttmacher Institute. Substance Use During Pregnancy. 2020. gynecologic-practice.pdf. Accessed January 9, 2019. https://www.guttmacher.org/state-policy/explore/substance-use- 35. Chang G. Screening for alcohol and drug use during pregnancy. during-pregnancy Accessed . February 3, 2020. Obstet Gynecol Clin N Am. 2014;41(2):205-212. http://doi. 53. Angelotta C, Applebaum PS. Criminal charges for child harm org/10.1016/j.ogc.2014.02.002 . from substance use in pregnancy J Am Acad . Psychiatry Law. 36. National Institute on Alcohol Abuse and Alcoholism. Fetal 2017;45(2):193-203. Alcohol Exposure. December 2019. https://www.niaaa.nih.gov/ 54. Stone R. Pregnant women and substance use: Fear, stigma, and sites/default/files/FASD.pdf . Accessed December 11, 2019. barriers to care. Health Justice. 2015;3(2). http://doi.org/10.1186/ 37. Burns E, Gray R, Smith LA. Brief screening questionnaires s40352-015-0015-5. to identify problem drinking during pregnancy: A systematic 55. Faherty LJ, Kranz Am, Russell-Fritch J, et al. Association of review. Addiction. 2010;105(4):601-614. http://doi.org/10.1111/ punitive and reporting state policies related to substance use j.1360-0443.2009.02842.x. in pregnancy with rates of neonatal abstinence syndrome. 38. DeVido J, Bogunovic O, Weiss RD. Alcohol use disorders in JAMA Netw Open. 2019;2(1):e1914078. http://doi.org/10.1001/ pregnancyHarv . Rev Psychiatry. 2015;23(2):112-121. http://doi. jamanetworkopen.2019.14078 . org/10.1097/HRP.0000000000000070. 56. U.S. Preventive Services Task Force. Screening and behavioral 39. Yonkers KA, Gotman N, Kershaw T, et al. Screening for prenatal counseling interventions to reduce unhealthy alcohol use in substance use: Development of the substance use risk profile- adolescents and adults. JAMA. 2018;320(18):1899-1909. http:// pregnancy scale. Obstet Gynecol. 2010;116(4):827-833. http:// doi.org/10.1001/jama.2018.16789 . doi.org/10.1097/AOG.0b013e3181ed8290. 57. Adebiyi BO, Mukumbang FC, Erasmus C. The distribution 40. Chasnoff I, Wells A, McGourty R, et al. Validation of the 4 P’s of available prevention and management interventions for Plus screen in pregnancy J Perinatol . . 2007;27(12):744-748. fetal alcohol spectrum disorder (2007 to 2017): Implications http://doi.org/10.1038/sj.jp.7211823 . for collaborative actions. Int J Environ Res Public Health. 41. National Institute on Drug Abuse. Resource Guide: Screening 2019;16(12):E2244. http://doi.org/10.3390/ijerph16122244 . for Drug Use in General Medical Settings. 2012. https://www. 58. Symons M, Pedruzzi RA, Bruce K, et al. A systematic review of drugabuse.gov/publications/resource-guide/preface . Accessed prevention interventions to reduce prenatal alcohol exposure and September 14, 2019. fetal alcohol spectrum disorder in indigenous communities. BMC 42. World Health Organization. Guidelines for the Identification and Public Health. 2018;18(1):1227. http://doi.org/10.1186/s12889- Management of Substance Use and Substance Use Disorders 018-6139-5. in Pregnancy. 2014. https://www.who.int/substance_abuse/ 59. Chamberlain C, O’Mara-Eves A, Porter J, et al. Psychosocial publications/pregnancy_guidelines/en . Accessed January 30, 2020. interventions for supporting pregnant women to stop smoking. 43. Coleman-Cowger VH, Oga EA, Peters EN, et al. Accuracy Cochrane Database Syst Rev. 2017;10:CD001055. http://doi. of three screening tools for prenatal substance Obstet use. org/10.1002/14651858.CD001055.pub4. Gynecol. 2019;133(5):952-961. http://doi.org/10.1097/ 60. Wright TE, Terplan M, Ondersma SJ, et al. The role of screening, AOG.0000000000003230. brief intervention, and referral to treatment in the perinatal 44. Ondersma SJ, Chang G, Blake-Lamb T, et al. Accuracy of five period. Am J Obstet Gynecol. 2016;215(5):539-547. http://doi. self-report screening instruments for substance use in pregnancy. org/10.1016/j.ajog.2016.06.038 . Addiction. 2019;114(9):1683-1693. http://doi.org/10.1111/ 61. Farr SL, Hutchings YL, Ondersma SJ, et al. Brief interventions add.14651. for illicit drug use among peripartum women. Am J Obstet 45. Chang G, Ondersma SJ, Blake-Lamb T, et al. Identification of Gynecol. 2014;211(4):336-343. http://doi.org/10.1016/j. substance use disorders among pregnant women: A comparison ajog.2014.04.005. of screeners. Drug Alcohol Depend. 2019;205: 107651. http:// 62. Terplan M, Ramanadhan S, Locke A, et al. Psychosocial doi.org/10.1016/j.drugalcdep.2019.107651 . interventions for pregnant women in outpatient illicit 46. Sheehan DW, Lecrubier Y, Sheehan KH, et al. The Mini- drug treatment programs compared to other interventions. International Neuropsychiatric Interview (M.I.N.I.): The Cochrane Database Syst Rev. 2015;2(4):CD006037. http://doi. development and validation of a structured diagnostic psychiatric org/10.1002/14651858.CD006037.pub3. interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59(supp 20):22-33. PMID: 9881538. Alcohol Research: Current Reviews 10 Vol 40 No 2 | 2020 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Alcohol Research : Current Reviews Pubmed Central

Maternal Substance Use: Consequences, Identification, and Interventions

Alcohol Research : Current Reviews , Volume 40 (2) – Jun 30, 2020

Loading next page...
 
/lp/pubmed-central/maternal-substance-use-consequences-identification-and-interventions-treUFoxWiR

References

References for this paper are not available at this time. We will be adding them shortly, thank you for your patience.

Publisher
Pubmed Central
ISSN
2168-3492
eISSN
2169-4796
DOI
10.35946/arcr.v40.2.06
Publisher site
See Article on Publisher Site

Abstract

FOCUS ON Alcohol Res. 2020;40(2):06 • https://doi.org/10.35946/arcr.v40.2.06 Published online [TK] Maternal Substance Use: Consequences, Identification, and Interventions 1,2 Grace Chang U.S. Department of Veterans Aa ff irs Boston Healthcare System, Boston, Massachusetts Harvard Medical School, Department of Psychiatry, Boston, Massachusetts Alcohol, tobacco, and cannabis are the substances most frequently used during pregnancy, and opioid-exposed pregnancies have increased fourfold. The purpose of this review is to describe the prevalence and consequences of prenatal exposure to alcohol, tobacco, cannabis, and opioids. Currently available screening questionnaires for prenatal substance use are summarized and contrasted with the measures available for prenatal alcohol use. Because screening for prenatal alcohol and substance use is but the prelude to efforts to mitigate the potential adverse consequences, attempts for the modification of these consequences are briefly reviewed. In addition, areas of future research related to the criminalization of prenatal substance use, which may inhibit both inquiry and disclosure, are discussed. Indeed, the full potential of effective interventions has yet to be realized. KEY WORDS: prenatal alcohol substance use; screening and intervention INTRODUCTION Prenata e lxposure to alcohol and other substances are summarized and contrasted with the measures has become increasingly common. The substances available for prenatal alcohol use. Because used most frequently during pregnancy are alcohs oc lr , eening for prenatal alcohol and substance use is tobacco, and cannabis. Moreover, between 1999 but the prelude to eo ff rts to mitigate the potential and 2014, the number of women with opioid use adverse consequences, attempts for the modic fi ation The disorder during labor and delivery quadrupled. of these consequences are also briefly reviewed. purpose of this review is to describe the prevalence It should be noted that this review article is not and consequences of prenatal exposure to alcohol in , tended to be a systematic review of the world tobacco, cannabis, and opioids. Currently availabll ei terature on either prenatal substance use or its screening questionnaires for prenatal substance up se r evention. Rather, it is a narrative literature review Alcohol Research: Current Reviews 1 Vol 40 No 2 | 2020 that is meant to be illustrative and to stimulate intellectual disability or low IQ; poor reasoning areas of future research because the full potentia a ln d judgment skills; sleep and sucking problems as of ee ff ctive interventions has yet to be realized. a baby; vision or hearing problems; and problems with the heart, kidneys, or bones. A recent multisite study using active case THE CONSEQUENCES OF ascertainment methods estimated that the PRENATAL SUBSTANCE USE prevalence of FASD among first graders ranged The consequences of prenatal substance use die ff r This is concerning because these from 1% to 5%. depending on the specic fi substances used. The disorders are associated with life-long disabilities. most commonly used substances include alcohol, However, early intervention treatment services can tobacco, cannabis, and opioids. improve a child’s development and function. There is continuing uncertainty about the Prenatal Alcohol Use and ee ff cts of low and low-to-moderate levels of For example, a Its Consequences alcohol intake during pregnancy. The estimated percentage of prenatal alcohol use recent cohort study reported craniofacial changes is approximately 15%, with past month use being with almost any level of prenatal alcohol intake, 2,3 A Centers for Disease approximately 13%. but the clinical signica fi nce of these changes is not Factors that may inu fl ence the ee ff cts of Control and Prevention surc vo ey nducte d from known. 2015 to 2017 found that nearly 4% of pregnant prenatal alcohol use include patterns of maternal women had engaged in binge drinking in the drinking, maternal and fetal genetics, as well as Alcohol use during pregnancy prior 30 days. socioeconomic and ethnic factors. Because there is is a highly preventable cause of birth defects no proven “safe” level of alcohol exposure during Despite the and developmental disabilities. pregnancy, the most prudent advice for pregnant recognition of the teratogenic properties of women is to abstain from drinking. alcohol, many women continue to disregard Prenatal Tobacco Use and advisories on avoiding alcohol during pregnancy. There is no known safe level of alcohol use Its Consequences Cigarette smoking in the antepartum period is while pregnant because there is no exact dose- response relationship between the amount of common. Past month use of tobacco products alcohol consumed during the prenatal period among pregnant women was approximately 15% and the extent of damage caused by alcohol in according to the 2017 National Survey on Drug 7 13 Thus, an infant born to a mother who Tobacco products include the fetus. Use and Health report. drank alcohol while pregnant may be normal the use of alternative forms of nicotine, such as or may manifest alcohol-related birth defects e-cigarettes and vaping, which until recently, have (e.g., problems with the heart, kidneys, bones, been perceived to be less harmful. For example, or hearing), alcohol-related neurodevelopmental in 2015, as many as 7% of women with a recent disorders (e.g., intellectual disabilities or problem ls iv e birth in Oklahoma and Texas reported using with behavior and learning), or fetal alcohol an electronic vapor product shortly before, during, Data specific to the ee ff cts spectrum disorders (FASD), which includes a wide or after pregnancy. range of ee ff cts, from mild to severe. An individualo f prenatal use of electronic vapor products are with FASD might have abnormal facial features; sparse. However, the Centers for Disease Control small head size; shorter than average height; lowa nd Prevention has issued interim guidance that body weight; poor coordination; hyperactive electronic cigarette products should never be behavior; dic ffi ulty with attention; poor memory; used by pregnant women or adults who do not dic ffi ulties in school, especially with mathematics; currently use tobacco products as it investigates learning disabilities; speech and language delays; Alcohol Research: Current Reviews 2 Vol 40 No 2 | 2020 the more than 200 cases of severe pulmonary the meta-analysis was underpowered to stratify disease associated with their use. for all secondary outcomes of interest. Another The use of any tobacco product during systematic review and meta-analysis from the pregnancy is associated with adverse maternal, same time frame found that pregnant women fetal, and neonatal outcomes. Examples of the who used marijuana had increased odds of being adverse consequences of tobacco use may begin anemic and that infants exposed to cannabis in with subfertility and delay in conception among utero had decreased birth weight and were more The women who smoke and extend to pregnancy likely to require neonatal intensive care. outcomes, which include increased risk of researchers from this review acknowledged that spontaneous pregnancy loss, placental abruptionb , ecause many cannabis users often use tobacco preterm premature rupture of membranes, placen at na d alcohol as well, discerning a cannabis-only previa, preterm labor and delivery, low birth ee ff ct was not possible. A population-based weight, and ectopic pregnancy. Prenatal cigarettc e ohort study of 661,617 women in Ontario, smoking may exert ee ff cts beyond pregnancy Canada, showed that the percentage of preterm as well and is associated with increased risks of births among self-reported cannabis users was asthma, infantile colic, and childhood obesity. 12% compared to 6% among nonusers, with this increase persisting even after adjusting for Prenatal Cannabis Use and Until there is definitive confounding factors. Its Consequences evidence demonstrating the safety of prenatal Past month cannabis use among pregnant women marijuana use, concerns that marijuana may ages 18 to 44 increased between 2002 and 2017 interfere with neurodevelopment as well as have Among pregnant from approximately 3% to 7%. other ee ff cts have resulted in the American adolescents, past month use (15%) was even College of Obstetricians and Gynecologists A recent cross-sectional study using data higher. (ACOG) advising women who are pregnant or from 367,403 pregnancies among 276,991 women thinking about pregnancy to avoid using marijuana in Northern California found that self-reported and other cannabinoids. daily, weekly, and monthly cannabis use before Prenatal Opioid Use and and during pregnancy increased between 2009 and 2017. The greatest increases were for daily use, Its Consequences Opioid use among pregnant women increased reaching 25% among those who used in the year before pregnancy and 21% among those who used fourfold between 1999 and 2014 and is present in 19 26 Explanations for the increases Women who during pregnancy. approximately 3% of pregnancies. in prenatal use include increasing acceptance use opioids during pregnancy are a diverse group of cannabis use and decreasing perceptions of because opioid use may occur in the context of cannabis-related harms. medical care, opioid misuse, or untreated opioid The association between prenatal cannabis use use disorder. Prenatal opioid use can have a far-reaching and maternal, perinatal, and neonatal outcomes A 2016 systematic review and meta- is unclear. clinical impact on infant outcomes. Infants with analysis concluded that maternal marijuana prenatal opioid exposure are typically born use during pregnancy was not an independent smaller and may have neonatal opioid withdrawal risk factor for adverse neonatal outcomes, such syndrome (NOWS). Infants with NOWS experience as low birth weight or preterm delivery, after withdrawal from opioids and require additional Characteristics of NOWS, also adjusting for confounding factors like tobacco medical care. However, limitations to the generalizability use. known as neonatal abstinence syndrome (NAS), of this meta-analysis include the relatively few include disturbances in gastrointestinal, autonomic, women in the risk-adjusted group, indicating that and central nervous systems, leading to irritability, Alcohol Research: Current Reviews 3 Vol 40 No 2 | 2020 high-pitched crying, poor sleep, and uncoordinated higher social risk, male sex, and lower quality sucking ree fl xes that lead to poor feeding. In 2014, caregiving environments. A systematic review and meta-analysis a baby was born with NOWS in the United States 29,30 every 15 minutes. synthesized data from 41 studies on the The full impact of opioid exposure during neurodevelopment of prenatal methadone-exposed pregnancy on fetal, infant, and childhood children. The analysis included 1,441 children outcomes, however, is still unknown. Explanationw s hose mothers were prescribed methadone during include the possibility of exposure to other pregnancy and 842 children whose mothers did Methadone-exposed substances as well as concomitant maternal, not receive methadone. medical, psychological, and socioeconomic issues. children appeared to be at increased risk for There is a growing body of evidence about the neurodevelopmental impairment, with lower association of opioids with specific birth defects, scores on the Mental Development Index and such as congenital heart defects, neural tube Psychomotor Development Index, as well as defects, and clubfoot. atypical visual evoked potentials, strabismus, For pregnant women with opioid use disorder, and nystagmus. However, these findings about substitution treatment with opioid agonists, such ais m pairment may be biased, with the studies not methadone and buprenorphine, imparts importanta ccounting for factors other than methadone. benet fi s particularly when compared to continued Indeed, results from this meta-analysis confirm illicit drug use. Advantages include more stable the need for more research and the many factors maternal drug levels, reduced withdrawal and dr tu hg a- t can impact pregnancy outcome. seeking behavior, and improved self-care, which should lead to a better pregnancy outcome because SCREENING FOR PRENATAL of reduced risk for fetal distress, miscarriage, SUBSTANCE USE growth restriction, and preterm birth. Compared to data on buprenorphine-maintained E arly universal screening of pregnant women for pregnancies, more longitudinal data on methadone a-lcohol use, substance use, or both is recommended exposed pregnancies are available. In a prospective by ACOG because alcohol and substance use is longitudinal study, 68 methadone-exposed not typically disclosed spontaneously by patients. children and 88 nonmethadone-exposed children ACOG recommends clinicians use validated were evaluated at 2.0 and 4.5 years for executive questionnaires or have a conversation with functioning and later emotional behavioral patients but does not endorse using routine urine 33 35,36 The methadone- Moreover, a positive screening and emotional adjustment. toxicology tests. exposed children had worse inhibitory control questionnaire does not result in a diagnosis. Rather, than the nonexposed children, when taking such a result is an opportunity for a patient and maternal education and prenatal benzodiazepine h er clinician to review health practices and make use into account. Another study used a school changes, if appropriate. readiness framework to assess the health and Screening for Prenatal Alcohol Use neurodevelopmental outcomes of a regional There is no known safe level of alcohol cohort of 100 methadone-exposed children and Alcohol is 110 randomly identie fi d nonmethadone-exposed consumption during pregnancy. children who were studied from birth to 4.5 years.a teratogen; in other words, it is capable of Children born to opioid-dependent mothers had interfering with fetal development, resulting in higher rates of delay and impairment across all birth defects. Although the consequences of light outcome domains, with multiple domain problemsa lcohol use among women, defined as consuming being common. Impaired school readiness was up to 32 g of alcohol per week, on pregnancy associated with greater maternal substance use, outcomes remain unsettled in the absence of Alcohol Research: Current Reviews 4 Vol 40 No 2 | 2020 suc ffi ient evidence, the potential for harm cannot Several recent studies have evaluated the Hence, ACOG has recommended be ruled out. accuracy of various screening tools for prenatal that all women seeking obstetric–gynecologic cas rubs e tance use. In one prospective cross-sectional be screened for alcohol use annually and within study conducted in Baltimore, MD, with 500 the first trimester of pregnancy. pregnant women, stratie fi d by trimester and use of Screening questionnaires for prenatal alcohol u ps re e natal care, researchers administered three index The have been well studied. For example, a systematic tests and compared them to reference tests. review of brief screening questionnaires to identifyt hree index tests were the proprietary 4P’s Plus problem drinking during pregnancy evaluated NIDA Quick Screen–ASSIST), and the SURP-P. seven instruments given to 6,724 participants. The reference tests were urine and hair testing, The measures included the TWEAK (Tolerance, which captured substance use up to the past 90 days. Worried, Eye-Opener, Amnesia, K/Cut Dow n); Alcohol use was not evaluated. The researchers the T-ACE (Tolerance [number of drinks], found that there were die ff rences in validity indices Annoyance, Cut Down, Eye-Opener); CAGE (i.e., sensitivity, specificity, positive predictive value, (Cut Down, Annoyed, Guilty, Eye-Opener), NET and negative predictive value) by age and race, (Normal Drinker, Eye-Opener, Tolerance); AUDIT but not by trimester, for all screening tools. The were highly sensitive across (Alcohol Use Disorder Identica fi tion Test); AUDIT-C SURP-P and 4P’s Plus (AUDIT Alcohol Consumption Questions), and all trimesters, races, and age groups. SMAST (Short Michigan Alcoholism Screening Another prospective cross-sectional screening Test). The screening questionnaires were accuracy study compared v fi e screening compared with a structured interview to ascertain in struments on their ability to identify illicit drinking status as a reference standard. The drug, opioid, and alcohol use under privacy T-ACE, AUDIT-C, and TWEAK were the three expectations consistent with current practice. questionnaires identie fi d to be the most promising The participants included 1,220 pregnant women screening tools for identifying risk drinking in who were receiving care in Boston, MA; Detroit, pregnant women. However, the sensitivity and MI; or New Haven, CT. The women were specificity of these three questionnaires outside the socioeconomically diverse and had a mean age of United States is unknown. 29 years. The study used a reference standard of substance use in three classes (i.e., illicit drugs, Screening for Prenatal Substance Use opioids, and alcohol); results were considered Screening instruments for prenatal alcohol positive if use was evident via a 30-day calendar The illicit use have been well studied, whereas screening recall or urine toxicology analysis. instruments for substances other than alcohol drug use reference standard included marijuana, 26,40 The World have been less well developed. cocaine, heroin, amphetamines, barbiturates, and Health Organization (WHO) guidelines for the hallucinogens. The v fi e screening instruments for identica fi tion and management of substance use substance use in pregnancy were the SURP-P; and substance use disorder during pregnancy CRAFFT, a v fi e-item screener with items related list the Substance Use Risk Profile-Pregnancy to car, relax, alone, forget, friends, and trouble; 41 © 42 the proprietary 4P’s Plu , s (SURP-P) scale, 5Ps, with items on parents, peers, partner, and the National Institute on Drug Abuse (NIDA) pregnancy, past (i.e., an adaptation of the 4P’s ); Wayne Indirect Drug Use Screener Quick Screen–Modie fi d Alcohol, Smoking, and Plus Substance Involvement Screening Test (ASSIST) (WIDUS); and NIDA Quick Screen–ASSIST. as potential screening measures for pregnant None of the five measures showed both high women, even though not all of these instruments sensitivity and high specificity, and the area had been evaluated among that population at the under the curve was low for nearly all measures, time of its recommendation. Alcohol Research: Current Reviews 5 Vol 40 No 2 | 2020 indicating that none could be recommended for CRAFFT (AUROC=0.75, 95% CI [0.72, 0.79]) applied practice with pregnant women. and SURP-P (AUROC=0.74, 95% CI [0.71, A companion study compared the same v fi e 0.78]) had the highest AUROCs for identifying measures in the identica fi tion of substance use substance use disorder, including alcohol. In disorder, including alcohol, cannabis, opioids, contrast, the NIDA Quick Screen had the lowest and stimulants, among the 1,220 pregnant AUROC (AUROC=0.62, 95% CI [0.59, 0.65]) Participants completed the Mini women. for identifying substance use disorder, including International Neuropsychiatric Interview alcohol. Overall, the tested measures were more 7.0.2, a short, structured diagnostic interview accurate in identifying alcohol use disorder than to identify substance use disorder, including substance use disorder (e.g., for identifying alcohol alcohol; cannabis; stimulants, such as cocaine or use disorder, the AUROCs for the CRAFFT and amphetamines; and opioids, such as heroin and the SURP-P were 0.78 and 0.77, respectively). Substance nonmedical use of prescription drugs. Barriers to Early Identification use disorder is distinct from substance use and represents a more signica fi nt and persistent patterby n Screening Pregnant women with substance use disorder of consumption that may increase the risk of adverse infant outcomes as well as indicate that are at increased risk for adverse health and the pregnant woman may need evaluation and social outcomes, making early identification 49 50 Of the 1,220 Because substance use is substantially referral for specialty treatment. crucial. women in this study, more than 15% satise fi d underreported, even among women who participate diagnostic criteria for substance use disorder and regularly in urine drug screens, use of validated more than 30% reported having used alcohol questionnaires to identify prenatal alcohol and 26,51 or other substances in the past month. There substance use has been recommended. There are, however, at least two barriers was little overlap between the women who had substance use disorder and the women who had to these recommendations. First, as discussed used alcohol or other substances within the past in the preceding section, current screening month. Nearly 10% of the women satise fi d criteria questionnaires have been found to be inadequate for alcohol use disorder, as defined in the fifth measures. According to a 2010 survey of edition of thD e iagnostic and Statistical Manual obstetrician-gynecologists, 58% did not use of Mental Disorders, and 9.0% satise fi d criteria for a validated screening tool to assess alcohol substance use disorder. Specica fi lly, cannabis use risk despite there being several validated tools It is likely that even fewer will disorder was the most common substance disorder available. diagnosed (8%). Approximately 3% satise fi d use a screening tool for prenatal substance criteria for more than one disorder. use, particularly as such tools are less well There were considerable variations by site. developed. A second barrier includes the punitive For example, alcohol use disorder was the most consequences stemming from state laws regarding common in Boston (15%) but infrequent in New prenatal substance use, which can result in patients Haven (5%). In contrast, substance use disorder not wanting to disclose and physicians not wanting 53-55 Hence, was the most common in Detroit (17%) but less to learn about their patients’ behaviors. frequent in Boston (3%). Measures of merit in addition to patients’ previous fears about (i.e., sensitivity, specificity, accuracy, and area stigmatization because of use, disclosure could An example of a punitive under the receiver operating curve [AUROC]) now pose a legal risk. were calculated with 95% cond fi ence intervals policy includes treating substance use during [CI] for the NIDA Quick Screen, CRAFFT, pregnancy as child abuse or neglect. This policy SURP-P, WIDUS, and 5Ps, using substance may arise from a desire to discourage women from use disorder as the criterion standard. The using substances while pregnant, to encourage Alcohol Research: Current Reviews 6 Vol 40 No 2 | 2020 women to seek treatment, and to ensure the safety and middle-income countries had not. However, of the neonate. the WHO noted that much of the evidence The association between states with punitive underlying the ee ff ctiveness of screening and brief or reporting policies related to substance use interventions during pregnancy originated from in pregnancy and rates of NAS was recently a time when reporting standards and measures evaluated in a study of 4,567,963 births from of bias were not in consistent use. Nonetheless, 8 U.S. states in varying years between 2003 the evidence indicated that asking women about States without punitive or reporting and 2014. alcohol and other substance use in a detailed and policies were compared with states that had such comprehensive way may increase their awareness policies, before and after policy enactment. The of the risks associated with these practices and main outcome measure was the rate of NAS. State psro mpt them to modify their behavior. that criminalized substance use during pregnancy Psychosocial Interventions for (e.g., grounds for civil commitment, child abuse, or neglect) had significantly higher rates of NAS in P renatal Alcohol Use In late 2018, the U.S. Preventive Services Task the 1st full year after enactment and more than 1 full year after enactment. In contrast, there waF s o nr o ce (USPSTF) renewed its recommendation for association with neonatal abstinence rates in stat se cs reening adults ages 18 year or older, including with policies requiring reporting of suspected pregnant women, for unhealthy alcohol use and prenatal substance use. A possible explanation providing persons engaged in risky or hazardous for this die ff rence includes the extent to which drinking with brief behavioral counseling pregnant women disengage from health care interventions to reduce unhealthy alcohol use (i.e., services when punitive measures are enforced, a grade B recommendation meaning that there is whereas reporting policies may not dissuade high certainty that the net benefit is moderate, or pregnant women from engaging with health moderate certainty that the net benefit is moderate The USPSTF bounds the harms care services, resulting in greater conversations to substantial). between physicians and their patients. However, of screening and brief behavioral counseling neither the punitive nor the reporting approach interventions for unhealthy alcohol use in adults resulted in reduced rates of NAS, which was the as small to none, based on the likely minimal presumed, desired outcome of these policies. risks of completing screening questionnaires, the noninvasive nature of the interventions, and the absence of reported harms in the evidence of the AFTER SCR EENING: behavioral interventions. INTERVENTION The USPSTF makes three special comments Because screening for prenatal alcohol and with regards to pregnant women. First, any alcohol substance use is but the prelude to eo ff rts to use by pregnant women is unhealthy. Second, mitigate the potential adverse consequences, validated alcohol screening tools for pregnant brief intervention and referral to treatment, if women are available, including the T-ACE and Brief indicated, have also been recommended. TWEAK. Third, brief counseling interventions interventions and psychosocial interventions have among pregnant women have increased the been examined by investigators and organizations likelihood that women remain abstinent from such as the WHO, which sought to develop alcohol use during pregnancy. evidence-based global guidelines for identifying Most interventions for FASD have been and managing substance use and substance use reported in North America, which has lower Global guidelines were disorder in pregnancy. FASD prevalence compared to Europe and Context-related desired because although several high-income other sites around the world. countries had developed national guidelines, lowd - ie ff rences may impact on the ee ff ctiveness of Alcohol Research: Current Reviews 7 Vol 40 No 2 | 2020 the interventions. For example, in a systematic The first systematic review included four review of prevention interventions to reduce articles published between 2002 and 2013. It prenatal alcohol exposure and FASD in began with 3,792 unique potential publications, indigenous communities, reviewers evaluated but the vast majority did not meet a priori quality studies conducted from 1989 to 2017. A total of criteria. Limited, but promising, evidence of brief 10 studies from an initial sample of 712 articles interventions reducing illicit drug use among were included if inclusion criteria were met. postpartum women was found. The second systematic review was completed Comparisons of study ee ff cts were made dic ffi ult by heterogenous study designs, target populations b, y researchers from the Cochrane Collaboration. and interventions. The reviewers concluded that They sought to evaluate the evidence on the ee ff ct there was minimal evidence to support the belief of psychosocial interventions, such as contingency that interventions intended to reduce the risk of management (CM) and motivational interviewing- prenatal alcohol exposure or FASD in indigenous based (MIB) techniques compared to that of populations have been ee ff ctive. usual care for pregnant women in outpatient illicit This group reviewed drug treatment programs. Psychosocial Interventions for 14 studies, with 1,298 pregnant women who Prenatal Cigarette Smoking received either CM or MIB techniques in addition Psychosocial interventions for supporting women to other comprehensive care. The women in the to stop smoking during pregnancy were assessed control group received usual care that included by the Cochrane Pregnancy and Childbirth pharmacological management, counseling, prenatal This review included 102 randomized Group. care, transportation, and/or childcare. There controlled trials, with 120 intervention arms. Da w te a re no die ff rences in retention or abstinence from 88 randomized controlled trials, involvinb ge havior between CM/MIB techniques and usual more than 28,000 women, were analyzed. comprehensive care. The quality of evidence from Intervention strategies included counseling, healt th h ese studies was assessed to be low to moderate. education, feedback, incentives, social support, and exercise. Nearly all studies were conducted in SUMMARY high-income countries. Results from the review Prenatal exposure to alcohol, tobacco, and yielded moderate- to high-quality evidence that psychosocial interventions increased the marijuana has become increasingly common. In proportion of pregnant women who had stopped addition, there has been a fourfold increase in the smoking by late pregnancy (35%), with a 17% number of opioid-exposed pregnancies. Prenatal reduction in infants born with low birth weight,e xposure to alcohol and other substances may have and a 22% reduction in neonatal intensive care an adverse impact on a developing fetus. Since admissions. There did not appear to be any adverse pregnant women may be reluctant to disclose psychological ee ff cts from the interventions. their use or may not appreciate the potential for harm, early identica fi tion is desirable. However, Psychosocial Interventions to Reduce identica fi tion is currently limited by the lack of Other Prenatal Substance Use adequate screening tools and the fear of legal and Screening, brief intervention, and referral to other sanctions, which may limit both inquiry and treatment in the perinatal period have been disclosure. Although ee ff ctive interventions for recommended for prenatal substance use. prenatal alcohol, cigarette, and other substances Subsequent to this recommendation, at least are available, these interventions rely on two systematic reviews of the evidence for identica fi tion and behavioral counseling. It is likely psychosocial interventions have been completed. that the full potential of ee ff ctive interventions cannot yet be realized in the current setting. Alcohol Research: Current Reviews 8 Vol 40 No 2 | 2020 Financial disclosure use—Interim guidance. MMWR Morb Mortal Wkly Rep. The author receives royalty payments from UpToDate. 2019;68(36):787-790. http://doi.org/10.15585/mmwr.mm6836e2 . 14. Committee on Underserved Women, Committee on Obstetric Practice. Committee Opinion Number 721: Smoking cessation Publisher’s note during pregnancy Obstet . Gynecol. 2017;130(4):e200-e204. Opinions expressed in contributed articles do not necessarily http://doi.org/10.1097/AOG.0000000000002353 . reflect the views of the National Institute on Alcohol Abuse and 15. Volkow ND, Han B, Compton WM, et al. Self-reported medical Alcoholism, National Institutes of Health. The U.S. government does and non-medical cannabis use among pregnant women in not endorse or favor any specic fi commercial product or commodity. Trade or proprietary names appearing in this publication are used the United States. JAMA. 2019;322(2):167-169. http://doi. only because they are considered essential in the context of the org/10.1001/jama.2019.7982 . studies reported herein. 16. Salas-Wright CP, Vaughn MG, Ugalde J, et al. Substance use and teen pregnancy in the United States: Evidence from NSDUH 2002-2012. Addict Behav. 2015;45:218-225. http://doi. References org/10.1016/j.addbeh.2015.01.039 . 1. Haight SC, Ko JY, Tong VT, et al. Opioid use disorder 17. Young-Wolff KC, Sarovar V, Tucker LY, et al. Self-reported documented at delivery hospitalization—United States, 1999- daily, weekly, and monthly cannabis use among women before 2014. MMWR Morb Mortal Wkly Rep. 2018;67(31):845-849. and during pregnancy JAMA . Netw Open. 2019;2(7):e196471. http://doi.org/10.15585/mmwr.mm6731a1 . http://doi.org/10.1001/jamanetworkopen.2019.6471 . 2. Denny CH, Acero CS, Naimi TS, et al. Consumption of alcohol 18. Hill KP. Medical use of cannabis in 2019. JAMA. August 2019. beverages and binge drinking among pregnant women aged 18-44 http://doi.org/10.1001/jama.2019.11868 . years—United States, 2015-2017. MMWR Morb Mortal Wkly Rep. 19. Silverstein M, Howell EA, Zuckerman B. Cannabis use in 2019;68 (16):365-368. http://doi.org/10.15585/mmwr.mm6816a1 . pregnancy: A tale of 2 concerns. JAMA. 2019;322(2):121-122. 3. Terplan M, Cheng D, Chisholm MS. The relationship between http://doi.org/10.1001/jama.2019.8860 . pregnancy intention and alcohol use behavior: An analysis of 20. Conner SN, Bedell V, Lipsey K, et al. Maternal marijuana use and PRAMS data. J Subst Abuse Treat. 2014;46(4):506-510. http:// adverse neonatal outcomes. Obstet Gynecol. 2016;128(4):713- doi.org/10.1016/j.jsat.2013.11.001 . 723. http://doi.org/10.1097/AOG.0000000000001649 . 4. Warren KR. A review of the history of attitudes toward drinking 21. Gunn JKL, Rosales CB, Center KE, et al. Prenatal exposure to in pregnancyAlcohol . Clin Exp Res. 2015;39(7):1110-1117. cannabis and maternal and child health outcomes: A systematic http://doi.org/10.1111/acer.12757 . review and meta-analysis. BMJ Open. 2016;6(4):e009986. http:// 5. Feldman HS, Jones KL, Lindsay S, et al. Prenatal alcohol exposure doi.org/10.1136/bmjopen-2015-009986 . patterns and alcohol-related birth defects and growth deficiencies: 22. Corsi DJ, Walsh L, Weiss D, et al. Association between self- A prospective study Alcohol . Clin Exp Res. 2012;36(4):670-676. reported prenatal cannabis use and maternal, perinatal, and http://doi.org/10.1111/j.1530-0277.2011.01664.x. neonatal outcomes. JAMA. 2019;322(2):145-152. http://doi. 6. Centers for Disease Control and Prevention. Fetal Alcohol org/10.1001/jama.2019.8734 . Spectrum Disorders (FASDs). Basics About FASDs. https://www. 23. Volkow ND, Compton WE, Wargo EM. The risks of marijuana cdc.gov/ncbddd/fasd/facts.html . Accessed January 30, 2020. use during pregnancy JAMA . . 2017;317(2):129-130. http://doi. 7. May PA, Chambers CD, Kalberg WO, et al. Prevalence of org/10.1001/jama.2016.18612 . fetal alcohol spectrum disorders in 4 US communities. JAMA. 24. Haight SC, Ko JY, Tong VT, et al. Opioid use disorder 2018;319(5):474-482. http://doi.org/10.1001/jama.2017.21896 . documented at delivery hospitalization—United States, 1999- 8. Chang G. Alcohol Intake and Pregnancy. May 2019. https:// 2014. MMWR Morb Mortal Wkly Rep. 2018;67(31):845-849. www.uptodate.com/contents/alcohol-intake-and-pregnancy . http://doi.org/10.15585/mmwr.mm6731a1 . Accessed January 30, 2020. 25. Committee on Obstetric Practice. Committee Opinion No. 711: 9. Muggli E, Matthews H, Penington A, et al. Association between Opioid use and opioid use disorder in pregnancy Obstet . Gynecol. prenatal alcohol exposure and craniofacial shape of children at 12 2017;130(2):e81-e94. http://doi.org/10.15585/mmwr.mm6731a1 . months of age. JAMA Pediatr. 2017;171(8):771-780. http://doi. 26. Ecker J, Abuhamad A, Hill W, et al. Substance use disorders org/10.1001/jamapediatrics.2017.0778 . in pregnancy: Clinical, ethical, and research imperatives of the 10. Mamluk L, Edwards HB, Savovic J, et al. Low alcohol opioid epidemic: A report of a joint workshop of the Society for consumption and pregnancy and childhood outcomes: Time Maternal-Fetal Medicine, American College of Obstetricians and to change guidelines indicating apparently “safe” levels of Gynecologists, and American Society of Addiction Medicine. Am alcohol during pregnancy? A systematic review and meta- J Obstet Gynecol. 2019;221(1):B5-B28. http://doi.org/10.1016/j. analysis. BMJ Open. 2017;7(7):e015410. http://doi.org/10.1136/ ajog.2019.03.022. bmjopen-2016-015410. 27. Honein MA, Boyle C, Redfield RR. Public health surveillance 11. McCance-Katz EFNational . Survey on Drug Use and Health: of prenatal opioid exposure in mothers and infants. Pediatrics. 2018. Rockville, MD: Substance Abuse and Mental Health 2019;143(3):e20183801. http://doi.org/10.1542/peds.2018-3801 . Services Administration; August 2019. https://www.samhsa.gov/ data/report/dr-elinore-f-mccance-katz-webcast-slides-national- 28. Sanlorenzo LA, Stark AR, Patrick SW. Neonatal abstinence survey-drug-use-and-health-2018 . Accessed January 30, 2020. syndrome: An update. Curr Opin Pediatr. 2018;30(2):182-186. 12. Kapaya M, D’Angelo DV, Tong VT, et al. Use of electronic vapor http://doi.org/10.1097/MOP.0000000000000589 . products before, during, and after pregnancy among women with 29. Yazdy MM, Desai RJ, Brogly SB. Prescription opioids in a recent live birth—Oklahoma and Texas, 2015. MMWR Morbid pregnancy and birth outcomes: A review of the literature. J Pediatr Mortal Wkly Rep. 2019;68(8):189-194. http://doi.org/10.15585/ Genet. 2015;4(2):56-70. http://doi.org/10.1055/s-0035-1556740 . mmwr.mm6808a1 . 30. Konijnenberg C, Melinder A. Prenatal exposure to methadone 13. Schier JG, Meiman JG, Layden J, et al. Severe pulmonary and buprenorphine: A review of the potential effects on cognitive disease associated with electronic-cigarette–product development. Child Neuropsychol. 2011;17(5):495-519. http:// doi.org/10.1080/09297049.2011.553591. Alcohol Research: Current Reviews 9 Vol 40 No 2 | 2020 31. Levine TA, Woodward LJ. Early inhibitory control and working47. Edwards AC, Ohlsson H, Svikis DS, et al. Protective memory abilities of children prenatally exposed to methadone. effects of pregnancy on risk of alcohol use disorder Am. . J. Early Hum Dev. 2018; 116:68-75. http://doi.org/10.1016/j. Psychiatry. 2019;176(2):138-145. http://doi.org/10.1176/appi. earlhumdev.2017.11.010 . ajp.2018.18050632. 32. Lee SJ, Pritchard VE, Austin NC, et al. Health and 48. Kozhimannil KB, Dowd WN, Ali MM, et al. Substance use neurodevelopment of children born to opioid-dependent mothers disorder treatment admissions and state-level prenatal substance at school entry J . Dev Behav Pediatr. 2020;41(1):48-57. http:// use policies: Evidence from a national treatment database. doi.org/10.1097/DBP.0000000000000711. Addict Behav. 2019;90:272-277. http://doi.org/10.1016/j. 33. Monnelly VJ, Hamilton R, Chappell FM, et al. Childhood addbeh.2018.11.019. neurodevelopment after prescription of maintenance methadone 49. Garg M, Garrison L, Leeman L, et al. Validity of self-reported drug for opioid dependency in pregnancy: A systematic review and use information among pregnant women. Matern Child Health J. meta-analysis. Dev Med Child Neurol. 2019;61(7):750-760. 2016;20(1):41-47. http://doi.org/10.1007/s10995-015-1799-6 . http://doi.org/10.1111/dmcn.141.17 50. Anderson BL, Dan EP, Floyd RL, et al. Knowledge, opinions, 34. American College of Obstetricians and Gynecologists, and practice patterns of obstetrician-gynecologists regarding their Committee on Ethics. Committee Opinion No. 633: Alcohol patients’ use of alcohol. J Addict Med. 2010;4(2):114-121. http:// Abuse and Other Substance Use Disorders: Ethical Issues in doi.org/10.1097/ADM.0b013e3181b95015. Obstetric and Gynecologic Practice. June 2015. https:// 51. Flavin J, Paltrow LM. Punishing pregnant drug-using women: www.acog.org/-/media/project/acog/acogorg/clinical/files/ Defying law, medicine, and common sense. J Addict Dis. committee-opinion/articles/2015/06/alcohol-abuse-and-other- 2010;29(2):231-244. https://doi.org/10.1080/10550881003684830. substance-use-disorders-ethical-issues-in-obstetric-and- 52. Guttmacher Institute. Substance Use During Pregnancy. 2020. gynecologic-practice.pdf. Accessed January 9, 2019. https://www.guttmacher.org/state-policy/explore/substance-use- 35. Chang G. Screening for alcohol and drug use during pregnancy. during-pregnancy Accessed . February 3, 2020. Obstet Gynecol Clin N Am. 2014;41(2):205-212. http://doi. 53. Angelotta C, Applebaum PS. Criminal charges for child harm org/10.1016/j.ogc.2014.02.002 . from substance use in pregnancy J Am Acad . Psychiatry Law. 36. National Institute on Alcohol Abuse and Alcoholism. Fetal 2017;45(2):193-203. Alcohol Exposure. December 2019. https://www.niaaa.nih.gov/ 54. Stone R. Pregnant women and substance use: Fear, stigma, and sites/default/files/FASD.pdf . Accessed December 11, 2019. barriers to care. Health Justice. 2015;3(2). http://doi.org/10.1186/ 37. Burns E, Gray R, Smith LA. Brief screening questionnaires s40352-015-0015-5. to identify problem drinking during pregnancy: A systematic 55. Faherty LJ, Kranz Am, Russell-Fritch J, et al. Association of review. Addiction. 2010;105(4):601-614. http://doi.org/10.1111/ punitive and reporting state policies related to substance use j.1360-0443.2009.02842.x. in pregnancy with rates of neonatal abstinence syndrome. 38. DeVido J, Bogunovic O, Weiss RD. Alcohol use disorders in JAMA Netw Open. 2019;2(1):e1914078. http://doi.org/10.1001/ pregnancyHarv . Rev Psychiatry. 2015;23(2):112-121. http://doi. jamanetworkopen.2019.14078 . org/10.1097/HRP.0000000000000070. 56. U.S. Preventive Services Task Force. Screening and behavioral 39. Yonkers KA, Gotman N, Kershaw T, et al. Screening for prenatal counseling interventions to reduce unhealthy alcohol use in substance use: Development of the substance use risk profile- adolescents and adults. JAMA. 2018;320(18):1899-1909. http:// pregnancy scale. Obstet Gynecol. 2010;116(4):827-833. http:// doi.org/10.1001/jama.2018.16789 . doi.org/10.1097/AOG.0b013e3181ed8290. 57. Adebiyi BO, Mukumbang FC, Erasmus C. The distribution 40. Chasnoff I, Wells A, McGourty R, et al. Validation of the 4 P’s of available prevention and management interventions for Plus screen in pregnancy J Perinatol . . 2007;27(12):744-748. fetal alcohol spectrum disorder (2007 to 2017): Implications http://doi.org/10.1038/sj.jp.7211823 . for collaborative actions. Int J Environ Res Public Health. 41. National Institute on Drug Abuse. Resource Guide: Screening 2019;16(12):E2244. http://doi.org/10.3390/ijerph16122244 . for Drug Use in General Medical Settings. 2012. https://www. 58. Symons M, Pedruzzi RA, Bruce K, et al. A systematic review of drugabuse.gov/publications/resource-guide/preface . Accessed prevention interventions to reduce prenatal alcohol exposure and September 14, 2019. fetal alcohol spectrum disorder in indigenous communities. BMC 42. World Health Organization. Guidelines for the Identification and Public Health. 2018;18(1):1227. http://doi.org/10.1186/s12889- Management of Substance Use and Substance Use Disorders 018-6139-5. in Pregnancy. 2014. https://www.who.int/substance_abuse/ 59. Chamberlain C, O’Mara-Eves A, Porter J, et al. Psychosocial publications/pregnancy_guidelines/en . Accessed January 30, 2020. interventions for supporting pregnant women to stop smoking. 43. Coleman-Cowger VH, Oga EA, Peters EN, et al. Accuracy Cochrane Database Syst Rev. 2017;10:CD001055. http://doi. of three screening tools for prenatal substance Obstet use. org/10.1002/14651858.CD001055.pub4. Gynecol. 2019;133(5):952-961. http://doi.org/10.1097/ 60. Wright TE, Terplan M, Ondersma SJ, et al. The role of screening, AOG.0000000000003230. brief intervention, and referral to treatment in the perinatal 44. Ondersma SJ, Chang G, Blake-Lamb T, et al. Accuracy of five period. Am J Obstet Gynecol. 2016;215(5):539-547. http://doi. self-report screening instruments for substance use in pregnancy. org/10.1016/j.ajog.2016.06.038 . Addiction. 2019;114(9):1683-1693. http://doi.org/10.1111/ 61. Farr SL, Hutchings YL, Ondersma SJ, et al. Brief interventions add.14651. for illicit drug use among peripartum women. Am J Obstet 45. Chang G, Ondersma SJ, Blake-Lamb T, et al. Identification of Gynecol. 2014;211(4):336-343. http://doi.org/10.1016/j. substance use disorders among pregnant women: A comparison ajog.2014.04.005. of screeners. Drug Alcohol Depend. 2019;205: 107651. http:// 62. Terplan M, Ramanadhan S, Locke A, et al. Psychosocial doi.org/10.1016/j.drugalcdep.2019.107651 . interventions for pregnant women in outpatient illicit 46. Sheehan DW, Lecrubier Y, Sheehan KH, et al. The Mini- drug treatment programs compared to other interventions. International Neuropsychiatric Interview (M.I.N.I.): The Cochrane Database Syst Rev. 2015;2(4):CD006037. http://doi. development and validation of a structured diagnostic psychiatric org/10.1002/14651858.CD006037.pub3. interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59(supp 20):22-33. PMID: 9881538. Alcohol Research: Current Reviews 10 Vol 40 No 2 | 2020

Journal

Alcohol Research : Current ReviewsPubmed Central

Published: Jun 30, 2020

There are no references for this article.