Substance abuse and pregnancy from an obstetric point of view

Abstract

In Germany we find about 2 000 newborns per year with a mother misusing drugs. It is to be feared that there is a substantial amount of underreported substance abuse in pregnant women. To care for these pregnancies from an obstetric point of view as well as from an addiction treatment point of view is a challenge for all health-care professionals, due to multiple drugs being used and the special psychosocial and health issues these mothers and babies -present. A selective search was undertaken in Pubmed, retrieving reviews and original articles from 2001-2013, with consideration of statements, recommendations and guidelines from national and international associations and committees on the topic. This review is intended to assist gynaecologists, obstetricians and paediatricians during the complex peripartum care for the drug abusing pregnant patient. When offering obstetric care for these pregnancies, several issues have to be taken into account: the special psychological situation of the pregnant drug user, with frequent occurrence of psychiatric comorbidities like depression and anxiety disorders, as well as gynaecological complications like premature labour, intrauterine growth restriction and maternal infectious diseases. The pharmacological complexity of the substances abused and the possible side-effects on the foetus have to be explained to the mother. Maintenance medication for foetomaternal risk reduction and maternal stabilisation remains the state-of-the-art treatment. Furthermore, it is important to explain the neonatal abstinence syndrome to the mother as well as the result of breast-feeding in the presence of smoking and/or infectious diseases. Professionalism and empathy are needed from gynaecologists in order to achieve risk reduction for mother and child in substance-using pregnancies. However, in spite of close cooperation of all health-care professionals and avoidance of stigma, it will be difficult to offer good obstetric care to the high-risk patients with poly-drug abuse.