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A Dangerous Duo: Pregnancy & Substance Abuse

by Landmark Recovery

July 31, 2019

We’re all acutely aware of the damaging effects of alcohol, tobacco and drugs but substance use during pregnancy is particularly risky.

Not only does the expectant mother feel the effects, but substance use of any nature can also create an array of problems for the unborn baby even if it doesn’t stray into outright abuse. Why is this?

Well, tobacco, alcohol or drugs can enter the placenta via the umbilical cord entering the growing baby’s bloodstream.

Health problems ranging from prematurity and low birth weight through to physical malformation, neurological damage and even miscarriage means the stakes couldn’t be much higher.

Today, then, we’ll be looking at the whole spectrum of substance use from legally tolerated substances like alcohol and tobacco, to prescription painkillers as well as drugs of abuse like heroin and cocaine.

You might be questioning whether substance use during pregnancy is really so widespread and you might be surprised at the answer.

How Common Is Substance Use During Pregnancy?

Studies have shown that almost 5% of pregnant American women abuse at least one substance.

The shocking news is that this figure could actually be even higher than an already-sobering 1 in 20. Fear of reprisals and outright shame can stop many women from seeking assistance if they’re struggling with substance abuse during pregnancy.

Why is the number of women abusing substances when pregnant so high, though?

Of all Americans with ongoing drug use disorders, fully 40% are female. Women are also most at risk of developing substance use disorders aged 19 to 29. Obviously, this coincides neatly with the reproductive years.

Here are some more shocking figures from the US National Survey on Drug Use and Health factoring in more than just drugs of abuse:

  • 5.9% of pregnant women use illegal drugs
  • 8.5% of pregnant women drink alcohol
  • 15.9% of pregnant women smoke cigarettes
  • Between 2000 and 2009, there was a 500% increase in opioid use during pregnancy

This translates to 380,000 unborn babies exposed to drugs in utero, 550,000 experiencing the damage caused by alcohol and over 1 million affected by tobacco before being born.

So, in summary, substance use and abuse are remarkably common during pregnancy even if it’s not publicly discussed on a regular basis.

With this prevalence taken into account, it’s time to examine why pregnancy and substance use is such a dangerous duo.

General Effects of Substance Use on Mother and Unborn Baby

Since the effects of different substances vary quite dramatically, we’ll divide them into 4 broad categories:

  1. Smoking During Pregnancy
  2. Drinking Alcohol During Pregnancy
  3. Using Illegal Drugs During Pregnancy
  4. Misusing Prescription Drugs During Pregnancy

1) Smoking During Pregnancy

The dangers of tobacco, in general, need no reiteration and during pregnancy, the risks to the unborn baby of a smoking mother are significant.

Sadly, with almost 10% of pregnant women still smoking, public health messages are still not hitting home hard enough.

There’s practically a doubled risk of stillbirth even in the event of passive exposure to tobacco smoke.

The nicotine and carbon monoxide present in tobacco smoke can also negatively impact oxygen supply to the fetus. With nicotine very readily crossing the placenta, concentrations of nicotine in the fetus’ bloodstream can be 15% higher than those found in the mother.

If the baby of a mother who smokes is carried to term – and 1000 infant deaths from tobacco use each year show this is not always the case – the problems don’t end there.

Newborns can show signs of withdrawal and stress in line with those reported from the use of other drugs during pregnancy.

Smoking while pregnant can bring about the following:

  • Low birth weight
  • Increased chance of obesity
  • Premature birth
  • SIDS (sudden infant death syndrome)

As a crowning insult, expectant mothers smoking more than a pack a day double the risk their newborn will become a smoker.

The danger doesn’t end when the child is born either. Nicotine can be easily passed through breast milk so nursing mothers should also refrain from smoking.

The message from all these adverse effects is crystal clear: when you’re pregnant, you’re doing more than eating for two. Everything you introduce to your body can be shared so make sure you use this exciting time of life as an opportunity to quit smoking. If you’re finding that easier said than done, check out this great resource for a helping hand.

2) Drinking Alcohol During Pregnancy

There’s no known safe amount of alcohol to consume during pregnancy so complete abstention is the best approach.

Drinking during pregnancy can bring about lifelong FASD (fetal alcohol syndrome disorder). FASD can lead to physical and behavioral issues along with learning problems.

FASD can cause babies to experience trouble with:

  • Emotional control
  • Focusing
  • Motor coordination
  • Socializing

One of the knotty issues with alcohol is that fetal alcohol exposure can occur at any stage of pregnancy, even before a woman knows she is pregnant. For this reason, if you’re actively trying to become pregnant, it’s a smart move to stop drinking preemptively.

There’s still relatively little research into the effects of alcohol when a mother is nursing her baby. The American Academy of Pediatrics suggests alcohol consumption should be minimized when breastfeeding and capped at a couple of beers or 8oz of wine. Nursing should also take place at least 2 hours after drinking alcohol. Of course, drinking no alcohol at all would be preferable but these official guidelines show you can indulge from time to time after your baby is born without deleterious effects being passed on to your bundle of joy.

If you’re in any way concerned about FASD and your baby, the Center for Disease Control and Prevention (CDC) has some great tools right here.

With possibly lifelong adverse effects being passed on to your baby, is that glass of wine during pregnancy really worth it?

3) Using Illegal Drugs During Pregnancy

When substance use is mentioned, the norm is to think about street drugs of abuse. Evidently, using these kinds of illegal drugs is inadvisable at any time and it’s twice as reckless during pregnancy.

We’ll glimpse now at the negative impact on unborn babies inflicted by:

  • Heroin
  • Marijuana
  • MDMA
  • Stimulants (Cocaine or Methamphetamine)


When heroin is introduced to the fetus via the placenta, this can create opioid dependency which manifests as NAS (neonatal abstinence syndrome).

NAS can cause the following unpleasant side effects:

  • Excessive crying
  • Gastrointestinal problems
  • Generalized discomfort
  • High-pitched crying
  • Irritability
  • Seizures

A word of warning here: pregnant women using heroin should strongly consider inpatient rehab since detoxing has a heightened risk of seizures and CNS (central nervous system) complications.


With over 25% of pregnant women admitting to past or current marijuana use and the drug becomingly increasingly widespread through ongoing legalization, how harmful is using this substance during pregnancy?

More research needs to be carried out into both short and long-term effects of marijuana on unborn babies.

The ACOG (American College of Obstetrics and Gynecology) suggested that using cannabis could lower birth weight when it’s consumed frequently and heavily.

If smoked with tobacco, marijuana can also indirectly bring about the effects listed above for smoking cigarettes.

This is an issue crying out for more research since the landscape is changing with more and more states legalizing medical marijuana at the same time as marijuana use during pregnancy doubling between 2010 and 2017.

No human research links marijuana use to miscarriage. There have, though, been some loose associations formed between using marijuana when pregnant and the child developing future hyperactivity disorders.

In short, more study is required in this sphere but there’s one thing that’s certain: if you’re smoking marijuana while pregnant, you should seriously consider an alternative delivery system if you’re still intent on using it.

As with all substances on our list today, the best policy is to discontinue use during pregnancy.


Molly is another drug that should obviously not be on any pregnant woman’s shopping list.

As with marijuana, there’s a lack of scientific evidence about the effects of MDMA when taken during pregnancy.

Some research indicates an increased likelihood of learning, memory and motor problems developing in the baby.

By far the best option is to put this party drug down permanently.

Stimulants (Cocaine or Methamphetamine)

Since many pregnant women abusing cocaine or methamphetamine also drink alcohol and smoke, it’s hard to isolate the precise effects brought about by stimulant abuse during pregnancy.

There are some general ill effects that come about through using cocaine during pregnancy that are well established, though. These include:

  • Difficult delivery
  • High blood pressure
  • Low birth weight
  • Maternal migraines
  • Premature membrane rupture
  • Seizures
  • Separation of placental lining from uterus
  • Spontaneous miscarriage
  • Withdrawal symptoms in a newborn baby

Methamphetamine use also creates some specific problems for unborn babies in later life including:

  • Anxiety
  • Attention disorders
  • Cognitive impairment
  • Depression

4) Misusing Prescription Drugs During Pregnancy

As if pregnancy isn’t confusing enough already, women face many choices about legal substances. Along with alcohol and tobacco, how about prescription painkillers? Are these safe to use during pregnancy?

There’s a glaring problem with research here: scientists cannot administer potentially dangerous drugs to pregnant women for obvious reasons. This means there’s not enough evidence in place to draw many firm conclusions. Using opioids obviously presents a number of well-known issues and can culminate in dependence in a short space of time.

There is one study that suggests opioid use during pregnancy increases the chance of NAS. This risk is further heightened when opioid painkillers are used along with tobacco and some antidepressant medication.

If you’re concerned about the effects of opioid use on your unborn baby, it’s crucial to speak with your doctor. Trying to stop using medication suddenly and without any form of assistance could cause more harm to the fetus than continuing to use prescription drugs while being closely monitored by your healthcare provider and specialist.

While opioids grab the most headlines when you mention the abuse of prescription drugs, using Valium or other tranquilizers during pregnancy has been linked to birth defects and withdrawal symptoms.

Regardless of what prescription drugs you are using, take the chance to voice your concerns to your doctor even if he or she is the one prescribing the medication.

Treatment of Substance Use in Pregnancy

As you can see from the above categories of substances, there’s no catch-all solution for treatment. Someone who’s struggling to stop smoking requires a very different level of help and care to an expectant mother laboring under a heavy cocaine habit.

Regardless of the substance in question, though, treatment of any kind of substance use has one common goal: total abstinence.

The key factor to bear closely in mind is that if you are using a substance, so is your baby.

With so many variables, it’s paramount that you formulate a clear and personalized plan for treatment so you give your baby the best start in life rather than handicapping her from the get-go.

So what do you do if you have tried to stop using substances and you just can’t manage to pull this off alone?

What To Do If You’re Concerned About Substance Use When Pregnant

Whether you’re using legal substances like alcohol and tobacco, prescription painkillers or street drugs during pregnancy, the first thing you should do is speak with your doctor to get some personalized advice.

It goes without saying that you should discontinue use of any harmful substances but this is not always quite so easy if you’re a heavy user and potentially dependent on the substance in question.

Once you’ve spoken with your healthcare provider and done your best to stop, you can always call our Indiana treatment center at 375-325-8331. We’ll more than happy to answer any questions you might have about substance use during pregnancy and we can help you to stop those damaging habits before it’s too late and your newborn suffers the consequences.

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About the Author

Landmark Recovery

Landmark Recovery

Landmark Recovery was founded with a determination to make addiction treatment accessible for all. Through our integrated treatment programs, we've helped thousands of people choose recovery over addiction and get back to life on their own terms. We're on a mission to save one million lives over the next century. We encourage all those struggling with substance use to seek professional help.