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Screening for smoking may reveal substance abuse during pregnancy

Robin Wulffson MD's picture
pregnancy, substance abuse, smoking, psychiatric disorder

Substance abuse during pregnancy impacts an innocent victim: the developing fetus.

Substance abuse during pregnancy increases the risk of miscarriage, stillbirth, and birth defects. Furthermore, children born from a mother who abuses substances can endure life-long health problems and a premature death. It is estimated that about 4% of pregnant women in the United States use illicit drugs such as marijuana, cocaine, Ecstasy and other amphetamines, and heroin.

Often, women who abuse substances during their pregnancy do not reveal their habit, even when directly questioned. New research addressing this situation was conducted by investigators in the Department of Obstetrics, Gynecology and Reproductive Health at the University of Maryland, in Baltimore. The findings were presented by Mishka Terplan, MD, MPH at the American Society of Addiction Medicine (ASAM) 43rd Annual Medical-Scientific Conference in Atlanta, Georgia, which ran from April 19-22.

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It is known that smoking is associated with other substance abuse problems such as illegal drugs as well as mental disorders. The researchers set out to establish the relationship between smoking and substance abuse in pregnant woman; they did so because of a lack of definitive studies among this population in the medical literature. The investigators reviewed medical chart review of all new obstetrical visits between July 2009 and July 2010 at a single low-income clinic. Demographic, obstetric, and drug use were compared between patients who had a psychiatric diagnosis and those who did not. The researchers compiled a group of 397 women who met the criteria for evaluation. They found that 65 (16%) had a psychiatric diagnosis; the most common diagnoses were depression and bipolar disorder. Furthermore, illicit drug use (33%) and smoking (34%) were common; however, alcohol use was rare (4%).

Patients who had a psychiatric diagnosis were not found to have an increased usage of illegal drugs compared to those who did not have such a diagnosis. However, for women who smoked, the odds of substance abuse was 4.1 times higher than nonsmokers. Dr. Terplan noted that further research was indicated regarding whether a relationship exists between smoking and mood disorders during pregnancy and postpartum is indicated.

Take home message:
This study is important for healthcare professionals because it increases awareness that a pregnant woman who smokes may also have a psychiatric disorder and/or be a substance abuser. It also can be of value to an individual who has a friend, relative, or spouse of a pregnant smoker. If these individuals make a close evaluation of the pregnant smoker’s behavior they may be able to determine if a problem exists. If so, they may be able to guide the woman towards appropriate therapy. Either directly confronting the individual or alerting her healthcare provider can be helpful.

Reference: American Society of Addiction Medicine

See also:
Drug addicted newborns: a national disgrace
Preventing substance abuse in pregnancy: a successful program