Drug and alcohol misuse in pregnancy

You may worry how drug and alcohol use may affect your pregnancy, and this leaflet will give you some information about how your baby could be affected.  This includes some common drugs available on prescription, which can be abused, and some illicit drugs sourced ‘on the street’.

All drugs could be harmful in pregnancy and even prescribed medications should be reviewed by your GP if you are planning a pregnancy or have become pregnant.

Try to stop taking illicit drugs as soon as you can.  If you have withdrawal symptoms when you reduce your use or stop taking drugs do not suddenly stop, you will need advice to help you reduce in a safe way. Sudden withdrawal can be dangerous for both you and your baby, speak to your midwife, GP or local drug service.  These services will not judge you.

If you have taken drugs as a one off before knowing you were pregnant, this is unlikely to cause any harm so try not to worry.

If abuse of prescription drugs or illegal drug use is a part of your life, getting the correct help can really improve the outcome for you and your baby.

Regardless of the drug or alcohol, there are generic risks associated with their use in pregnancy, including Small for Gestational Age (SGA). SGA means a baby is underdeveloped and underweight for their stage in pregnancy. SGA is associated with stillbirth, premature labour and cot death. ¹

Cannabis

Research has shown that cannabis use in pregnancy can affect the development of your unborn baby. ²

Cannabis gives off five times more carbon monoxide than smoking tobacco.  This increases the risk of miscarriage, stillbirth, and baby growing and developing slower than expected. There is also twice the risk of sudden infant death (cot death).

The same research has shown that babies exposed to cannabis can experience delays in meeting their milestones such as crawling and walking. ²

Breastfeeding is best for you and your baby, and has many health benefits. However, cannabis attaches itself to the fat molecules in breast milk so it passes to the baby and can remain in the baby’s system for many weeks, even if you breastfeed several hours after using cannabis. Due to low birth weight, newborns can have problems maintaining their temperature, blood sugar and feeding issues.

New psycho-active substances and previously legal highs, including synthetic cannabis e.g. Spice, are changed in their chemical content when they are produced, so their effects on the baby are broad and unpredictable.

Cocaine and crack cocaine

Research into the effects of cocaine and crack cocaine in pregnancyindicate that it is associated with haemorrhage (heavy bleeding), miscarriage, stillbirth and premature labour (early labour before 37 weeks).³

Cocaine and crack increase the mother’s heart rate, which can reduce the oxygen supply to the baby, which can cause reduced growth and development.

There have been reports of babies having a bleed on the brain (stroke) which can cause brain damage. If you have been using cocaine or crack, your baby will require a brain scan soon after birth.

These drugs can also increase the mother’s blood pressure, which causes blood vessels to the placenta to narrow. This pressure can cause the placenta to separate from the womb, which is called a placental abruption and can be fatal for both mother and baby.

If they are used just before birth, baby may be agitated, restless and difficult to comfort. Baby can experience unpleasant withdrawal symptoms similar to those experienced by mother, i.e. sleepy and unresponsive.

Cocaine does pass through breast milk, so despite the health benefits, breastfeeding is not recommended.

Benzodiazepines

These are more commonly known as sedatives or sleeping tablets. They are highly addictive for both you and your baby. Benzodiazepines pass freely through the placenta and have been linked to facial abnormalities such as cleft palate. Baby may experience withdrawal symptoms soon after birth, including fever, sweating, disturbed sleep and poor feeding.

If opiates such as heroin are also used, the withdrawal symptoms from both can be worse. It is advised to reduce and stop this drug under medical advice.

Ecstasy and Amphetamines

Crystal meth, Speed, Wiz, Ice

The effects are not yet fully understood and more research is needed, but it is strongly suspected that they can cause heart and lung defects, and facial abnormalities such as cleft palate.

These drugs also increase the mother’s blood pressure and in turn, this can effect baby’s blood pressure and oxygen levels. This can also cause placental abruption, slow growth and development.  This means baby is not just smaller than expected butisalso underdeveloped for the stage in pregnancy.

Baby may also experience withdrawal symptoms at birth including being drowsy, jittery and breathing problems caused by the lungs being underdeveloped.

Opiates

Sometimes your GP may prescribe opiates for pain such as codeine phosphate, dihydrocodeine and tramadol.  Some opiates are taken illicitly, such as heroin.

You may be prescribed an opiate as a substitute medication such as Methadone and Buprenorphine.  These do pass freely through the placenta, and all opiates are highly addictive when used over a period of time.

Discuss with your GP if you wish to stop the prescribed drugs. If you experience withdrawal symptoms when you try to reduce or stop, this can be very dangerous for mother and baby. Do not stop suddenly; speak to your midwife, GP or local drug service for advice.

Babies can experience withdrawal symptoms at birth but these can be treated very safely with medication. These symptoms can include fever, excessive sneezing, jittery, diarrhoea and vomiting, excessive sucking and feeding,high temperature, irritability and be difficult to comfort, and rarely seizures.

Baby will be required to remain in hospital for 72 hours after birth to monitor and manage any withdrawal symptoms.

Gabapentin, Pregabalin and Amitriptyline

Gabapentin and Pregabalin may be prescribed for seizures and pain.  Amitriptyline can be prescribed for seizures and depression.  You will need to speak to your GP as soon as know you are pregnant if you are taking any of these medications.

More research is required into their effects on pregnancy, but it is generally advised you only continue if the benefits considerably outweigh any potential risks.

When taken with opiates, Gabapentin can enhance its effects, and therefore withdrawal symptoms from the drug for both mother and baby.

There have been reports of babies withdrawing from all of these drugs at birth.

Remember if you have withdrawal symptoms when you reduce or stop taking a drug, whether prescribed or ‘street drugs’, seek medical advice and do not stop suddenly.

Alcohol

Alcohol is not safe at any point in your pregnancy and is not advised as it can cause fetal alcohol spectrum disorder FASD. This is an irreversible but preventable condition, which can cause facial abnormalities, learning disabilities, and poor brain and organ development.

Using more than one drug at any one time can increase the risks associated with the drugs. Chemical reactions can occur when drugs are mixed and the effect is unpredictable.  An example of this is when alcohol and cocaine are used together it produces cocaethylene, which is highly toxic and very dangerous.

References

Mbrace-uk (2021)

Mothers and babies: Reducing risk through audits and confidential enquiries across the UK.

https://www.npeu.ox.ac.uk/mbrrace-uk

Thompson, R (2019)

‘Marijuana use in pregnancy: A review’.  

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7090387/#:~:text=A%20previous%20

large%20systematic%20review,CI%2C%200.8%E2%80%932.08

Gouin K, Murphy K, Shah PS (2011)

Effects of cocaine use during pregnancy on low birthweight and preterm birth: systematic review and meta analyses.

https://pubmed.ncbi.nlm.nih.gov/21257143

Resources

FRANK – Talk to Frank
Website: https://talktofrank.com

NICE (National Institute for Health and Care Excellence)
Website: http://www.nice.org.uk/guidance/cg110

Local drug and alcohol services (you can self refer)

Hartlepool Action Recovery Team (HART)
Hartlepool
Telephone: 01429 285000

Change Grow Live
Stockton and Billingham
Telephone: 01642 673888
24 hour helpline: 0800 052 2050

Lifeline Project
Peterlee and East Durham
Telephone: 0300 026 6666

Community Midwives:

Hartlepool
Telephone: 01429 522279

Stockton
Telephone: 01642 383441

Peterlee and East Durham
Telephone: 01429 522270

Comments, concerns, compliments or complaints

Patient Experience Team (PET)

We are continually trying to improve the services we provide. We want to know what we’re doing well or if there’s anything which we can improve, that’s why the Patient Experience Team (PET) is here to help. Our Patient Experience Team is here to try to resolve your concerns as quickly as possible. The office is based on the ground floor at the University Hospital of North Tees if you wish to discuss concerns in person. If you would like to contact or request a copy of our PET leaflet, please contact:

Telephone: 01642 624719

Freephone: 0800 092 0084

Opening hours: Monday to Friday, 9:30am to 4:00pm

Email: [email protected]

Out of hours

Out of hours if you wish to speak to a senior member of Trust staff, please contact the hospital switchboard who will bleep the appropriate person.

Telephone: 01642 617617

Data protection and use of patient information

The Trust has developed Data Protection policies in accordance with Data Protection Legislation (UK General Data Protection Regulations and Data Protection Act 2018) and the Freedom of Information Act 2000. All of our staff respect these policies and confidentiality is adhered to at all times. If you require further information on how we process your information please see our Privacy Notices.

Telephone: 01642 383551

Email: [email protected]

Leaflet feedback

This leaflet has been produced in partnership with patients and carers. All patient leaflets are regularly reviewed, and any suggestions you have as to how it may be improved are extremely valuable. Please write to the Clinical Governance team, North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, TS19 8PE or:

Email: [email protected]

Leaflet Reference: PIL1281
Date for Review: 09/06/2024