Navigating Substance Use in Pregnancy and Postpartum
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Let’s talk about substance use in pregnancy and postpartum. This includes:
Caffeine
Alcohol
Smoking and Other Tobacco Products
Cannabinoids
Illicit drugs
Other than caffeine, which is ok to consume in moderation, I can easily sum up the recommendations surrounding the other substances on the list above in one word: AVOID.
For many, it really is that simple. Just avoid substances during pregnancy and while breastfeeding or chest feeding. Done.
But what about those who are struggling with addiction and find out they’re pregnant? What about those who are using cannabis to treat a medical issue? The recommendations are simple, but the actual experience for people is unbelievably complex.
If this is you, you likely have questions swirling in your head, like:
If I’m honest with my care provider about my substance use, will I be reported?
Will I be drug tested at my prenatal visit or during my hospital stay?
Will I know if I’m being drug tested?
If anyone finds out I’m using, can I be charged with child abuse?
Will they take my baby away?
Will I face legal consequences?
Abstinence-Only Approach
An abstinence-only approach emphasizes complete avoidance of these certain substances as the primary goal. It promotes the belief that total abstinence is the only acceptable outcome and often neglects the underlying factors contributing to substance use. This approach typically focuses on prevention and discourages any form of use, without providing guidance or support for individuals who struggle with addiction.
This approach, which is widespread in the United States, prevents people from seeking care, getting help, and accessing resources. It punishes those that are backed into a corner and struggling and negatively impacts outcomes.
Among those aged 35 to 44, overdose mortality more than tripled during this period…
NIDA Director and senior author on this study, Nora Volkow, M.D., says:
The stigma and punitive policies that burden pregnant women with substance use disorder increase overdose risk by making it harder to access life-saving treatment and resources… Reducing barriers and the stigma that surrounds addiction can open the door for pregnant individuals to seek and receive evidence-based treatment and social support to sustain their health as well as their child’s health.
She knows there is a better way.
Harm Reduction
In contrast, a harm reduction approach recognizes that complete abstinence may not be immediately achievable for everyone and prioritizes minimizing the negative consequences associated with substance use. It promotes practical strategies and support systems to reduce harm, such as providing access to clean needles, overdose prevention education, substance testing services, and access to treatment options. The emphasis is on meeting individuals where they are, offering non-judgmental support, and promoting safer use practices while providing avenues for treatment and recovery.
While a harm reduction approach is often seen as more realistic and inclusive, in reality, finding this kind of support within our health care system can be challenging for multiple reasons:
Stigma surrounding substance use, especially in pregnancy
Misinformation
Possible legal risks
Potential custody issues
The link below is a great resource for understanding some of these risks, which vary by state:
🔗 How States Handle Drug Use During Pregnancy | ProPublica
Recommendations and Information
Here is more specific information and recommendations for a variety of substances.
Caffeine
Limiting caffeine intake during pregnancy may be beneficial. Excessive amounts of caffeine can make it hard to sleep and can affect how you feel (jittery or nauseous, for example). You could experience other negative side effects, like increased blood pressure, increased heart rate, and indigestion. Caffeine can pass though the placenta and affect the baby, as well. It's possible, though not conclusive, that too much caffeine increases the risk of miscarriage and of the baby being born earlier or smaller than expected. The possible miscarriage link is associated with high levels of caffeine consumption.
While coffee is a common source of caffeine, there are others:
tea
espresso
pop/ soda
certain medications
certain supplements
energy drinks and shots
chocolate
Energy drinks and shots are not recommended in pregnancy. Besides caffeine, they contain other ingredients that vary among brands. We just don’t know enough about how these different ingredients could impact a developing fetus.
Small amounts of caffeine can pass into human milk, so there are also limits for those breast/ chest feeding. Too much caffeine can cause babies, especially newborns, to be fussy and have trouble sleeping.
Not pregnant: 400 mg or less per day
Lactating: 300 mg or less per day
Pregnant/ trying to conceive: 200 mg or less per day
Alcohol
People assigned female at birth who are not pregnant should limit daily intake of alcohol to one drink or less per day. Excessive alcohol consumption can lead to a variety of health problems, like heart disease, liver disease, and cancer. It also becomes difficult to consume all of the necessary essential nutrients, while remaining within recommended daily calorie limits, when consuming too many alcoholic drinks per day.
While avoiding alcohol is the safest option, drinking in moderation is compatible with lactation. One drink or less per day is not known to cause harm to infants, though waiting at least two hours after each drink of alcohol is highly recommended. Alcohol can be detected in breast milk for several hours, which is why its best to wait between having a drink and initiating a feeding. "Pumping and dumping" to attempt to remove alcohol from breastmilk quicker isn't necessary or effective. Drinking excessive amounts of alcohol can be harmful and impairs a caregiver's ability to safely care for an infant.
Examples of a Standard "Drink":
12 oz. of beer (5% alcohol)
8 oz. of malt liquor (7% alcohol)
5 oz. of wine (12% alcohol)
1.5 oz. of liquor (40% alcohol/ 80 proof)
Smoking and Other Tobacco Products
Smoking can have a negative effect on fertility, increase the risk of pregnancy complications, cause harm to a developing fetus, and increase the risk of Sudden Infant Death Syndrome (SIDS). Exposure to secondhand smoke is also dangerous.
Cigarettes and other tobacco products contain a chemical called nicotine. Smoking is associated with higher levels of risk than smokeless products that also contain nicotine. Other tobacco products and electronic cigarettes/ vapes are also not recommended during pregnancy. However, a person struggling to quit smoking cigarettes may choose to vape or chew gum containing nicotine instead, as a way to reduce harm.
Cannabinoids
Cannabinoids are a group of chemical compounds that are naturally found in the cannabis plant (Cannabis sativa). The most well-known cannabinoids are THC and CBD, but there are over 100 different cannabinoids identified in cannabis.
Currently, the FDA strongly advises against the use of marijuana (contains THC) and products that contain CBD during pregnancy and while breastfeeding or chest feeding. This is due to concerns over potential risks, as well as limited research.
However, some individuals may choose to use cannabis during pregnancy and postpartum for various reasons, such as managing specific health conditions. Just like with medications, it is crucial to approach this decision with careful consideration and in consultation with knowledgeable professionals to reduce potential harm. More research is needed to understand the true impacts of cannabis use during the pregnancy and postpartum period.
Laws are changing frequently on cannabis use. Some individuals may choose to use cannabis during pregnancy and postpartum for various reasons, such as managing specific health conditions. Just like with medications, it is crucial to approach this decision with careful consideration and in consultation with knowledgeable professionals to reduce potential harm. More research is needed to understand the true impacts of cannabis use during the pregnancy and postpartum period.
Illicit Drugs
Illicit drugs are those that are illegal to possess or use, like: heroin, fentanyl, cocaine, methamphetamines, and, in some states, marijuana.
They also include drugs or substances that are legal but are being misused. Here are some examples:
Taking prescription drugs without a prescription
Using prescription drugs in a way other than prescribed
Inhaling certain household or industrial products
Illicit drug use carries additional risk in pregnancy and when breastfeeding or chest feeding. And it can be even more challenging to seek help.
Final Thoughts
This issue is not as simple as just “avoid” for everyone. Getting informed on your rights and the potential legal and other risks is a great start.
Additional Resource to Explore
Substance use is one of the health and safety topics on my To-Do Lists by Trimester spreadsheet. Find it in my toolkit, called Proactive Pregnancy: Early Essentials for Expectant Parents. Click the button below to check it out!