THE EDUCATOR - Fall 1998

Chemical Dependency and Pregnancy

By Washington State Department of Health Community and Family Health

How widespread is chemical dependency during pregnancy?

Chemical dependency refers to sustained use of alcohol or illicit drugs leading to symptoms of tolerance and withdrawal, and to continued use despite recognition of an ongoing problem. Currently, there is no statewide population- based data, however, DOH can estimate this number using Medicaid data, and assuming that similar proportions of non-Medicaid covered pregnant women are chemically dependent.

Medicaid claims data show 6.5% (4,056/63,892) of women who gave birth in 1994-1995 and received Medicaid-paid maternity care were diagnosed or treated for chemical dependency during pregnancy or in the first two months after delivery. This number is believed to be an underestimate as women may not be diagnosed and/or treated, due to variability in provider recognition of chemical dependency and women not receiving prenatal care.

Thus, it is estimated that 10-12% of the approximately 80,000 infants born each year in Washington are drug-exposed. Most of these infants do not show measurable signs/symptoms or effects at birth or early childhood. Far fewer infants, 1-1.2% of births are drug-affected. These infants show measurable signs/symptoms at birth or shortly thereafter from drug or alcohol use in pregnancy.

Who is at risk for chemical dependency in pregnancy?

Chemically dependent pregnant women are more likely than non-chemically dependent women to be victims of violence, victims of early sexual abuse, depression, isolation, living in poverty, or to have psychiatric disorders. These women are also more likely to have substance using partners.

What are the public health implications of chemical dependency in pregnancy? Infants of alcohol-dependent women are at risk for a range of alcohol-related birth defects including fetal alcohol syndrome and other fetal alcohol effects.

Infants of drug dependent women are at risk for low birth weight both due to pre-term delivery (less than 37 weeks gestation) and intrauterine growth retardation. As low birth weight is one of the major causes of infant mortality, they are also at increased risk for infant mortality compared to other infants. It is unclear, however, to what extent these outcomes are related to actual drug effects or to correlates of drug use in pregnancy, including cigarette smoking, alcohol use, inadequate nutrition, infections and/or undetected pregnancy complications.

Other adverse reproductive outcomes, such as congenital mal-formations and behavioral problems have been suggested in the scientific literature, but findings are indeterminate due to the inability to identify chemically dependent women, and to determine what drugs or alcohol are used at what time in pregnancy and in what amounts.

Chemically dependent women are more likely to provide a compromised home for their children because of their dependency, poverty, community isolation and other factors associated with substance use, and their children are more likely to be placed in foster care. In addition, they are less likely to seek health services and more likely to become pregnant unintentionally.

What activities are currently being undertaken to reduce chemical dependency in pregnancy and its effects?

The optimal strategy for reducing chemical dependency in pregnancy is to address the issue before women become pregnant, or if that is not possible, to provide intervention as early in pregnancy as possible.

To that end, the Maternity Care Access Act (First Steps) and Drug Omnibus Legislation passed in 1989 made pregnant women a priority for treatment of chemical dependency, enhanced early detection and intervention in pregnancy, and provided case management and support services to Medicaid-eligible chemically dependent pregnant women. Since passage of these bills, the percentage of chemically dependent women identified during the prenatal period has increased from less than 50% in 1989 to over 80% in 1994.

Currently, there are eleven hospitals certified to provide fetal stabilization and intensive inpatient treatment for chemically dependent pregnant women on Medicaid. In 1996, approximately 350 women received such services. Specialized long-term residential treatment for pregnant, postpartum, and parenting women (and their children under age six) on Medicaid is available on a limited basis: six programs provide a total of 74 beds for women and 61 beds for their children. Each program carries a list of 1520 women waiting to enter.

The Birth to 3 Program in Seattle and Tacoma provides outreach, case management and other support services to highest risk mothers who are chemically dependent and their families after the birth of a drug-exposed child.

Yakima First Steps Community Mobilization Project for Pregnant Substance Abusers was a successful demonstration project from 1993-1996 which enhanced existing pre-natal services with provider and hospital training, extended short- and long-term treatment services, child services, outreach and parenting education.

Information for this fact sheet comes from The Health of Washington State, Washington State Department of Health, 1996; Substance Abuse, Treatment, and Birth Outcomes for Pregnant and Postpartum Women in Washington State, 1995, and Substance Use During Pregnancy: Prevalence, Effects and Costs, 1997, Washington State Department of Social and Health Services; Effects of InUtero Exposure to Street Drugs, American Journal of Public Health 1993; and from staff in Division of Alcohol and Substance Abuse, Department of Social and Health Services.

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