Pregnant women who make use of substances need help, not judgement.

According to the Gender Perspective of Addictive Disorders study, some of the reasons women make use of substances are:

• high levels of poverty among women
• lower levels of educational and unemployment status
• extended family responsibilities in single woman-headed households
• exposure to intergenerational trauma and gender-based violence
• mental illness, including anxiety and depression.

Rising illicit drug use among South African women is raising the alarm for women at risk of significant pregnancy complications and the optimal future development of their infants and children.

the risks

Dr Lisa Dannatt, member of the South African Society of Psychiatrists (SASOP), says the use of substances in pregnancy increases the risks of “negative pregnancy and child health outcomes”.  Stigma and judgement also impede access to pregnancy healthcare.

Substance abuse disorders

“Women are at greatest risk of developing a substance use disorder in their reproductive years. The highest prevalence rates are seen in adolescence and early adulthood.”

Unplanned pregnancies

“A further concern is that 41% of all pregnancies globally are unplanned,” says Dr Dannat.  “This means many women make use of substances before they become aware of their pregnancy, while substance use itself increases the risk of unintended pregnancy.”

Foetal and expectant mother health impact

“All drugs, including nicotine and alcohol, carry risks to both the developing foetus and the health of the expectant mother”, says Dr Dannat. “Risks for the pregnant woman include pre-eclampsia, miscarriage, premature delivery and excessive bleeding during and after birth.

“Substances of abuse readily cross the placenta, risking poor growth and development of foetal vital organs, especially the brain. The infant is at risk of birth defects, low birth weight, and cardiac and respiratory problems at birth. All of these lead to significant negative health outcomes – at birth and long term,” she explains.

Read our article on women and alcohol.

Children’s prospects affected

“A child’s lifelong prospects for physical health and brain development are laid down in the first 1 000 days of life, from conception to about two years old,” she explains.

“Making use of substances in these first 1 000 days not only impacts the developing foetus, but also goes further into impacting mother-child bonding, breastfeeding and the child’s ongoing growth and development, as well as their prospects in education and life.

“Children can develop social and emotional difficulties due to poor maternal bonding. And those raised in households where people make use of substances are more likely to have schooling and behavioural difficulties and mental health challenges. They may also go on to develop problems with substance dependence and abuse,” she says.

Barriers to accessing pregnancy care

“The health of women using drugs and alcohol during pregnancy is further endangered by barriers to accessing pregnancy care,” says Dr Dannat.

“Women using substances are often reluctant to seek maternal healthcare or struggle to keep appointments. Their use of substances may be linked to co-occurring physical and mental illness. They may also fear being stigmatised or having the baby removed from their care.

“They may have transport and childcare difficulties, poor coping skills and a lack of social or family support. The lack of access to care and untreated medical and mental health co-morbidity can all negatively affect pregnancy outcomes and child health,” Dr Dannat explains.

education and information needed

She adds that misinformation on the use of substances in pregnancy is rife, with many women unconcerned about the impacts of legal or socially acceptable substances such as alcohol, tobacco or cannabis.

“The reasons for women’s use of substances and their vulnerability to substance disorders differs from men’s. Particularly in relation to maternal healthcare, an integrated and women-specific approach is needed to address physical and mental health.

“Healthcare practitioners need to address misinformation and educate about the use of substances in pregnancy, and prevent and manage maternal substance use.”

improving access to treatment is essential

In addition to initiatives to prevent substance use, Dr Dannatt said measures are needed to:

• remove stigma
• improve access to healthcare and substance treatment services for pregnant women
• improve pregnancy planning
• provide greater social support.

Pregnant women who make use of substances are advised to contact their healthcare provider for assessment and discussion of further care.