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Polysubstance Abuse During Pregnancy: The Effects on Both Mother and Neonate

Sarah Richmond

Department of Nursing, Delaware Technical Community College

NUR340-501 Nursing Research

Professor Tammy Layer

April 21, 2024

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Polysubstance Abuse During Pregnancy: The Effects on Both Mother and Neonate

Polysubstance abuse during pregnancy is a crucial topic, as it negatively impacts the lives

of mothers and their babies. Polysubstance abuse is defined as the continuous usage of more than

one drug (Polysubstance use during pregnancy, CDC). Polysubstance abuse is becoming more

common in pregnancies throughout the world today, resulting in longer hospital stays,

withdrawal effects, parental stigma and detachment, and an overall increase in morbidity and

mortality risks. According to a survey conducted in 2012 5.9% of pregnant women reported

using illicit drugs and this number is on the rise with more access to street drugs, and less access

to healthcare (Prince, 2023). In fact, as recently as 2020 another survey was taken where 40% of

women who use drugs admitted to using during their pregnancy (Polysubstance use during

pregnancy, CDC). Throughout this paper, different data will be analyzed and reviewed to

develop a deeper understanding of factors that contribute to drug use, barriers to receiving

healthcare, and recommendations to combat this detrimental issue.

Statement of the Problem

Being that many are unaware of the implications drug use may have to both patients, it is

inherently important to provide education on this topic and to research ways to decrease the

negative side effects. The research question throughout this paper is as follows: What are ways to

reduce the short term and long-term effects of polysubstance use on both mother and baby? This

question will help guide new research and evidence-based practice and will provide feasible
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solutions to mothers all over the world. An article recently highlighted the varied reasons for the

increase of drug abuse and relates them to: genetic, physiological, biological, environmental, and

socioeconomic factors (Prince, 2023). While the side effects of the neonate depend on the

substance that is being abused, each substance may cause some physical mutations to the infant.

For example, opioids are linked to premature birth, poor growth, birth defects and neonatal

abstinence syndrome (Polysubstance use during pregnancy, CDC). Nurses must be aware of

when a neonate has been exposed or at risk from withdrawal as each Neonatal Intensive Care

Unit has a specific course of treatment they will follow. It is also the nursing role to provide

education, uphold patient confidentiality, provide equality and most important advocate for both

mother and the neonate. To properly enact these characteristics, it is important to examine data

and research through literature reviews.

Literature Review

It is necessary to understand the increase of drug use throughout the world, as there are

similarities in contributing factors despite global location. A qualitative study was conducted in

Kenya that involved surveying pregnant women on factors that contribute to participating in drug

usage. For this study, 45 women were chosen and were given the option of choosing a

collaborative group discussion or a private interview style discussion (Mburu et al., 2020). After

the study was finished, the results were analyzed to determine the similarities of each woman’s

demographics and history, and to understand several factors that lead to drug use. The authors

determine that the four main reasons women were using drugs during pregnancy were: coping

with the stress of the pregnancy, managing/decreasing withdrawal, influence, and pressure of

relationships, and just not wanting to change their lifestyles (Mburu et al., 2020). It is also of

importance to note that while these women knew doing drugs during pregnancy was not in the
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favor of them nor the baby, that all these women described a lack of resources and mentioned

barriers to receiving care. This article highlights the need to reduce barriers and increase

resources as many lives are at risk if this vulnerable population’s needs are not met.

In comparison, another study determined that one way to reduce common barriers was to

create a program to help support those in need, the program “Drug Free Moms and Babies

Project Pilot Program” (Lilly et al., 2019) involved understanding factors but also providing

different solutions. This article reviewed different methods to combat drug abuse during

pregnancy and touched on the negative side effects for mothers and babies. The article found that

substance abuse is associated with increased morbidity and mortality for both the infant and the

mother. Of the infant’s side effects the most common are low birth weight, withdrawal

symptoms, growth defects, preterm birth, and sudden infant death syndrome (Lilly et al., 2019).

The mother’s most common side effects are postpartum hemorrhaging, placenta previa, ectopic

pregnancies and psychological side effects such as depression and anxiety (Lilly et al., 2019).

Likewise with the previous study, this article also highlights barriers to receiving treatment

despite utilizing a new program. Many women who previously were eager to participate in the

program soon missed appointments or dropped out due to transportation issues and lack of

childcare (Lilly et al., 2019). Despite the barriers, the program showed that there was a decline

from 81% of positive drug screens during the first trimester to 22% during delivery for those

who completed the program (Lilly et al., 2019). This study highlights that even though barriers

exist, when resources are successfully presented, mothers can meet goals and reduce negative

effects from drug use.

It is obvious that drug use has an extreme impact on neonates and mothers throughout the

postpartum period. The bigger question is how to safely reduce the short term and long-term side
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effects. A study in 2016 tried different ways to help decrease these effects and even tried to

reduce the infants from receiving any kind of defects or withdrawal in the postpartum period. To

successfully implement this study, women were chosen based on positive opioid urine drug

testing and then were placed through a detoxification program. Despite best efforts to overall

control and diminish the spread of neonatal withdrawal syndrome, it was found that

detoxification during pregnancy caused an array of issues. Among these issues were higher rates

of relapse, low detoxification completion rates, and limited data on how the effects of

detoxification actual effects the infant after their delivery (Terplan et al., 2018). This study

provides extreme significance since a lot of studies aim to only improve the neonate's outcome

and can cause more harm to the mother while doing so.

As briefly touched on, one of the main barriers to receiving care is the fact that this is

considered a vulnerable population. A recent review examines different stigma that pregnant

women face while using drugs. While it is a sensitive subject and many feel strongly in favor of

the infant, it is impossible for both to receive beneficial care when stigma exists. Mothers need to

know that they are heard, regardless of their current situation. Many women admit to not

receiving care at all due to many different issues, but one of the main is stigma. Some pregnant

women fear that child welfare services and parental rights will be taken away, or that they will be

turned away all together and their infant will not even receive care due to the stigma associated

with a controversial topic (Weber et al., 2021). In addition to these barriers to receiving care,

many will not receive routine screening at all, and as a result STD rates and other negative

factors will additionally effect both the mother and baby (Weber et al., 2021). It is vital to these

families to provide a safe environment, that is judgment free as many women face fear of

knowing the potential pain, they may have caused their infant. Withdrawal is becoming more
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prevalent in the world today, however there are solutions that can safely treat neonates

experiencing negative side effects, which need to be accurately portrayed to the families.

Neonatal Abstinence Syndrome takes place after a neonate is born and occurs when the

neonate is experiencing active withdrawal. Neonates experiencing withdrawal can be identified

through urine and meconium screening and thus evidence-based practice has emerged after years

of understanding the unique needs of the infant. Other guidelines such as different withdrawal

scales that can be used, and pharmacological guidelines have all been developed and may be

used to specialize a care plan. While it depends on the NICU, most have started to shy away

from just giving the infant drugs such as morphine and turned to a less invasive approach. These

different approaches are a result of extensive research from the early 2000s to the current day

(Macmullen et al.). According to national guidelines, it is important to screen infants at risk for

NAS, provide comfort measures/support, correct deficiencies, encourage bonding, administer

pharmacological treatment and advocate for the neonates needs. Evidence-based practice is

necessary to decrease the impact of withdrawal on infants. Education is also vital as it allows

these families to visualize that they are standard practices to reduce the short- and long-term

effects that drug use has on neonates.

Analysis

Throughout the articles, different methodologies were used to highlight the issue of drug

abuse during pregnancy and to explore solutions to this ongoing issue. The most common

method found through the literature review was by qualitative studies. The reason these

qualitative studies are so valuable and hold such pertinent data is because understanding why

many fall victim to drug use is necessary to decrease the issue from reoccurring. All studies
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concluded that drug abuse does more harm when not adequately treated and jeopardizes not only

the physical health of the mother and baby but decreases bonding and produces challenges

throughout the future. The only downside to qualitative studies is if a mother feels there is stigma

or bias present she may not answer truthfully, thus potentially skewing the results of the study. It

is important that those involved in the study determine internal bias and continue education to

help provide an inclusive environment and create positive rapport.

Recommendations

One recommendation to reduce the issue of drug use during pregnancy is to provide

comprehensive education and support programs for expectant mothers. While some similar

programs may already exist, many are not easily accessible and may not provide a welcoming

environment. To help reduce this likelihood it is important to develop support groups that can be

fully online and will provide the expectant mothers resources based on their personal needs.

These programs can include information on the risks and consequences of drug use during

pregnancy and resources for seeking help. Additionally, it is important to ensure accessible and

affordable healthcare to the mothers who need substance abuse treatment. Holding seminars,

providing free screenings, handing out education brochures, are all ways to provide education.

Also incorporating free transportation services would allow many to safely arrive to their

appointments. Another recommendation would be for the mothers to fill out surveys during

regular OBGYN visits asking them about their drug use history and allow them to answer as

much or as little as possible. Surveys are an important way to help evaluate data, as they may

allow one to open up with no pressure from a physical presence being involved.
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The research that would be most beneficial regarding this topic would be qualitative and

quantitative research. Quantitative research can provide statistical data and measure different

interventions or outcomes while qualitative research can provide perspective and understanding.

By utilizing bother approaches, one can gain comprehensive understanding and mitigate the

effects of drug use during pregnancy. An example of a title would be “Understanding the Factors

that Influence Drug Use During Pregnancy: A Qualitative Exploration,” this implies qualitative

research and would help gather in-depth data through different methods. This approach allows

for a deeper understanding of the factors influencing drug use and provides insight.

When collecting qualitative data, it is important to ensure protection of the rights of the

patient. One of the ways to do this is to uphold patient confidentiality. Upholding confidentiality

will help promote a positive experience and will help promote a good patient relationship. The

implications for nursing practice in addressing drug use during pregnancy are significant. Nurses

play a vital role in providing education, support, nonjudgmental care and much more. By

understanding the factors that influence drug use during pregnancy through research, nurses can

tailor their interventions and support specific patient needs. Examples of these interventions

could be providing resources for substance abuse treatment, promoting prenatal care, and

providing emotional support. By adopting a compassionate and integrated approach, nurses can

contribute to minimizing negative effects and promoting well-being of both mother and baby.
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References

Centers for Disease Control and Prevention. (2023, August 18). Polysubstance use during

pregnancy. Centers for Disease Control and Prevention.

https://www.cdc.gov/pregnancy/polysubstance-use-in-pregnancy.html

Lilly, C. L., Ruhnke, A. M., Breyel, J., Umer, A., & Leonard, C. E. (2019, June 10). Drug free

moms and babies: Qualitative and quantitative program evaluation results from a rural

Appalachian State. Preventive medicine reports.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6580012/

Macmullen, N., Bloman, P., & Dulski, L. (n.d.). Evidence-based nurse-driven interventions for

the care of newborns with neonatal abstinence syndrome. Advances in neonatal care :

official journal of the National Association of Neonatal Nurses.

https://pubmed.ncbi.nlm.nih.gov/25068529/

Mburu, G., Ayon, S., Mahinda, S., & Kaveh, K. (2020, September). Determinants of women’s

drug use during pregnancy: Perspectives from a qualitative study. Maternal and child

health journal. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7419458/

Prince, M. K. (2023, July 21). Substance use in pregnancy. StatPearls [Internet].

https://www.ncbi.nlm.nih.gov/books/NBK542330/
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Snoek, A., & Horstkötter, D. (2018, November). Ethical issues in research on substance-

dependent parents: The risk of implicit normative judgements by researchers. Bioethics.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6282773/

Terplan, M., Laird, H. J., Hand, D. J., Wright, T. E., Premkumar, A., Martin, C. E., Meyer, M.

C., Jones, H. E., & Krans, E. E. (2018, May). Opioid detoxification during pregnancy: A

systematic review. Obstetrics and gynecology.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6034119/

Weber, A., Miskle, B., Lynch, A., Arndt, S., & Acion, L. (2021, November 23). Substance use in

pregnancy: Identifying stigma and improving care. Substance abuse and rehabilitation.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8627324/