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Substance Use and Pregnancy

Numbers to call for help with substance use:
  • MOMS Helpline: 844-624-6667 (M-F, 7:30 a.m. - 5 p.m. EST). Access MOMS Helpline by text message at 844-666-7898 (844-MOMS-TXT) for English and 844-737-6262 (844-SER-MAMA) for Spanish.
  • Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline: 800-662-4357 (24/7)
  • National Council on Alcoholism and Drug Dependence (NCADD) Hope Line: 800-622-2255 (24/7)
  • U.S. Department of Veterans Affairs Veterans Crisis Line: 800-273-8255 (24/7)

Substance use and pregnancy

If you are pregnant and you use drugs, tobacco, alcohol or caffeine, so does your baby. What you eat, drink or use passes on to your child through the placenta. Babies do not process substances the same way adults do.

ALWAYS ASK YOUR HEALTH CARE PROVIDER if it’s safe to use any drug, medication, over-the-counter medicine, vitamin or home remedy. Your doctor may change your prescriptions while you are pregnant.

Risks of taking drugs not recommended by your doctor include:

Risks to the babyRisks to the mother
Miscarriage and stillbirthDeath (maternal mortality)
Abnormalities of the placentaAddiction
Premature labor Heart attack 
Fetal Alcohol Spectrum Disorders (FASD)Respiratory failure
Neonatal Abstinence Syndrome (NAS)Stroke
Sudden Infant Death Syndrome (SIDS)Seizure
Small head circumference 
Low birth weight 
Development and behavioral problems 

Common questions about substance use and pregnancy

Q. I used drugs before I knew I was pregnant. I’m afraid it will affect my baby. What should I do?
A. Be honest with your healthcare provider. The earlier you talk about it, the better chance you and your baby have for a healthy pregnancy and delivery. If you don’t have a doctor or healthcare provider, call toll free 844-624-6667 for referrals to doctors and providers near you.

Q. If I go to the doctor, will I be tested to see if I’m taking drugs?
A. In Indiana, the law requires healthcare providers to ask all pregnant women questions about substance use. Some providers might even do urine screening. The intention of the law is that doctors will be able to provide early treatment for complications from drug use. The healthcare provider may not report the results of a positive screen to law enforcement or the Department of Child Services (DCS) unless they have the patient’s written consent or a court order or see other signs of crime or child abuse. For more about verbal screening in Indiana, go here.

Q. Can I take methadone or buprenorphine (Suboxone) as part of medication-assisted treatment (MAT) while I’m pregnant?
A. In most cases, yes. The American College of Obstetricians and Gynecologists (ACOG) recommends methadone or buprenorphine combined with counseling for opioid dependent pregnant women. This treatment has been prescribed for decades. As long as the patient does not have a setback and take drugs, MAT is safe during pregnancy.

Q. What about my prescription medicine? Can I take that while I’m pregnant?
A. Possibly. Always ask your doctor before taking any medicine whether prescription or over-the-counter. This includes vitamins, supplements and home remedies.

Q. Can I use CBD (cannabidiol oil) while pregnant?
A. CBD oil is a hemp-derived substance often taken by pregnant women for relief of various pregnancy symptoms like backaches, morning sickness, stress and chronic pain. There is little research on the effects of taking CBD oil during pregnancy. Because it is not regulated by the U.S. Food and Drug Administration (FDA), CBD oil may contain some amount of THC. The American College of Obstetricians and Gynecologists (ACOG) advises against using any form of marijuana while pregnant. If you are using CBD oil, talk to your healthcare provider about whether or not to continue.

Q. Are antidepressants safe for pregnant women to take?
A. Talk to your doctor or healthcare provider if you are taking antidepressants and are pregnant. Treating pregnant patients with antidepressants is complicated. Your provider will weigh the benefits versus the risks to you and your baby. Treatment of depression is important for pregnant women. Untreated depression can threaten the woman’s health and her prenatal care. There is a small amount of evidence that some antidepressants can cause birth defects, such as heart problems in the fetus.

DO NOT just stop taking your medication unless directed to by your healthcare provider. Your provider may develop a plan specifically for you to reduce or stop medication safely and effectively. Managing your own medication can cause physical and/or mental health risks.

Q. How much alcohol is it safe to drink during pregnancy?
A. The U.S. Surgeon General recommends not drinking any alcohol while pregnant. Though some children appear to be unaffected by alcohol exposure, there is a risk that the baby can be born with Fetal Alcohol Spectrum Disorder (FASD).

Risks of drinking during pregnancy include:

To the babyTo the mother
MiscarriageHigh blood pressure
StillbirthBone loss
Lifelong physical and mental disabilities including:
Heart problems
Kidney and bone defects
Abnormal facial features
Small head size
Shorter than average height
Low body weight
Learning disabilities
Hyperactivity
Speech disabilities and more
Liver damage
 Kidney damage
 Weakened immune system

Q. What are the risks of smoking while pregnant?
A. Tobacco smoke can harm babies before and after they’re born. Smoking during pregnancy can damage the unborn baby’s lung and brain and may be linked to a higher risk of miscarriage. Carbon monoxide in tobacco smoke can keep the developing baby from getting enough oxygen. Tobacco smoke also contains other chemicals that can harm unborn babies. Mothers who smoke are more likely to deliver their babies early. Preterm delivery is a leading cause of death, disability and disease among newborns.

Risks of smoking during pregnancy include:

To the babyTo the mother
Low birth weightIncreased heart rate
Stunted growthIncreased blood pressure
Learning problemsSweating
Behavioral problemsNausea
Increased risk for addictionDiarrhea
Sudden Infant Death (SIDs)Lung damage
Ectopic (tubal) pregnancyIncreased risk of cancer

About commonly-used substances

Alcohol

Drinking during pregnancy runs the risk of developing Fetal Alcohol Spectrum Disorders (FASD). These disorders cannot be cured, but early prenatal treatment can be the difference between abnormal and healthy development of your baby.

Tobacco

Nicotine passes through the placenta of a pregnant woman and concentrates in high levels in the baby. The more tobacco a pregnant woman uses, the greater the chance and severity of health problems for her child. Vaping and smokeless tobacco (chewing tobacco, dissolvable tobacco products and snuff) are also unsafe during pregnancy. If you use tobacco and want to quit, call the Indiana QUIT Line at 1-800-QUIT NOW or visit online.

NOTE: It is unsafe for an infant to breathe tobacco smoke in the air once mom and dad take their baby home.

Marijuana

The chemical in marijuana that creates the feeling of being high is THC. It and other chemicals in the drug pass through the placenta to the baby. Studies show a high incidence of users combining marijuana with other drugs, alcohol, and tobacco. Consuming marijuana while pregnant increases the risk of several health problems for both mother and baby.

Cocaine

Cocaine can cause a pregnant woman to miscarry or hemorrhage and go into labor early because the drug can make the uterus contract. Risks to the mother include weight loss, heart attack, stroke, respiratory failure and infections from shared needles. The baby may suffer placental abruption, low birth weight, small head circumference, premature birth, or development and behavioral problems.

Opioids

Pregnant women who use heroin, oxycodone, hydrocodone or codeine are likely to have babies with Neonatal Abstinence Syndrome (NAS). A baby born with NAS suffers withdrawal after birth. NAS children also have high rates of Sudden Infant Death Syndrome (SIDS). These are infant deaths that occur while the baby is sleeping. Women who use or are dependent on opioids should not attempt to quit on their own. Instead, they should work with their doctor to develop treatment plans.

Amphetamines

On the street, amphetamines can take the form of methamphetamine and crystal meth or a number of other substances. They are also found in prescription drugs and over-the-counter medications. There is little research on the effects of amphetamines on pregnancy, but there are studies that show women who use amphetamines during pregnancy suffer a variety of health problems at higher than normal rates.

Inhalants

These are often used in conjunction with other drugs, so it’s difficult for researchers to link inhalants with specific birth defects. However, animal studies have shown that the drugs are linked to a variety of birth defects and health disorders for mom and baby.

Helpful Links

ISDH Overdose Prevention

ISDH Medication-Assisted Treatment

ISDH Treating Opioid Use Disorder During Pregnancy

American Pregnancy Association Use of Illegal Drugs During Pregnancy

Centers for Disease Control and Prevention (CDC) Substance Use During Pregnancy

National Institutes for Health (NIH) Substance Use While Pregnant and Breastfeeding

Liv Pregnancy Mobile App and Website

Perinatal Substance Use Practice Bundle