Substance Use in Women Raises Reproductive Health Risks

Pregnancy and substance use clearly do not mix, and the Workshop “Women and Substance Use: Emerging Research and Clinical Topics,” shines the spotlight on this issue from 3 to 5 p.m. today in Rooms 204-205.

The workshop, led by Catherine Friedman, M.D., provides a review of contemporary topics of clinical and research interest related to this segment of the addiction community. Dr. Friedman is Assistant Clinical Professor in the Department of Psychiatry and Human Behavior at Alpert Medical School of Brown University, and Attending Psychiatrist at the Center for Women’s Behavioral Health, Women and Infants Hospital, Providence, RI. She notes that pregnancy and prevention among women diagnosed with substance use disorders is a chief concern of addiction specialists, as well as primary care physicians who treat women and children.

“Nationwide, more than 7,000 babies are born to opioid-dependent women each year. And in many localities, this number is increasing,” Dr. Friedman says. “For example, at Magee Hospital in Pittsburgh, 176 babies were born to opioid-dependent women in 2009, and that’s up from 25 babies in 2002.”

The workshop will feature presentations on “Reproductive Counseling as a Prevention Tool in Substance Abuse Treatment,” “Integrating SBIRT into Prenatal Care,” “Methamphetamine and Pregnancy,” “Methadone Induction in Pregnancy—Inpatient vs. Outpatient,” and “A Comprehensive Women-Centered Approach to Reducing Drug Use and Preventing HIV: Emerging Evidence from a Southern-African Intervention for Methamphetamine-Addicted Pregnant Women.” This last presentation, she notes, is a substitution for another topic previously listed in ASAM’s conference materials.

During the session, Dr. Friedman will discuss the benefits and drawbacks of methadone induction in pregnancy in both the inpatient and outpatient settings, as well as the systemic difficulties in implementing changes in local practice. In various states, she says, custom and availability of services dictates whether a pregnant woman is started on methadone on an inpatient or outpatient basis. Little research exists on which setting is the better option.

“Both the stage of pregnancy and social factors likely influence the optimal setting for methadone induction during pregnancy, and this may vary from woman to woman,” Dr. Friedman says. “But there are options to introduce both inpatient and outpatient induction, even in settings where only one option currently exists.”

In her presentation, “Reproductive Counseling as a Prevention Tool in Substance Abuse Treatment,” Jacquelyn Starer, M.D., FACOG, FASAM, will discuss dual prevention strategies to reduce the number of drug-exposed pregnancies by focusing on pregnancy planning in addition to screening and treatment of substance use disorders in women of reproductive age.

“The most important takeaway from this is to understand that a thorough reproductive history and reproductive counseling in treatment settings is a critical tool to prevent unplanned pregnancies in women with substance use disorders,” Dr. Starer says. “Reproductive issues are the primary concern of young women. If not properly counseled, an unplanned pregnancy can negatively impact the woman’s recovery and harm the fetus.”

Dr. Starer is Chair of ASAM’s Women and Substance Use Disorders Action Group, Coordinator of the Division of Opioid Dependent Pregnant Women at Community Substance Abuse Centers in Chelsea, Mass., and Associate Attending Physician at Faulkner Hospital Addiction Recovery Program in Boston. The Women and Substance Use Disorders Action Group has accomplished much during the last year, including the development of joint publication with the American Congress of Obstetricians and Gynecologists (ACOG) on opioid abuse, dependence, and addiction during pregnancy.

“We are delighted to have partnered with ACOG to create the Joint Committee Opinion, ‘Opioid Abuse, Dependence, and Addiction In Pregnancy,’ and we expect that the Committee Opinion will have a great impact on the care for pregnant women suffering from addiction when its released later this month.”

In all, Dr. Friedman says she hopes the workshop will expand the health care community’s discussion of substance use in women and how it is complicated by pregnancy and potential pregnancy.

“There are many compelling, unanswered clinical and research questions on how best to evaluate and treat reproductive-age or pregnant women who use substances,” she says. “Social and political factors also affect the care available to this population.”