Screening and Management of Substance Use in Pregnancy: A Review


      Substance use during pregnancy has important implications for health care providers, policy makers, and can negatively impact a woman's health and the health of her children. Understanding trends, patterns of use and outcomes are critical to prevention campaigns, building awareness, and providing effective care. This review will discuss the current therapeutic approaches and recommendations for screening and patient management for substance use in pregnancy and during the postpartum period, and it is geared towards any care providers who care for patients or those who may care for patients who may be at risk for substance use during pregnancy.


      La consommation de substances psychoactives pendant la grossesse est un facteur important dont doivent tenir compte les fournisseurs de soins de santé et les décideurs, car elle peut affecter la santé de la mère et de ses enfants. Il est essentiel de comprendre les tendances ainsi que les habitudes de consommation et leurs conséquences pour mettre sur pied des campagnes de prévention, sensibiliser la population et offrir des soins efficaces. Cette revue, qui aborde les approches thérapeutiques et les recommandations actuelles en matière de dépistage et de prise en charge de la consommation pendant et après la grossesse, s'adresse à tous les fournisseurs qui suivent ou pourraient suivre des patientes qui risquent de consommer pendant leur grossesse.

      Key Words


      BI (brief interventions), FASD (fetal alcohol spectrum disorder), NAS (neonatal abstinence syndrome), NRD (nicotine replacement therapy), OAT (opioid agonist treatment)
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        • Sokol R.J.
        • Martier S.S.
        • Ager J.W.
        The T-ACE questions: practical prenatal detection of risk-drinking.
        Am J Obstet Gynecol. 1989; 160 (discussion 868-70): 863-868
        • Chang G.
        Alcohol-screening instruments for pregnant women.
        Alcohol Res Health. 2001; 25: 204-209
        • Saunders J.B.
        • Aasland O.G.
        • Babor T.F.
        • et al.
        Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption–II.
        Addiction. 1993; 88: 791-804
        • Mayfield D.
        • McLeod G.
        • Hall P.
        The CAGE questionnaire: validation of a new alcoholism screening instrument.
        Am J Psychiatry. 1974; 131: 1121-1123
        • Ebrahim S.H.
        • Gfroerer J.
        Pregnancy-related substance use in the United States during 1996–1998.
        Obstet Gynecol. 2003; 101: 374-379
        • Crome I.B.
        • Ismail K.M.K.
        • Birnbach D.
        Substance misuse in pregnancy.
        in: Powrie M.F. Greene M.F. Camann W. de Swiet's medical disorders in obstetric practice. Wiley-Blackwell, West Sussex, UK2010: 477-504
        • Grekin E.R.
        • Svikis D.S.
        • Lam P.
        • et al.
        Drug use during pregnancy: validating the drug abuse screening test against physiological measures.
        Psychol Addict Behav. 2010; 24: 719-723
        • Bessa M.A.
        • Mitsuhiro S.S.
        • Chalem E.
        • et al.
        Underreporting of use of cocaine and marijuana during the third trimester of gestation among pregnant adolescents.
        Addict Behav. 2010; 35: 266-269
        • Yonkers K.A.
        • Howell H.B.
        • Gotman N.
        • et al.
        Self-report of illicit substance use versus urine toxicology results from at-risk pregnant women.
        J Subst Use. 2011; 16: 372-389
        • Cook J.L.
        • Green C.R.
        • Lilley C.M.
        • et al.
        Fetal alcohol spectrum disorder: a guideline for diagnosis across the lifespan.
        CMAJ. 2016; 188: 191-197
        • Keegan J.
        • Parva M.
        • Finnegan M.
        • et al.
        Addiction in pregnancy.
        J Addict Dis. 2010; 29: 175-191
        • ACOG Committee on Health Care for Underserved Women
        • American Society of Addiction Medicine.
        ACOG committee opinion No. 524: opioid abuse, dependence, and addiction in pregnancy.
        Obstet Gynecol. 2012; 119: 1070-1076
        • American College of Obstetricians and Gynecologists Committee on Health Care for Underserved Women
        ACOG committee opinion no. 473: substance abuse reporting and pregnancy: the role of the obstetrician-gynecologist.
        Obstet Gynecol. 2011; 117: 200-201
        • National Institute on Drug Abuse
        Cocaine: Abuse and addiction [NIDA Research Report Series, NIH Publication No. 10–4166].
        • Bhuvaneswar C.G.
        • Chang G.
        • Epstein L.A.
        • et al.
        Cocaine and opioid use during pregnancy: prevalence and management.
        Prim Care Companion J Clin Psychiatry. 2008; 10: 59-65
        • Simpson T.L.
        • Miller W.R.
        Concomitance between childhood sexual and physical abuse and substance use problems. A review.
        Clin Psychol Rev. 2002; 22: 27-77
        • Alto W.A.
        • O'Connor A.B.
        Management of women treated with buprenorphine during pregnancy.
        Am J Obstet Gynecol. 2011; 205: 302-308
        • Astley S.J.
        • Bailey D.
        • Talbot C.
        • et al.
        Fetal alcohol syndrome (FAS) primary prevention through FAS diagnosis: I. Identification of high-risk birth mothers through the diagnosis of their children.
        Alcohol Alcohol. 2000; 35: 499-508
        • Streissguth A.P.
        • Bookstein F.L.
        • Barr H.M.
        • et al.
        Risk factors for adverse life outcomes in fetal alcohol syndrome and fetal alcohol effects.
        J Dev Behav Pediatr. 2004; 25: 228-238
        • Peterson K.
        Biomarkers for alcohol use and abuse–a summary.
        Alcohol Res Health. 2004; 28: 30-37
        • Bager H.
        • Christensen L.P.
        • Husby S.
        • et al.
        Biomarkers for the detection of prenatal alcohol exposure: a review.
        Alcohol Clin Exp Res. 2017; 41: 251-261
        • Wright T.E.
        Biochemical screening for in utero drug exposure.
        Drug Metab Lett. 2015; 9: 65-71
        • Markovic N.
        • Ness R.B.
        • Cefilli D.
        • et al.
        Substance use measures among women in early pregnancy.
        Am J Obstet Gynecol. 2000; 183: 627-632
        • Sanaullah F.
        • Gillian M.
        • Lavin T.
        Screening of substance misuse during early pregnancy in Blyth: an anonymous unlinked study.
        J Obstet Gynaecol. 2006; 26: 187-190
        • Huestis M.A.
        • Choo R.E.
        Drug abuse's smallest victims: in utero drug exposure.
        Forensic Sci Int. 2002; 128: 20-30
        • Yonkers K.
        • Little B.
        Management of psychiatric disorders in pregnancy.
        Arnold Publishers, London, England2001
        • Ostrea Jr, E.M.
        • Knapp D.K.
        • Tannenbaum L.
        • et al.
        Estimates of illicit drug use during pregnancy by maternal interview, hair analysis, and meconium analysis.
        J Pediatr. 2001; 138: 344-348
        • Strano-Rossi S.
        • Chiarotti M.
        Solid-phase microextraction for cannabinoids analysis in hair and its possible application to other drugs.
        J Anal Toxicol. 1999; 23: 7-10
        • Poole N.
        • Dell C.A.
        Girls, women and substance use.
        (Ottawa, ON)2005
        • Sarkar M.
        • Burnett M.
        • Carriere S.
        • et al.
        Screening and recording of alcohol use among women of child-bearing age and pregnant women.
        Can J Clin Pharmacol. 2009; 16: e242-e263
        • Greaves L.
        • Poole N.
        Victimized or validated? Responses to substance-using pregnant women.
        Can Woman Stud. 2004; 24: 87-92
        • Rutman D.
        • Callahan M.
        • Lundquist A.
        • et al.
        Substance use and pregnancy: Conceiving women in the policy-making process.
        (Ottawa, ON)2000
        • Silva S.A.
        • Pires A.P.
        • Guerreiro C.
        • et al.
        Balancing motherhood and drug addiction: the transition to parenthood of addicted mothers.
        J Health Psychol. 2013; 18: 359-367
        • Stone R.
        Pregnant women and substance use: fear, stigma, and barriers to care.
        Health Justice. 2015; 3
        • Finnegan L.
        Substance abuse in Canada. Licit and illicit drug use during pregnancy: Maternal, neonatal and early childhood consequences.
        (Ottawa, ON)2013
        • Eggertson L.
        Stigma a major barrier to treatment for pregnant women with addictions.
        CMAJ. 2013; 185: 1562
        • Richardson J.
        • Fendrich M.
        • Johnson T.P.
        Neighborhood effects on drug reporting.
        Addiction. 2003; 98: 1705-1711
        • Annas G.J.
        Testing poor pregnant patients for cocaine–physicians as police investigators.
        N Engl J Med. 2001; 344: 1729-1732
        • McKnight S.
        • Coo H.
        • Davies G.
        • et al.
        Rooming-in for infants at risk of neonatal abstinence syndrome.
        Am J Perinatol. 2016; 33: 495-501
        • Abrahams R.R.
        • Kelly S.A.
        • Payne S.
        • et al.
        Rooming-in compared with standard care for newborns of mothers using methadone or heroin.
        Can Fam Physician. 2007; 53: 1722-1730
        • Ordean A.
        • Kahan M.
        • Graves L.
        • et al.
        Obstetrical and neonatal outcomes of methadone-maintained pregnant women: a canadian multisite cohort study.
        J Obstet Gynaecol Can. 2015; 37: 252-257
        • Graves L.E.
        • Turner S.
        • Nader M.
        • et al.
        Breastfeeding and opiate substitution therapy: starting to understand infant feeding choices.
        Subst Abuse. 2016; 10: 43-47
        • Niccols N.
        • Dell C.A.
        • Clarke S.
        Treatment issues for Aboriginal mothers with substance use problems and their children.
        Int J Ment Health Addict. 2010; 8: 320-335
        • Ries R.K.
        Principles of addiction medicine.
        5th ed. Wolters Kluwer Health, China2014
        • Stade B.C.
        • Bailey C.
        • Dzendoletas D.
        • et al.
        Psychological and/or educational interventions for reducing alcohol consumption in pregnant women and women planning pregnancy.
        Cochrane Database Syst Rev. 2009; (CD004228)
        • CAN-ADAPTT
        Canadian smoking cessation clinical practice guideline.
        (Toronto, ON)2011
        • WHO
        Recommendations for the prevention and management of tobacco use and second-hand smoke exposure in pregnancy.
        • Chamberlain C.
        • O'Mara-Eves A.
        • Oliver S.
        • et al.
        Psychosocial interventions for supporting women to stop smoking in pregnancy.
        Cochrane Database Syst Rev. 2013; (CD001055)
        • Terplan M.
        • Smith E.J.
        • Kozloski M.J.
        • et al.
        Methamphetamine use among pregnant women.
        Obstet Gynecol. 2009; 113: 1285-1291
        • Gates P.J.
        • Sabioni P.
        • Copeland J.
        • et al.
        Psychosocial interventions for cannabis use disorder.
        Cochrane Database Syst Rev. 2016; (CD005336)
        • Coleman T.
        • Chamberlain C.
        • Davey M.A.
        • et al.
        Pharmacological interventions for promoting smoking cessation during pregnancy.
        Cochrane Database Syst Rev. 2015; (CD010078)
        • Trivedi D.
        Cochrane review summary: pharmacological interventions for promoting smoking cessation during pregnancy.
        Prim Health Care Res Dev. 2013; 14: 327-329
        • WHO
        Guidelines for the identification and management of substance use and substance disorders in pregnancy.
        • CPSO
        Methadone maintenance treatment: Program standards and clinical guidelines.
        (4th Ed. Toronto, ON)2011
        • Jones H.E.
        • Kaltenbach K.
        • Heil S.H.
        • et al.
        Neonatal abstinence syndrome after methadone or buprenorphine exposure.
        N Engl J Med. 2010; 363: 2320-2331
        • Minozzi S.
        • Amato L.
        • Bellisario C.
        • et al.
        Maintenance agonist treatments for opiate-dependent pregnant women.
        Cochrane Database Syst Rev. 2013; (CD006318)
        • Brogly S.B.
        • Saia K.A.
        • Walley A.Y.
        • et al.
        Prenatal buprenorphine versus methadone exposure and neonatal outcomes: systematic review and meta- analysis.
        Am J Epidemiol. 2014; 180: 673-686
        • Wiegand S.L.
        • Stringer E.M.
        • Stuebe A.M.
        • et al.
        Buprenorphine and naloxone compared with methadone treatment in pregnancy.
        Obstet Gynecol. 2015; 125: 363-368
        • Debelak K.
        • Morrone W.R.
        • O'Grady K.E.
        • et al.
        Buprenorphine + naloxone in the treatment of opioid dependence during pregnancy-initial patient care and outcome data.
        Am J Addict. 2013; 22: 252-254
        • Jumah N.A.
        • Edwards C.
        • Balfour-Boehm J.
        • et al.
        Observational study of the safety of buprenorphine+naloxone in pregnancy in a rural and remote population.
        BMJ Open. 2016; 6: e011774
        • Dooley J.
        • Gerber-Finn L.
        • Antone I.
        • et al.
        Buprenorphine-naloxone use in pregnancy for treatment of opioid dependence: retrospective cohort study of 30 patients.
        Can Fam Physician. 2016; 62: e194-e200
        • Jumah N.A.
        • Graves L.
        • Kahan M.
        The management of opioid dependence during pregnancy in rural and remote settings.
        CMAJ. 2015; 187: e41-e46
        • Babor T.F.
        • Caetano R.
        • Casswell S.
        • et al.
        Alcohol: No Ordinary Commodity: Research and Public Policy: Oxford Scholarship.
        • Campbell C.A.
        • Hahn R.A.
        • Elder R.
        • et al.
        The effectiveness of limiting alcohol outlet density as a means of reducing excessive alcohol consumption and alcohol-related harms.
        Am J Prev Med. 2009; 37: 556-569
        • Novak S.P.
        • Reardon S.F.
        • Raudenbush S.W.
        • et al.
        Retail tobacco outlet density and youth cigarette smoking: a propensity-modeling approach.
        Am J Public Health. 2006; 96: 670-676
        • National Treatment Strategy Working Group
        A systems approach to substance use in Canada: Recommendations for a national treatment strategy: National Framework for Action to Reduce the Harms Associated with Alcohol and Other Drugs and Substances in Canada.