Substance use and pregnancy: Fact or fiction?

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Is it ever safe to drink alcohol when breastfeeding? What are the risks to my baby if I smoke marijuana while carrying or breastfeeding? Is it safe for me to be on prescription medication while I’m pregnant?

Expectant mothers always have questions when they discover they are pregnant, but when the use of psychotropic medication and other substances are involved, it has always been hard to get clear answers. Until now.

A new manual published by the Centre for Addiction and Mental Health (CAMH) in partner ship with Motherisk entitled, Exposure to Psychotropic Medications and Other Substances during Pregnancy and Lactation, aims to help health care providers sort out the facts to help make better decisions for mother and baby.

Statistics show that 25 per cent of Canadians smoke, five per cent drink alcohol daily and 10 per cent report symptoms consistent with alcohol or illegal drug dependence. Many of the over 400,000 Canadian women each year who give birth may have used such substances before they knew they were pregnant. In addition, one study showed that 6.6 per cent of women between the ages of 15 and 45 were on an antidepressant during the year prior to conception.

These figures alone show that substance use, whether prescription, illicit or otherwise is a reality for many women. It is understandable how difficult it can be for an expectant mother to make the best choice.

While this manual discusses the use of antidepressants and pain medication – substances that people are more willing to accept – the guide also touches on illicit substances such as cocaine, club drugs and inhalants. Wende Wood, psychiatric pharmacist at CAMH and co-author of the manual, notes that although some topics may be controversial and hard to talk about, substance use in pregnant women is an issue that must be addressed.

She adds: “These issues are complicated and people don’t like to think women will use substances during pregnancy, but issues of addiction and other substance use are a reality. The good news is that service providers can now use this resource to help guide patients in reducing the harms associated with use.”

A lot of misinformation exists concerning drug use during pregnancy. Much of this information has been passed on to the general public through the media, well-meaning family and friends, and even health-care practitioners. Prior to the 1950s, it was thought that a pregnant woman developed a “placental barrier” through which nothing that would hurt the baby could pass. As a result, during that era, there was little concern over what a woman may be exposed to during pregnancy.

Then, the thalidomide tragedy occurred and the common belief, as often happens, swung to the other extreme. Today, it is widely believed that women should not be exposed to any medication or other substance while pregnant, as most substances can harm the fetus. Common sense should tell us, however, that the truth lies somewhere in-between.

Well known by many to be the leading preventable cause of neurodevelopmental deficits in Canada, alcohol was also thought to be harmful to the fetus during breastfeeding. This manual has developed an algorithm to calculate the amount of time needed between consuming alcohol and breastfeeding in order to avoid risks of passing alcohol onto the baby.

Medications such as antidepressants and antipsychotics had been long thought to have a negative effect on the fetus and many women have been inclined to discontinue use. Dr. Adrienne Einarson, Motherisk, says: “While it is always best to consult with your doctor, in general, if a woman is being treated successfully with pharmacotherapy for mental illness before she becomes pregnant, her treatment should continue throughout pregnancy as well. Untreated depression and other mental illnesses – regardless of the severity – can harm both the mother and her baby.”

The health care provider’s challenge is to know the true risks and benefits – to both the mother and her fetus or baby – of taking versus stopping the use of a medication or other substance. Yet the average health-care provider is not well equipped to give the best advice to women who are pregnant or breastfeeding and exposed to psychotropics. This manual will be available in this fall to help fill the gaps.

To receive a copy of the manual call CAMH publications at 1 800-661-1111 or visit www.camh.net/publications.