Guidelines for the treatment of substance use in pregnancy

March 2017
Burns L, Coleman-Cowger V and Breen C. (2016). Managing Maternal Substance Use in the Perinatal Period: Current concerns and treatment approaches in the United States and Australia. Substance Abuse: Research and Treatment.; 10(Suppl 1): 55–61. Published online 2016 Dec 8. doi: 10.4137/SART.S34558

Substance use in pregnancy can have adverse effects on mother and fetus alike. The authors draws together information from both the peer-reviewed and grey literature to provide a contemporary overview of patterns and outcomes of the three main drugs, alcohol, tobacco, and cannabis, used in Australia and the US during pregnancy to provide a concise summary of current guidelines for policy makers and practitioners who provide treatment for women who use substances in pregnancy.

Treatment: alcohol When substance use is severe, more intensive treatment is required. if For alcohol use disorders it may be necessary (where possible) to provide a supervised detoxification as a first-line approach, preferably as an inpatient as rapid detoxification can be fatal to mother and fetus.The recommended treatment is to focus on psychological and social approaches because most pharmacotherapies are contraindicated in pregnancy

Treatment: tobacco A stepped care approach to smoking cessation is advocated, including nicotine replacement therapy (NRT) when a pregnant woman is otherwise unable to quit. It is recommended that pregnant women who smoke use intermittent NRT formulations such as tablets and lozenges at the lowest possible dose rather than patches.

Treatment: cannabis All pregnant women should be offered support for cessation and relapse prevention at each antenatal visit. There is currently no gold standard treatment identified specifically for cannabis use during pregnancy. It is suggested that at the very least women should be offered a brief intervention including feedback on their cannabis use, education regarding the impact of cannabis use and their score on the SDS.