Children who are prenatally exposed to drugs are at risk for developing a series of health conditions, or physical or intellectual disabilities. Although the use of drugs by women who are pregnant is decreasing, the amount of use is still shocking and unacceptable. Research indicates that more than 5 percent of women use illicit drugs while pregnant; 15 percent of pregnant women ages 15 to 17 use or abuse illicit drugs. (Levine, Liu, Das, Lester, Lagasse, Shankaran, et al., 2008) Women of color and women from low income families are disproportionately more likely to use drugs than their white, upper class counterparts. Prevention outreach and awareness campaigns can help inform mothers that using substances during pregnancy can lead to a variety of issues, including maternal anxiety and depression, child development delays or disabilities, domestic violence, and suboptimal support for the children in a family. (Marques, Pokorni, Long, & Teti 2007). The developmental delays experienced by the children can include problems with motor skills, learning disabilities, and behavior problems.
Though drugs have clear negative effects on children and families, there is little research being done to identify promising practices implemented to prevent the use of drugs like cocaine, heroin, or prescription pills (http://www.drugabuse.gov/sites/default/files/prenatal.pdf).
during pregnancy. Researchers have focused more on alcohol use and tobacco as causes of Fetal Alcohol Spectrum Disorder (FASD), low birthweight, and other developmental issues. Slowly, researchers and policy-makers are prioritizing early intervention programs that support and empower women, especially young, low-income, women of color, to not use drugs, preventing their deleterious effects on the children. Recent studies have indicated that certain programs decrease the rate of substance abuse and strengthen indicators of academic success in children.
Several intervention projects are being implemented in our country’s most underserved and disadvantaged communities. These come in the form of community partnerships with private companies, medical services associated with hospitals and universities, state- and federally- funded programs through schools, and grassroots awareness campaigns from non-profit organizations. Each of these programs targets certain demographics of women and the specific issues that they face. These can greatly influence how a mother experiences her pregnancy and whether a child is exposed to drugs.
The Johns Hopkins School of Public Health
http://www.jhsph.edu/news/news-releases/2014/in-home-visits-reduce-drug-use-depression-in- pregnant-teens.html) released a report that highlighted an intervention framework that was implemented in an underserved American Indian community, and showed great promise. The Native American population is at high risk for substance abuse, especially alcohol abuse and the community has a high incidence of fetal alcohol syndrome. (http://www.drugabuse.gov/sites/default/files/prenatal.pdf) The program, “Family Spirit”, reaches out to young mothers-to-be, offering resources and services necessary to maintain a healthy pregnancy and raise healthy children. The program includes home-visiting by nurses and paraprofessionals using a curriculum designed specifically for the Native American population. Findings from a study of 322 expectant Native American teens indicated that many of the teens had experienced substance abuse, depressive symptoms, residential instability, and did not complete high school, all factors that can have a negative impact on a child. The nurses in the program worked very closely with the Family Spirit participants, sharing best practices for dieting and avoiding substances during pregnancy, as well as tips for breastfeeding, reading at night, and coping with stressful situations after the child is born. The nurses and paraprofessionals were also members of the American Indian community, making the initial trust-building a much smoother process. At the end of the three year study period, researchers concluded that the program decreased maternal depression and decreased the rate of illicit substance abuse. Based on these positive results, Family Spirit is now eligible for federal funding, and other communities are looking to replicate this program.
The Family Spirit program is just one example of what states can do to address substance abuse during pregnancy. Other institutions are coming together to brainstorm ways to sensitively confront mothers who are potentially engaging in dangerous behavior. A report presented at the National Abandoned Infants Assistance (AIA) Resource Center conference in California (2014) described how, four unique, federally-funded programs collaborated to identify common issues across states, share best strategies for policy implementation and service dissemination, and devise new ways to address issues of prenatal substance exposure in children. The conference presented approaches used to engage mothers in discussions on sensitive subjects like drug use and underlying problems. A referral flowchart was developed for primary care physicians to discuss with mothers the need for specialists or entering programs to decrease drug use and to access resources and information necessary for a healthy pregnancy and to avoid prenatal drug exposure in children.
The society, government, civil society, and communities should do more to encourage, incentivize, and reward programs that prioritize substance abuse during pregnancy. Ensuring that every mother can live in a drug-free and safe space is crucial to ensure that every child, regardless of ability or disability, can thrive.
Levine, T. P., Liu, J., Das, A., Lester, B., Lagasse, L., Shankaran, S., et al. (2008). Effects of prenatal cocaine exposure on special education in school-aged children. Pediatrics,122(1), e83-e91.
Marques, P. R., Pokorni, J. L., Long, T., & Teti, L. O. (2007). Maternal depression and cognitive features of 9-year-old children prenatally-exposed to cocaine. American Journal of Drug and Alcohol Abuse, 33(1), 45-61.
Olds, David et al. (2004). Effects of home visits by paraprofessionals and by nurses: Age 4 follow-up results of a randomized trial, Pediatrics, 114(6), 1560-1568.
Demographic and Psychosocial Characteristics of Substance-abusing Pregnant Women. National Center for Biotechnology Information. U.S. National Library of Medicine, 26
Mar. 1999. Web. 27 Jan. 2015. <http://www.ncbi.nlm.nih.gov/pubmed/10214543>.
Prenatal Exposure to Drugs of Abuse. National Institute on Drug Abuse, May 2011. Web. 27 Jan. 2015. <http://www.drugabuse.gov/sites/default/files/prenatal.pdf>.
Dan Silkman (GU ‘15)