Improve Identification of Pregnant People at Risk

Key Information

Primary Prevention The implementation of thorough screening and education in primary care settings for all females of reproductive age, not just those who are currently pregnant, could drastically impact the occurrence of prenatal substance use. Since about half of all pregnancies are unplanned, many people could be using alcohol or other substances without knowing they are pregnant. Physicians can provide broad education on the risks of using substances and the possibility of unknowingly becoming pregnant while continuing to use. Early detection and intervention for substance use during childbearing age can offer an opportunity for people to take necessary precautions such as contraception or abstaining from substance use if there is a chance of becoming pregnant. Medical providers and public health officials can increase education about the effects of substances and the associated risks. Women, in general, have unique risks pertaining to alcohol, tobacco, and illicit substance use when compared to males. For example, the National Center for Addiction and Substance Abuse (CASA) reports the following facts for women when compared to men:

• Greater impairment after drinking the same amount of alcohol;
• Accelerated development of alcohol-related problems;
• Greater susceptibility to the development of alcohol-related medical disorders;
• Increased asthma attacks;
• Becoming addicted to nicotine at lower levels of use;
• Greater impairment of lung functioning;
• Greater difficulty quitting smoking;
• Greater susceptibility to brain damage from heavy use of Ecstasy;
• Greater likelihood of hospitalization from nonmedical use of pain medications;
• Moderate to heavy alcohol consumption increases risks for breast cancer;
• Increased risk of female infertility;

Along with all of these harmful impacts of substance use on women in general, substance use also places women of reproductive age at a heightened risk for unplanned pregnancy. Medical provider training and improved local support for prevention in this area could potentially reduce the number of people who knowingly or unknowingly become pregnant and expose their unborn children to substances. Physicians can also screen and empower people who use substances to seek treatment or take precautions so as to not become pregnant through the use of contraceptives.

Screening, Brief Intervention, and Referral to Treatment (SBIRT). Brief Screening consists of the provider asking a series of questions that can help to identify where patients fall along a continuum of substance use, not merely just “addicted” or “non-addicted.” SBIRT’s model of substance use has six categories:

• abstinence
• experimental use
• social use
• binge use
• abuse
• substance use disorder

The goal of SBIRT is to identify individuals who are unaware that their behaviors are putting them at risk for developing more serious issues. With feedback and support from medical providers, these individuals have the opportunity to make an informed decision and change their current behavior or to seek treatment if needed. If a patient is deemed “moderate” or “high risk” or having “problematic use” the provider can provide a brief intervention and referral for treatment. SBIRT can be implemented with minimal time and effort on behalf of the provider. The impact SBIRT has on the patient is invaluable and helps to connect patients who need education and referral to treatment.

Relevant Research

Who is at Risk?

Women who were exposed to adverse childhood experiences (ACEs) and are socioeconomically vulnerable have a greater risk of using illicit substances, tobacco, and alcohol. White pregnant people are more likely to use tobacco when compared to black and Hispanic populations. During pregnancy, Black people are more likely to use illicit substances when compared to Hispanics and white people. This data shows that prenatal substance use is present among multiple races and ethnicities. Therefore, medical providers and public health professionals should intervene by identifying all people at risk for developing or continuing substance use during pregnancy.

people with psychiatric comorbidities are at a higher risk of using multiple substances during pregnancy. A study on the results of the National Survey of Drug Use and Health (NSDUH) showed that people who experienced a major depressive episode within the last year were more likely to engage in alcohol and tobacco use during pregnancy when compared to pregnant people who abstained from substances. The study also found that environmental stressors and lack of consistent prenatal care were correlated with worsening maternal and fetal outcomes. The World Health Organization (WHO) recommends engaging people in prevention efforts to improve mental health before becoming pregnant since mental health issues are a risk factor for developing a substance use disorder.

Parent Impact and Involvement in Prevention

Parents play a vital role in preventing teen girls from unplanned pregnancies. Because teens are more likely to not notice that they are pregnant and much more likely to engage in risky behaviors such as substance use and binge drinking, parents should aim to educate their teens early. Parents can begin to talk with their children about not only the risks of substance use, but the risks of becoming pregnant, and how to prevent unwanted pregnancy. SAMHSA reports that most pregnant teens used marijuana and drank alcohol more frequently than other substances before pregnancy. Experts believe that this trend exists because teens have a misconception that there are fewer risks involved when choosing to use these substances compared to other illicit drugs. It may be beneficial to increase prevention and intervention strategies for these particular substances among teens. Public health campaigns can begin to highlight the direct and indirect consequences of use, such as criminal justice involvement, unwanted pregnancy, addiction, and greater risk of exposure to sexually transmitted diseases.