Addiction Treatment for Pregnant Women

Scope of Substance Use in Pregnancy: According to national survey data, approximately 5.4% of pregnant women report using illicit substances during pregnancy, and rates of alcohol and tobacco use are even higher. Opioid use in pregnancy has risen sharply over the past two decades, mirroring the broader opioid epidemic. These numbers likely underrepresent the true prevalence, as many women underreport substance use due to fear of legal consequences or losing custody of their children.

Substance use during pregnancy crosses all demographic lines. It affects women of every age, race, income level, and geographic region. Recognizing how widespread this issue is helps reduce the false assumption that it only happens in certain communities.

Risks to Mother and Baby: Continued substance use during pregnancy poses significant medical risks to both the mother and the developing baby. Maternal risks include placental abruption, preeclampsia, preterm labor, infectious disease transmission, nutritional deficiencies, and overdose death.

For the baby, risks vary by substance but may include:

• Premature birth and low birth weight
• Neonatal Abstinence Syndrome (NAS) — a withdrawal condition in newborns exposed to opioids in utero, requiring medical monitoring and sometimes extended hospital stays
• Birth defects and developmental delays
• Fetal alcohol spectrum disorders (FASDs) from alcohol exposure
• Stillbirth and sudden infant death syndrome (SIDS)
• Long-term neurodevelopmental and behavioral challenges

Importantly, the risks of untreated addiction during pregnancy are almost always greater than the risks of evidence-based treatment. Seeking help protects both mother and baby.

Barriers and Stigma: Pregnant women with substance use disorders face enormous barriers to accessing care. Stigma is the most pervasive — many women fear being judged by healthcare providers, reported to child protective services, or criminally prosecuted. These fears are not unfounded, as policies vary widely by state.

Other common barriers include:

• Lack of treatment programs that accept pregnant women
• Absence of childcare for existing children during treatment
• Transportation difficulties, especially in rural areas
• Co-occurring mental health conditions like depression and anxiety that go untreated
• Domestic violence or controlling partners who prevent access to care
• Financial constraints and lack of insurance coverage

A compassionate, non-punitive approach to care is essential. Research consistently shows that women who feel safe and supported are far more likely to engage in treatment and achieve positive outcomes for themselves and their babies.

Recognizing the Need for Help: Many pregnant women with substance use disorders recognize that they need help but feel trapped by their addiction. Warning signs that a pregnant woman may be struggling include missed prenatal appointments, reluctance to discuss substance use history with providers, expressing guilt or hopelessness about the pregnancy, or continuing to use substances despite a desire to stop.

If you are pregnant and using substances, know that reaching out for help is an act of courage and love for both yourself and your baby. Treatment works, and specialized programs exist to support you without judgment.

Medical Indicators: Healthcare providers may identify substance use through a combination of screening tools, clinical observation, and laboratory findings. Common medical indicators include:

• Late entry into prenatal care or irregular attendance
• Unexplained poor weight gain or nutritional deficiencies
• Signs of withdrawal such as tremors, sweating, or agitation
• Track marks, nasal irritation, or other physical signs of drug use
• Positive urine drug screens
• History of hepatitis C, HIV, or other infections associated with intravenous drug use
• Intrauterine growth restriction (IUGR) or other unexplained fetal complications

Universal screening — asking every pregnant woman about substance use in a non-judgmental way — is considered best practice. This approach reduces stigma and increases the likelihood that women will disclose and accept help.

Signs for Partners and Family Members: Loved ones are often the first to notice changes that may indicate substance use during pregnancy. Be aware of behavioral changes such as:

• Withdrawal from family and social activities
• Mood swings, irritability, or unexplained emotional outbursts
• Secretive behavior, unexplained absences, or financial problems
• Neglecting prenatal care or refusing to see a doctor
• Changes in sleep patterns, appetite, or personal hygiene
• Finding drug paraphernalia, empty bottles, or unfamiliar medications

If you suspect a loved one is struggling, approach the conversation with compassion rather than confrontation. Express concern for her well-being and the baby's health, and offer to help her find treatment designed for women. Avoid ultimatums or threats, which often push women further away from care.

Pre-Existing Substance Use Disorders: Many women who use substances during pregnancy had an active addiction before becoming pregnant. The pregnancy may have been unplanned, and stopping substance use abruptly can be medically dangerous — particularly with opioid dependence, where sudden withdrawal can cause miscarriage, preterm labor, or fetal distress.

For these women, pregnancy can be a powerful motivator for change, but the physical and psychological grip of addiction makes quitting without professional help extremely difficult and potentially harmful. Medically supervised treatment provides a safe pathway to stability.

Mental Health and Pregnancy: Co-occurring mental health conditions significantly increase the risk of substance use during pregnancy. Conditions such as depression, anxiety, post-traumatic stress disorder (PTSD), and bipolar disorder may worsen during pregnancy due to hormonal changes, life stressors, and the emotional weight of impending parenthood.

Women with a history of trauma — including childhood abuse, sexual assault, or domestic violence — are at particularly elevated risk. Substances may serve as a coping mechanism for unresolved pain. Effective treatment must address both the addiction and the underlying mental health conditions simultaneously through integrated care models.

Social Determinants of Health: Broader social and environmental factors play a significant role in substance use during pregnancy. These social determinants include:

• Poverty and housing instability
• Lack of health insurance or access to affordable healthcare
• Living in communities with high rates of substance availability
• Limited education and employment opportunities
• Intimate partner violence and lack of social support
• Intergenerational patterns of substance use within families
• Systemic racism and disparities in healthcare access and quality

Addressing these root causes requires a comprehensive approach that goes beyond treating the addiction itself. Programs that provide housing assistance, job training, legal advocacy, and family support services alongside clinical treatment tend to produce the best long-term outcomes for mothers and their children.

Medication-Assisted Treatment (MAT) During Pregnancy: For pregnant women with opioid use disorder, Medication-Assisted Treatment is the gold standard of care. Abruptly discontinuing opioids during pregnancy is dangerous and can lead to miscarriage, preterm labor, or fetal distress. MAT provides a safe, medically supervised alternative.

Buprenorphine (the active ingredient in Suboxone) is often the preferred medication for pregnant women. Research shows that buprenorphine is associated with lower rates of neonatal abstinence syndrome (NAS), shorter hospital stays for newborns, and higher birth weights compared to untreated opioid use. Methadone remains another well-established option with decades of safety data in pregnancy.

Both medications reduce cravings and withdrawal symptoms, allowing the mother to engage in prenatal care and focus on her health and her baby's development. Babies born to mothers on MAT may still experience mild NAS, but symptoms are typically manageable with medical support and are far less severe than those associated with continued illicit opioid use.

Behavioral Therapy: Cognitive-Behavioral Therapy (CBT) and other evidence-based behavioral therapies are safe and effective during pregnancy. These approaches help women identify triggers for substance use, develop healthy coping strategies, and address the emotional and psychological factors that contribute to addiction.

Additional therapeutic modalities that benefit pregnant women include:

• Motivational interviewing to strengthen commitment to change
• Contingency management programs that reinforce positive behaviors
• Trauma-informed therapy for women with histories of abuse or violence
• Group therapy with other pregnant or parenting women in recovery
• Mindfulness-based stress reduction techniques

The most effective programs combine behavioral therapy with medication (when appropriate) and integrate prenatal care into the treatment plan.

Integrated Prenatal Care: Best outcomes for mother and baby occur when addiction treatment and prenatal care are fully integrated. This means OB-GYN providers, addiction medicine specialists, mental health clinicians, and social workers collaborate as a unified care team.

Integrated prenatal programs typically provide:

• Regular prenatal checkups, ultrasounds, and fetal monitoring
• Nutritional counseling and supplementation for healthy fetal development
• Screening and treatment for infectious diseases (hepatitis C, HIV)
• Coordination of medication management between providers
• Birth planning that accounts for the mother's recovery needs
• Lactation support and guidance on breastfeeding while on MAT

This model of care reduces the number of appointments women must attend at different locations, removes barriers to compliance, and ensures that no aspect of the mother's or baby's health falls through the cracks.

Postpartum Support and Continuing Care: The postpartum period is a particularly vulnerable time for relapse. Hormonal shifts, sleep deprivation, the stress of caring for a newborn, and potential complications like postpartum depression all increase the risk of returning to substance use.

Comprehensive postpartum care for women in recovery includes:

• Continued MAT or medication management without interruption
• Screening and treatment for postpartum depression and anxiety
• Parenting support and infant bonding programs
• Peer recovery support from other mothers in recovery
• Childcare assistance to allow continued participation in treatment
• Long-term recovery planning and relapse prevention strategies

Maintaining continuity of care from pregnancy through the postpartum period and beyond is critical. Women who remain engaged in treatment after delivery have significantly better outcomes for both their own recovery and their children's development.

Residential Treatment for Pregnant Women: Residential treatment provides 24-hour structured care in a safe, substance-free environment. For pregnant women with severe addictions, unstable living situations, or co-occurring disorders, residential programs offer the highest level of support.

Pregnancy-specific residential programs typically include:

• On-site or closely coordinated prenatal medical care
• MAT management with daily medication supervision
• Individual and group therapy sessions
• Nutrition planning, prenatal fitness, and wellness activities
• Parenting classes and preparation for life with a newborn
• Case management for housing, legal issues, and benefits enrollment
• Accommodation for existing children in some programs

Many residential programs allow women to stay through delivery and into the early postpartum period, providing a stable environment during the most critical transition. This continuity of care significantly reduces the risk of relapse and supports healthy mother-infant bonding.

Outpatient Treatment for Pregnant Women: Intensive outpatient programs (IOP) and standard outpatient treatment allow pregnant women to receive care while maintaining their daily responsibilities, including work, caring for other children, and attending prenatal appointments.

Outpatient options for pregnant women typically include:

• Regular MAT appointments with medication management
• Individual counseling sessions focused on recovery and pregnancy
• Group therapy with other pregnant or parenting women
• Coordination with the woman's OB-GYN or midwife
• Drug screening to support accountability
• Referrals to community resources for housing, food, and transportation

Outpatient care is appropriate for women with stable housing, a supportive home environment, and mild to moderate substance use disorders. For women who need more structure, intensive outpatient programs provide multiple sessions per week while still allowing them to return home each evening. The flexibility of outpatient care makes it an important option for continuing treatment through the postpartum period and beyond.