Substance Abuse among Pregnant Women on the Rise During COVID-19

Key TakeawaysMany pregnant and postpartum women are engaging in unhealthy behaviors to cope with the stress of the pandemic—including drugs and alcohol.Right now, marijuana is the number one substance for which women seek treatment during pregnancy.The rise of telemedicine has created additional touchpoints for substance use treatment and prenatal care.

Key Takeaways

Many pregnant and postpartum women are engaging in unhealthy behaviors to cope with the stress of the pandemic—including drugs and alcohol.Right now, marijuana is the number one substance for which women seek treatment during pregnancy.The rise of telemedicine has created additional touchpoints for substance use treatment and prenatal care.

The number of people struggling with substance use disorders has gone up during COVID-19, and a new study out of Washington State University COVID‑19 Infant, Maternal, and Family Health Research Collaborative suggests pregnant women are included in this group.

Over the past year, Crystal Smith, PhD, an assistant research professor at Washington State University Elson S. Floyd College of Medicine, has been researching substance use in pregnant women and gathering insights directly from the women themselves about their experiences. Her preliminary findings illustrate that pregnant women didn’t suddenly become substance users to cope with a crisis—there’s more to it, often dating back to their pre-pregnancy mental state.

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“We found pre-COVID-19 reports of poorer mental health were significantly associated with the number of substances these women used to cope with the pandemic,” Smith tells Verywell. “Not surprisingly, elevated levels of stress and depressive symptoms and poorer mental health at the first time point during the COVID-19 pandemic were also significantly related to higher numbers of substances used at the second time point during the COVID-19 pandemic.”

Substance Use Disorders in Pregnancy

Asubstance use disorder, also known as drug addiction, is persistent drug use that leads to health problems and affects relationships at work, school or home. If a woman is pregnant, drug use can also affect her developing fetus.

The rate of substance use in pregnancy has increased significantly in the past decade—coinciding with the opioid epidemic.

According to Alta DeRoo, MD, FACOG, FASAM, an OBGYN and addiction medicine physician who is medical director of the three Better Ford Centers in California, the most common drugs pregnant women receive treatment for include alcohol, marijuana, methamphetamine, and opioids. “People are often self-medicating for their untreated mental illness,” she tells Verywell. “It’s a good thing to keep in mind when we think of the things that contribute to substance use.”

Alcohol

Most of the pregnant women DeRoo sees are struggling with alcohol addiction; most are young, white, and single with high school education. “We know 18–25-year-old women have the highest alcohol intake,” DeRoo says in reference to 2019 data from the Substance Abuse and Mental Health Services Administration (SAMHSA).“This is ripe childbearing age.”

Study: Who Is Drinking More Alcohol During COVID-19?

About 6–9% of babies born in the U.S. have FAS, according to the Centers for Disease Control and Prevention (CDC)—similar in prevalence to Trisonomy21 or Down Syndrome.

Marijuana

Right now, marijuana is the number one substance for which women seek treatment during pregnancy.DeRoo says this is likely due to its “perceived safety in pregnancy and the recent legalization trends of recreational use across many states.” A study published inMorbidity and Mortality Weekly Reportfound that more than 40% of women who were marijuana users before pregnancy continued to during pregnancy.

In 2019, the U.S. Food and Drug Administration issued a statement “strongly” advising women not to use cannabis in any form—including CBD—when pregnant or breastfeeding, because it may pose “serious risks.“For example, THC, the main psychoactive component of cannabis, crosses the placenta and can affect fetal brain development in the prefrontal cortex—resulting in problems with executive functioning as a child ages.There’s also evidence it can be passed through breast milk.

Research from the University of Colorado Anschutz Medical Campus also showed pregnant women who use cannabis are 50% more likely to have babies who weigh less at birth—regardless of maternal age, race, level of education, and tobacco use during pregnancy.

Unfortunately, many marijuana dispensaries continue to market their products to treat morning sickness and nausea in the first trimester. In fact, a researcher posing as a pregnant woman called 400 Colorado dispensaries asking about products for morning sickness; almost 70% recommended marijuana.

“In our past research on cannabis, we heard moms are getting their medical advice from budtenders at marijuana dispensaries instead of their healthcare provider,” Barbosa-Leiker says. “They see it as a safer alternative to smoking tobacco or drinking alcohol. Many also see it as the best form of medical management to work through trauma, stress, depression, bipolar disorder, or an unsafe relationship; it isn’t just for fun or out of boredom.”

Both the American Academy of Pediatrics (AAP)and the American College of Obstetricians and Gynecologists (ACOG)recommend women avoid using marijuana while trying to get pregnant, during pregnancy, and while they are breastfeeding.

Opioids

Since the start of the pandemic, the opioid epidemic has taken an increasing toll on pregnant women and infants nationwide—especially in parts of the Northwest.In West Virginia, 5% of infants born in the state were diagnosed with neonatal abstinence syndrome (NAS)/neonatal opioid withdrawal syndrome (NOWS) in 2017 and the percentage is expected to climb.

On March 3, 2021, the American Medical Association issued a brief reporting increases in opioid- and other drug-related overdoses during COVID-19.It says, “More than 40 states have reported increases in opioid-related mortality as well as ongoing concerns for those with a mental illness or substance use disorder.”

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Barbosa-Leiker says every pregnant woman with a substance use disorder her team has spoken with was using before pregnancy. “One woman told us she was taking ten ibuprofen a day to manage chronic pain after a car accident and then unexpectedly found out she was pregnant,” Barbosa-Leiker says.

What This Means For YouIf you or a loved one is pregnant or postpartum and struggling with substance use or addiction, help is available. Contact theSubstance Abuse and Mental Health Services Administration (SAMHSA) National Helplineat 1-800-662-4357 for information on support and treatment facilities in your area.

What This Means For You

If you or a loved one is pregnant or postpartum and struggling with substance use or addiction, help is available. Contact theSubstance Abuse and Mental Health Services Administration (SAMHSA) National Helplineat 1-800-662-4357 for information on support and treatment facilities in your area.

Rise in Telemedicine Creates Improved Access to Care

According to a recent study in theJournal of Substance Abuse Treatment, this new care delivery model may be another silver lining to come out of the pandemic as it’s provided the flexibility to have many more patient touchpoints.

A Phone Call a Day Can Reduce COVID-19 Loneliness

Future Interventions to Break the Cycle of Addiction

During the pandemic, DeRoo says many former Betty Ford Center patients have relapsed. “COVID provided a perfect environment of isolation and prevented the human connection that others need in recovery, however, we were able to keep our doors open to welcome back those in recovery,” DeRoo says. This cycle of addiction, she adds, can be broken for a new generation with education and outreach to children and parents—especially those who are at a higher risk. For the substance use disorder to develop, one needs exposure to that substance.

With 80% of teens saying their parents are the biggest influence on their decision to drink, according to the AAP, communication early and often about the dangers of substance use is essential.AAP recommends parents:

Whenever a healthcare provider is screening for substance use, Barbosa-Leiker stresses the importance of maintaining a caring and nonjudgmental attitude. “If a pregnant mother feels judged, she is more likely to avoid prenatal care altogether,” she says.

Smith recommends improved mental health programs during pregnancy and postpartum. “If we could tailor interventions to address increased stress and depression, we may also mitigate the emergence of greater substance use among pregnant women during a pandemic,” Smith says.

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit ourcoronavirus news page.

18 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Barbosa-Leiker C, Smith CL, Crespi EJ, etc.Stressors, coping, and resources needed during the COVID-19 pandemic in a sample of perinatal women.BMC Pregnancy Childbirth. 2021;21(1):171. doi: 10.1186/s12884-021-03665-0Ecker J, Abuhamad A, Hill W, et al.Substance use disorders in pregnancy: clinical, ethical, and research imperatives of the opioid epidemic: a report of a joint workshop of the Society for Maternal-Fetal Medicine, American College of Obstetricians and Gynecologists, and American Society of Addiction Medicine.Am J Obstet Gynecol.2019;221(1):B5-B28. doi: 10.1016/j.ajog.2019.03.022Substance Abuse and Mental Health Services Administration.2019 National Survey on Drug Use and Health: women.Centers for Disease Control and Prevention.Data and statistics: prevalence of FASDs.Martin CE, Longinaker N, Mark K, Chisolm MS, Terplan M.Recent trends in treatment admissions for marijuana use during pregnancy.J Addict Med. 2015 Mar-Apr;9(2):99-104. doi: 10.1097/ADM.0000000000000095.Ko JY, Coy KC, Haight SC, et al.Characteristics of marijuana use during pregnancy — eight states, Pregnancy Risk Assessment Monitoring System, 2017.MMWR Morb Mortal Wkly Rep. 2020;69:1058–1063. doi: 10.15585/mmwr.mm6932a2Food and Drug Administration.What you should know about using cannabis, including CBD, when pregnant or breastfeeding.Warner TD, Roussos-Ross D, Behnke M.It’s not your mother’s marijuana: effects on maternal-fetal health and the developing child.Clin Perinatol. 2014;41(4):877-894. doi:10.1016/j.clp.2014.08.009Crume TL, Juhl AL, Brooks-Russell A, Hall KE, Wymore E, Borgelt LM.Cannabis use during the perinatal period in a state with legalized recreational and medical marijuana: the association between maternal characteristics, breastfeeding patterns, and neonatal outcomes.J Pediatr.2018 Jun;197:90-96. doi: 10.1016/j.jpeds.2018.02.005Dickson B, Mansfield C, Guiahi M, et al.Recommendations from cannabis dispensaries about first-trimester cannabis use.Obstetrics & Gynecology. 2018;131(6):1031-1038. doi: 10.1097/AOG.0000000000002619Ryan SA, Ammerman SD, O’Connor ME; Committee on Substance Use and Prevention; Section on Breastfeeding.Marijuana use during pregnancy and breastfeeding: implications for neonatal and childhood outcomes.Pediatrics. 2018;142(3):e20181889. doi: 10.1542/peds.2018-1889American College of Obstetricians and Gynecologists.Committee opinion: marijuana use during pregnancy and lactation.Patrick SW, Barfield WD, Poindexter BB; Committee on Fetus and Newborn, Committee on Substance Use and Prevention.Neonatal opioid withdrawal syndrome.Pediatrics. 2020;146(5):e2020029074. doi: 10.1542/peds.2020-029074Umer A, Loudin S, Maxwell S, et al.Capturing the statewide incidence of neonatal abstinence syndrome in real time: the West Virginia experience.Pediatr Res. 2019;85(5):607-611. doi: 10.1038/s41390-018-0172-zAmerican Medical Association.Issue brief: Reports of increases in opioid- and other drug-related overdose and other concerns during COVID pandemic.American College of Obstetrics and Gynecologists.Committee Opinion: Opioid Use and Opioid Use Disorder in Pregnancy.Patton EW, Saia K, Stein MD.Integrated substance use and prenatal care delivery in the era of COVID-19.J Subst Abuse Treat.2021; 124:108273. doi: 10.1016/j.jsat.2020.108273.American Academy of Pediatrics.Why to have the alcohol talk early.

18 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Barbosa-Leiker C, Smith CL, Crespi EJ, etc.Stressors, coping, and resources needed during the COVID-19 pandemic in a sample of perinatal women.BMC Pregnancy Childbirth. 2021;21(1):171. doi: 10.1186/s12884-021-03665-0Ecker J, Abuhamad A, Hill W, et al.Substance use disorders in pregnancy: clinical, ethical, and research imperatives of the opioid epidemic: a report of a joint workshop of the Society for Maternal-Fetal Medicine, American College of Obstetricians and Gynecologists, and American Society of Addiction Medicine.Am J Obstet Gynecol.2019;221(1):B5-B28. doi: 10.1016/j.ajog.2019.03.022Substance Abuse and Mental Health Services Administration.2019 National Survey on Drug Use and Health: women.Centers for Disease Control and Prevention.Data and statistics: prevalence of FASDs.Martin CE, Longinaker N, Mark K, Chisolm MS, Terplan M.Recent trends in treatment admissions for marijuana use during pregnancy.J Addict Med. 2015 Mar-Apr;9(2):99-104. doi: 10.1097/ADM.0000000000000095.Ko JY, Coy KC, Haight SC, et al.Characteristics of marijuana use during pregnancy — eight states, Pregnancy Risk Assessment Monitoring System, 2017.MMWR Morb Mortal Wkly Rep. 2020;69:1058–1063. doi: 10.15585/mmwr.mm6932a2Food and Drug Administration.What you should know about using cannabis, including CBD, when pregnant or breastfeeding.Warner TD, Roussos-Ross D, Behnke M.It’s not your mother’s marijuana: effects on maternal-fetal health and the developing child.Clin Perinatol. 2014;41(4):877-894. doi:10.1016/j.clp.2014.08.009Crume TL, Juhl AL, Brooks-Russell A, Hall KE, Wymore E, Borgelt LM.Cannabis use during the perinatal period in a state with legalized recreational and medical marijuana: the association between maternal characteristics, breastfeeding patterns, and neonatal outcomes.J Pediatr.2018 Jun;197:90-96. doi: 10.1016/j.jpeds.2018.02.005Dickson B, Mansfield C, Guiahi M, et al.Recommendations from cannabis dispensaries about first-trimester cannabis use.Obstetrics & Gynecology. 2018;131(6):1031-1038. doi: 10.1097/AOG.0000000000002619Ryan SA, Ammerman SD, O’Connor ME; Committee on Substance Use and Prevention; Section on Breastfeeding.Marijuana use during pregnancy and breastfeeding: implications for neonatal and childhood outcomes.Pediatrics. 2018;142(3):e20181889. doi: 10.1542/peds.2018-1889American College of Obstetricians and Gynecologists.Committee opinion: marijuana use during pregnancy and lactation.Patrick SW, Barfield WD, Poindexter BB; Committee on Fetus and Newborn, Committee on Substance Use and Prevention.Neonatal opioid withdrawal syndrome.Pediatrics. 2020;146(5):e2020029074. doi: 10.1542/peds.2020-029074Umer A, Loudin S, Maxwell S, et al.Capturing the statewide incidence of neonatal abstinence syndrome in real time: the West Virginia experience.Pediatr Res. 2019;85(5):607-611. doi: 10.1038/s41390-018-0172-zAmerican Medical Association.Issue brief: Reports of increases in opioid- and other drug-related overdose and other concerns during COVID pandemic.American College of Obstetrics and Gynecologists.Committee Opinion: Opioid Use and Opioid Use Disorder in Pregnancy.Patton EW, Saia K, Stein MD.Integrated substance use and prenatal care delivery in the era of COVID-19.J Subst Abuse Treat.2021; 124:108273. doi: 10.1016/j.jsat.2020.108273.American Academy of Pediatrics.Why to have the alcohol talk early.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Barbosa-Leiker C, Smith CL, Crespi EJ, etc.Stressors, coping, and resources needed during the COVID-19 pandemic in a sample of perinatal women.BMC Pregnancy Childbirth. 2021;21(1):171. doi: 10.1186/s12884-021-03665-0Ecker J, Abuhamad A, Hill W, et al.Substance use disorders in pregnancy: clinical, ethical, and research imperatives of the opioid epidemic: a report of a joint workshop of the Society for Maternal-Fetal Medicine, American College of Obstetricians and Gynecologists, and American Society of Addiction Medicine.Am J Obstet Gynecol.2019;221(1):B5-B28. doi: 10.1016/j.ajog.2019.03.022Substance Abuse and Mental Health Services Administration.2019 National Survey on Drug Use and Health: women.Centers for Disease Control and Prevention.Data and statistics: prevalence of FASDs.Martin CE, Longinaker N, Mark K, Chisolm MS, Terplan M.Recent trends in treatment admissions for marijuana use during pregnancy.J Addict Med. 2015 Mar-Apr;9(2):99-104. doi: 10.1097/ADM.0000000000000095.Ko JY, Coy KC, Haight SC, et al.Characteristics of marijuana use during pregnancy — eight states, Pregnancy Risk Assessment Monitoring System, 2017.MMWR Morb Mortal Wkly Rep. 2020;69:1058–1063. doi: 10.15585/mmwr.mm6932a2Food and Drug Administration.What you should know about using cannabis, including CBD, when pregnant or breastfeeding.Warner TD, Roussos-Ross D, Behnke M.It’s not your mother’s marijuana: effects on maternal-fetal health and the developing child.Clin Perinatol. 2014;41(4):877-894. doi:10.1016/j.clp.2014.08.009Crume TL, Juhl AL, Brooks-Russell A, Hall KE, Wymore E, Borgelt LM.Cannabis use during the perinatal period in a state with legalized recreational and medical marijuana: the association between maternal characteristics, breastfeeding patterns, and neonatal outcomes.J Pediatr.2018 Jun;197:90-96. doi: 10.1016/j.jpeds.2018.02.005Dickson B, Mansfield C, Guiahi M, et al.Recommendations from cannabis dispensaries about first-trimester cannabis use.Obstetrics & Gynecology. 2018;131(6):1031-1038. doi: 10.1097/AOG.0000000000002619Ryan SA, Ammerman SD, O’Connor ME; Committee on Substance Use and Prevention; Section on Breastfeeding.Marijuana use during pregnancy and breastfeeding: implications for neonatal and childhood outcomes.Pediatrics. 2018;142(3):e20181889. doi: 10.1542/peds.2018-1889American College of Obstetricians and Gynecologists.Committee opinion: marijuana use during pregnancy and lactation.Patrick SW, Barfield WD, Poindexter BB; Committee on Fetus and Newborn, Committee on Substance Use and Prevention.Neonatal opioid withdrawal syndrome.Pediatrics. 2020;146(5):e2020029074. doi: 10.1542/peds.2020-029074Umer A, Loudin S, Maxwell S, et al.Capturing the statewide incidence of neonatal abstinence syndrome in real time: the West Virginia experience.Pediatr Res. 2019;85(5):607-611. doi: 10.1038/s41390-018-0172-zAmerican Medical Association.Issue brief: Reports of increases in opioid- and other drug-related overdose and other concerns during COVID pandemic.American College of Obstetrics and Gynecologists.Committee Opinion: Opioid Use and Opioid Use Disorder in Pregnancy.Patton EW, Saia K, Stein MD.Integrated substance use and prenatal care delivery in the era of COVID-19.J Subst Abuse Treat.2021; 124:108273. doi: 10.1016/j.jsat.2020.108273.American Academy of Pediatrics.Why to have the alcohol talk early.

Barbosa-Leiker C, Smith CL, Crespi EJ, etc.Stressors, coping, and resources needed during the COVID-19 pandemic in a sample of perinatal women.BMC Pregnancy Childbirth. 2021;21(1):171. doi: 10.1186/s12884-021-03665-0

Ecker J, Abuhamad A, Hill W, et al.Substance use disorders in pregnancy: clinical, ethical, and research imperatives of the opioid epidemic: a report of a joint workshop of the Society for Maternal-Fetal Medicine, American College of Obstetricians and Gynecologists, and American Society of Addiction Medicine.Am J Obstet Gynecol.2019;221(1):B5-B28. doi: 10.1016/j.ajog.2019.03.022

Substance Abuse and Mental Health Services Administration.2019 National Survey on Drug Use and Health: women.

Centers for Disease Control and Prevention.Data and statistics: prevalence of FASDs.

Martin CE, Longinaker N, Mark K, Chisolm MS, Terplan M.Recent trends in treatment admissions for marijuana use during pregnancy.J Addict Med. 2015 Mar-Apr;9(2):99-104. doi: 10.1097/ADM.0000000000000095.

Ko JY, Coy KC, Haight SC, et al.Characteristics of marijuana use during pregnancy — eight states, Pregnancy Risk Assessment Monitoring System, 2017.MMWR Morb Mortal Wkly Rep. 2020;69:1058–1063. doi: 10.15585/mmwr.mm6932a2

Food and Drug Administration.What you should know about using cannabis, including CBD, when pregnant or breastfeeding.

Warner TD, Roussos-Ross D, Behnke M.It’s not your mother’s marijuana: effects on maternal-fetal health and the developing child.Clin Perinatol. 2014;41(4):877-894. doi:10.1016/j.clp.2014.08.009

Crume TL, Juhl AL, Brooks-Russell A, Hall KE, Wymore E, Borgelt LM.Cannabis use during the perinatal period in a state with legalized recreational and medical marijuana: the association between maternal characteristics, breastfeeding patterns, and neonatal outcomes.J Pediatr.2018 Jun;197:90-96. doi: 10.1016/j.jpeds.2018.02.005

Dickson B, Mansfield C, Guiahi M, et al.Recommendations from cannabis dispensaries about first-trimester cannabis use.Obstetrics & Gynecology. 2018;131(6):1031-1038. doi: 10.1097/AOG.0000000000002619

Ryan SA, Ammerman SD, O’Connor ME; Committee on Substance Use and Prevention; Section on Breastfeeding.Marijuana use during pregnancy and breastfeeding: implications for neonatal and childhood outcomes.Pediatrics. 2018;142(3):e20181889. doi: 10.1542/peds.2018-1889

American College of Obstetricians and Gynecologists.Committee opinion: marijuana use during pregnancy and lactation.

Patrick SW, Barfield WD, Poindexter BB; Committee on Fetus and Newborn, Committee on Substance Use and Prevention.Neonatal opioid withdrawal syndrome.Pediatrics. 2020;146(5):e2020029074. doi: 10.1542/peds.2020-029074

Umer A, Loudin S, Maxwell S, et al.Capturing the statewide incidence of neonatal abstinence syndrome in real time: the West Virginia experience.Pediatr Res. 2019;85(5):607-611. doi: 10.1038/s41390-018-0172-z

American Medical Association.Issue brief: Reports of increases in opioid- and other drug-related overdose and other concerns during COVID pandemic.

American College of Obstetrics and Gynecologists.Committee Opinion: Opioid Use and Opioid Use Disorder in Pregnancy.

Patton EW, Saia K, Stein MD.Integrated substance use and prenatal care delivery in the era of COVID-19.J Subst Abuse Treat.2021; 124:108273. doi: 10.1016/j.jsat.2020.108273.

American Academy of Pediatrics.Why to have the alcohol talk early.

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