Alcohol, other drugs and pregnancy

Alcohol and other drug (AOD) use have effects on sexual and reproductive health which can sometimes cause severe consequences. The mixed consumption patterns of drugs, especially the combination of nicotine, cocaine and alcohol, the use of heroin and medications including synthetic opioids and the growing frequency of new psychoactive drug use (NPS) in Europe makes it however often difficult to identify the primary substance and offer effective measures fast.

Problematic AOD use can decrease fertility indirectly by undermining both general health and nutrition of WUD, while heroin can affect fertility directly. The effects of heroin on menstruation and fertility are heightened by the associated chaotic lifestyle and poor nutrition. Drug use, and especially heroin use, can cause amenorrhea and anovulation, but not necessarily at the same time. Many women and even some service providers mistakenly assume that conception cannot occur in the absence of menstruation; this is not true and leads to unexpected, and very often unwanted, pregnancies.

Alcohol consumption during pregnancy is the most important and preventable cause of congenital malformations. It is not just intense alcohol consumption that causes this damage, it is now assured that even lower regular alcohol consumption or occasional drinking can lead to significant health problems in the unborn child. Any glass of alcohol that has not been drunk during pregnancy results in benefits for the child’s development.

Acute alcohol withdrawal can be fatal due to the possibility of severe vegetative symptoms. In pregnancy, alcohol withdrawal should only be performed under specialist medical supervision in an inpatient setting. A close observation with heart sounds control and ultrasound scans is essential and the process of withdrawals should be closely accompanied by psychosocial care and appropriate relapse prevention.

Pregnant women dependent on opioids should be encouraged to use opioid maintenance treatment whenever available rather than to attempt opioid detoxification. Opioid maintenance treatment in this context refers to either methadone- or buprenorphine maintenance treatment. Pregnant patients with opioid dependence who wish to undergo detoxification should be advised that relapse to illicit opioid use is more likely following medication- assisted withdrawal than while undertaking opioid maintenance treatment. Moreover, evidence does not support detoxification as a recommended treatment intervention as a result of low detoxification completion rates, high rates of relapse, and limited data regarding the effect of detoxification on maternal and neonatal outcomes beyond delivery.

There are no sufficient harm reduction strategies nor recommendations for pregnant women who use NPS; the chemical composition of substances appearing on the black market changes quickly, which makes it difficult to conduct research on the harm reduction response. However, the consumption of NPS in Hungary (cathinones) has been linked to a high frequency of use and chaotic lifestyle, which then has negative effects on the health for both women and their children.

WUD may be concerned about infertility and seek advice to restore their menstrual periods. The stabilization of AOD use and lifestyle habits may be sufficient to restore them.

It is important to provide women with free rapid tests for HIV and HCV and free pregnancy tests to make them aware of their infection status and start treatment as early as possible to prevent mother-to-child transmission. All pregnant women should be offered screening for blood-borne viruses (BBVs) and STIs; interventions to prevent mother to child transmission should be immediately offered in case of positive results. In case of positive results, good post-test counselling and support are essential, in order to make women aware of their condition and the related impact on their lives, and to ensure linkage to care and treatment to protect their health and prevent MTCT.

Free pregnancy tests available in HR services in Latvia increases early detection of pregnancy and brings important benefits:

• earlier referral for termination if pregnancy is unwanted;
• provision of effective contraception if WUD are not pregnant and do not want to conceive; and
• provision of pre-pregnancy care including prescription of folic acid to those women who are planning to become pregnant.