Addressing Perinatal Substance Use

Clinicians need guidance for screening, assessment and treatment of substance use in pregnancy. In this review, we examine the literature and current clinical practices that address substance use disorders in pregnant women. We provide current medication based treatment and psychosocial intervention options for alcohol, opioid, tobacco, cannabinoid and cocaine use disorders in pregnancy. Evidence supports using validated screening questionnaires, while toxicology testing has low sensitivity and is not an appropriate screen for substance use. While universal screening is recommended, clinicians must be aware of the legal implications of mandated reporting as a barrier to care for pregnant women seeking treatment for substance use disorder. Assessment requires full evaluations of psychiatric comorbidities as these are common and treatment of associated conditions improves recovery for pregnant women with substance use disorder. Trauma is associated with substance use in pregnancy and trauma-informed care mitigates risk to pregnant women. Research supports an increasing number of medication based treatment options for pregnant women with substance use disorder. Substance use in pregnancy is multifactorial and requires a comprehensive clinical approach that addresses trauma and comorbid psychiatric illness. The fear of legal repercussions that women experience when seeking substance use disorder treatment during pregnancy is a barrier to their recovery and care. Shared decisions making, a harm reduction approach, and trauma informed care work to address this barrier while legal advocacy can function to better protect women seeking treatment.