4. Illegal substance use during pregnancy: what do we know about risks and detoxification?

Substance use during pregnancy implies risks for both mother and child, depending mainly on the substance used and the intensity and chronicity of use. Detoxification of psychoactive substances in these specific pregnant populations should therefore carefully being considered based on the available literature of risks and benefits.

We here present an overview of the risks associated with illegal substance use during pregnancy, for the course of the pregnancy and for the child in the short and long term, based on data from meta-analyses and systematic reviews around the most used illicit substances (cannabis, cocaine, opiates, and amphetamines) published in the last 30 years, as well as the possibilities for detoxification of these substances during pregnancy.

Cocaine and amphetamines cause the greatest risk for placenta abruption, preterm birth and low birthweight. Cannabis causes maternal anemia and low birthweight. There was evidence of teratogenicity after prenatal exposure to opiates, as well as for a neonatal abstinence syndrome (NAS). For opioid use disorder in pregnancy, detoxification as well as maintenance treatment with methadone or buprenorphine can be considered.

Illicit substance use during pregnancy is associated with multiple risks but there are still some gaps in knowledge. Guidelines for treatment of illegal substances exist, and propose detoxification depending on the trimester and the substance abused. Psychoeducation concerning substance use during pregnancy combined with questioning about active use should be included in standard prenatal care.

Disclosure of interest: No funding and no pharmaceutical grants were received for this work.