Models of intervention and care for psychostimulant users, 2nd edition - monograph series no. 51

Part III: Management of the pregnant and lactating psychostimulant user

Page last updated: April 2004

Psychostimulant use during pregnancy is part of a spectrum of complex, high-risk behaviours that have been reported to result in significantly increased complications for both the mother and infant. Even though questions remain about the impact of psychostimulants on the developing foetus or lactating neonate, psychostimulant use during pregnancy may be a marker for subsequent risk of poor child health or impaired care giving. Psychostimulant use during pregnancy may be associated with poor nutrition, poorer socio-demographic characteristics (Savitz et al., 2002), higher rates of both licit and illicit substance use (Bada et al., 2002), less involvement in antenatal care and increased likelihood of being victims of violence (Bauer et al., 2002). These factors (especially smoking, alcohol use and low folate intake) may be more strongly associated with poor pregnancy outcomes than the pharmacological effects of psychostimulants alone.

Management strategies should address both psychostimulant use and the associated risk factors. Pregnant women and mothers who use psychostimulants should be encouraged to seek pre, peri and postnatal care; such care has been shown to optimise infant outcome (Racine et al., 1993).

Non-judgmental environments are essential to ensure disclosure of psychostimulant or other drug use and maintain involvement with antenatal and postnatal care. If mothers perceive that they are likely to have their infants removed, then many will either avoid antenatal care altogether or attend but conceal their drug use (Cairns, 2001). Cairns suggests that the goals of antenatal care are to engage the family, stabilise the mother's drug use, assess other areas such as nutrition, poverty, infection, housing and home environment and to educate the mother.

It has been observed (Corse, 1998) that reductions in substance use are less likely to occur if a women enters prenatal care late in her pregnancy and thus there is an important role for encouraging pregnant substance users to seek prenatal care early in their pregnancy. Prenatal care is important; however, it is equally important to continue provision of care and support throughout the postnatal period. This area is not well addressed by the literature.

Psychostimulants do pass into breast milk. The decision to engage in or avoid breast-feeding should be influenced by an individual's pattern of drug use. It is prudent to avoid breast-feeding during periods of heavy psychostimulant use. If use occurs once daily or less frequently, it may be possible to minimise the infant's drug exposure by breast-feeding away from the time of peak milk levels. Patient factors such as personal preferences or presence of a chaotic lifestyle should be considered in clinical decision-making.