Substance abuse is one of the biggest public health problems across the world. Women are especially at risk of the substance abuse problem as statistics indicate that they have the highest risk of developing a substance use disorder in their productive years, particularly between 18 and 29 years. These statistics put pregnant women or the soon-to-be pregnant women at higher risk of substance abuse. Prenatal substance abuse can bring many deleterious consequences for the mother and the child, including the development of chronic diseases, such as cancer. Furthermore, the cost of managing substance abuse and the resulting consequences can be especially burdening to the family and health care system. APNs (advanced practice nurses) have specialty competencies with the potential to mitigate the advancement and consequences of substance abuse among pregnant women significantly. The competencies, therefore, call for more proactive action from APNs. APNs’ role is especially important, as abused substances put the life and health of the mother and the unborn child at risk, leading to high health care costs.
Substance use and abuse is a great problem among pregnant women. According to Kassada, Marcon, Pagliarnini, & Rossi (2013), there is an 18.23% prevalence rate of drug abuse among pregnant women, and while this rate is lower than that of non-pregnant women, it still raises concern. Lester, Andreozzi, and Appiah (2014) inform that cigarettes and alcohol have the highest rates of use among pregnant women at 17.6% and 13.8%, respectively. Illicit drugs and marijuana/hashish also account for a significant rate of abused substances at 3.4% and 2.9%, respectively (Lester et al., 2014). Cocaine, heroin, and methamphetamine are also among other substances abused at significant rates. The rates of use are also varied among different groups. In their study, Lester et al. (2014) found out that substance abuse, especially cocaine use, was high among poor women of color. The statistics were even worse for poor unmarried African American women.
One of the theories that explain drug use among the poor, who have a high prevalence rate in drug use, is the subcultural evolution theory. According to Golub, Johnson and Dunlap (2005), the theory argues that drug use emerges from an interaction between prevailing conditions and individual identity development. For most poor inner-city neighborhoods, poverty is a prevailing condition. Chein (1980) argues that a higher rate of drug use among pregnant women (and juveniles) is associated with the distribution of conditions of human misery, including poor quality housing and educational facilities in poor inner-city neighborhoods. People living in such neighborhoods experience discrimination and significant socioeconomic deprivation. Chein (1980) further posits that parents of children living in these socioeconomically deprived areas are almost always fatigued and preoccupied with the struggles and offer little guidance to their children. With an experience of substance use (having seen drug addicts and knowing the illegal and dangerous nature of drugs), people living in such neighborhoods still indulge in substance abuse, a fact that points to a poor attitude towards self, future, and society. For women in such conditions, therefore, substance abuse offers an escape from the reality of their deplorable living conditions, a habit that they continue with even during pregnancy.
The negative effects of substance abuse on pregnant women create significant concern. Substance abuse can cause debilitating consequences for not only the women but also the unborn children. Forray (2016) warns that heavy alcohol use during pregnancy is associated with adverse birth outcomes, including a heightened risk of miscarriage, stillbirth, and infant mortality. Other negative consequences of alcohol use during pregnancy include congenital anomalies, preterm delivery, small-for-gestational-age, low birth weight, and reduced gestational age (O’Leary, Jacoby, D’Antoine, Bartu, & Bower, 2012). Alcohol use is especially dangerous for the health of the fetus, as Forray (2016) explains that it has been established to be responsible for fetal alcohol spectrum disorder and adverse neurodevelopmental outcomes. Some of the effects develop later in the child’s life since prenatal alcohol use is associated with cognitive and behavioral challenges, negative language and speech outcomes, psychosocial challenges in adulthood, and deficits in executive functioning.
The effects of smoking are as adverse as prenatal alcohol use. Forray (2016) and Stone (2015) posit that smoking during pregnancy has negative effects on birth outcomes, such as damage to the umbilical cord structure, high risk of miscarriage, low birth weight, and placental abruption. Horne et al. (2014) also warn that prenatal smoking increases the risk of ectopic pregnancy. The effects of smoking go beyond the prenatal period to after birth, whereby second-hand smoke puts newborns at risk of contracting respiratory and ear infections, cognitive impairment, and behavioral dysfunction, as well as sudden death infant syndrome.
Cannabis use also has similar adverse effects on both the health of the mother and the child. Research shows a linkage between prenatal cannabis use and preterm labor, small-for-gestational-age, neonatal intensive care unit admission, and low birth weight (Forray, 2016). Along with the risk of clinical depression for the mother, cannabis use during pregnancy has negative consequences for the child, including stunted fetal growth and slow growth of adolescent brains, poor academic performance and achievement later in life, and low attention and executive functioning.
Part of the reason for the criminalization of cocaine use during pregnancy in some U.S. states is due to the deleterious effects on the child and the mother. Kassada et al. (2013), through their study of the prevalence of drug abuse among pregnant women, discovered that prenatal cocaine use has risk factors associated with it, including placental abruption, the premature rupture of membranes, and preterm birth. Their study also discovered long-term effects for the infant, including stifled cognitive, motor, and language development (Forray, 2016; Kassada et al., 2013). Both methamphetamine and heroin have similar effects on both the mother and the fetus, including developmental and behavioral defects, intrauterine fetal death, and gestational hypertension.
Aside from the clinical effects of substance abuse for the mother and the child, the economic cost of treatment calls for speedy intervention. Metz, Köchl, and Fischer (2012) inform that a multidisciplinary treatment of substance abuse among pregnant women costs about $46,000 a month. The treatment cost covers pharmacological, counseling, and psychiatric treatment. With a mean stay of 79 days in the hospital, it cost $69,200 for the treatment of opioid-exposed infants (Metz et l. 2012). Given the high risk of preterm births, it costs, even more, to care for the infants. Estimates indicate that it cost $102,452, $ 277,423, and $ 526,466 in health care expenditure for infants born 37 weeks, 33 weeks, and 28 weeks before gestation (Metz et al., 2012). These costs are too high for many, especially those from poor economic backgrounds.
The potentially debilitating effects of substance use to pregnant mothers and infants call for the advanced knowledge and qualification of APNs as intervening professionals. Certified nurse-midwives, for instance, with their competencies in providing prenatal care for mothers and babies, have a significant role to play in arresting prenatal substance use (Woo, Lee, & Tam, 2017). Through a multidisciplinary approach, certified nurse-midwives have the opportunity to provide pharmacological treatment to substance abuse addiction as well as refer the pregnant mothers to counseling programs focused on helping the mothers to overcome their addiction.
As primary care providers, nurse practitioners bring a lot of competencies in dealing with substance abuse among pregnant women. According to Woo et al. (2017), nurse practitioners’ role is to meet the primary care needs of underserved populations and provide continuity of care within the healthcare system by coordination care to patients’ needs. The bulk of pregnant women, as aforementioned, come from poor neighborhoods, which are traditionally underserved with health care facilities and personnel. Therefore, their role as primary care providers falls within the scope of dealing with these women, who are obviously in need of health care services.
Substance abuse remains one of the biggest public health problems in the world. It is an even urgent concern for pregnant women, given its prevalence, effects, and the cost of treatment and care for infants exposed to substance use. APNs, such as certified nurse-midwives and nurse practitioners, have advanced competencies in dealing with specific health issues in the healthcare setting. Their role and competencies equip them to deal with substance abuse among pregnant women better.
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Horne, A. W., Brown, J. K., Nio-Kobayashi, J., et al. (2014). The association between smoking and ectopic pregnancy: Why nicotine is bad for your fallopian tube. PLoS One, 9(2), e89400. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3930728/
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