Demographic and psychosocial characteristics of substance-abusing pregnant women

Women who abuse drugs and alcohol during pregnancy are an elusive population who often remain unidentified to practitioners and researchers and hence have not been well studied. In trying to understand better the characteristics of women who use drugs during pregnancy, the present article relies extensively on information gathered in studies of women in substance abuse treatment who, as epidemiologic studies show, may be more severely impaired than other substance-abusing women and, therefore, may not be typical of substance-abusing women identified in the course of obstetric practice. Yet, those pregnant women who are actually identified by medical providers as substance users are often those whose behavior raises concerns with health providers (such as presenting for labor having had no prenatal care) and thus also may represent only a relatively impaired group of substance-abusing women. The most objective picture available of the universe of women who use drugs during pregnancy comes from blinded urine toxicology screens conducted at samples of representative hospitals across states and across the country. The startling finding to emerge from these studies is that common perceptions of substance abuse as a problem of poor, ethnic minority, and young individuals is inaccurate and that this perception may all too often be acted on by medical providers in a prejudicial manner. These studies show similar rates of substance use during pregnancy by women of different racial, social class, and age categories. Demographic features are only related to type of substance used, with black women and poorer women more likely to use illicit substances, particularly cocaine, and white women and better educated women more likely to use alcohol, the substance whose teratogenic effects have been most clearly documented. Despite the even distribution of substance use across demographic categories, poor women and women of color are far more likely to be reported to health and child welfare authorities for use of substances during pregnancy than are other women, even when their base rates for use of illicit drugs are considered. Data from both epidemiologic studies and samples of women seeking treatment for substance abuse problems indicate that the lives of substance-abusing women are fraught with difficulties past and present. Substance-abusing women are likely to have been raised by parents who were substance abusers, particularly alcoholics. Although the intergenerational patterns of substance abuse may have some genetic basis, there is also ample evidence suggesting problematic relationships in families with a substance-abusing parent that raises concerns about intergenerational transmission of problematic parenting behavior. Perhaps the most startling research finding reported in studies reviewed in this article is the high proportion of substance-abusing women who have experienced early sexual abuse. Although most studies have not had adequate comparison groups of non-substance-abusing women, the fact remains that most studies suggest a third to a half of substance abusing women experienced some kind of sexual abuse during childhood. Substance-abusing women's lives remain complicated as adults. They are commonly involved with men who are also users of drugs, they are often the victims of domestic violence, and they suffer from a variety of psychiatric disorders. Studies of epidemiologic and treatment populations indicate that the majority of substance-abusing women have one or more types of comorbid mental disorders, with depression being the most common and the most elevated compared with substance-abusing men, but antisocial personality being extremely high compared with samples of non-substance-abusing women. These findings are of great concern given a growing body of research with non-substance-abusing women, suggesting that family violence and maternal psychopathology can have a profound effect on women's parenting and development o