Drug use during pregnancy is a worldwide problem and the consequences of continued drug misuse in pregnancy can be significant.1 Pregnancy may provide opportunities to engage vulnerable women in essential healthcare. However, women with an addiction may have poor adherence with prenatal appointments, presenting late in pregnancy or not until labour. Hence, drug liaison midwives (DLMs) were appointed to the three Dublin maternity hospitals in 1999.

A 2023 retrospective observational cohort study was conducted at an Irish tertiary maternity unit.2 In this study, published in the European Journal of Obstetrics & Gynecology and Reproductive Biology, all women with opioid use disorder (OUD) or substance use in pregnancy delivered under this service between 2010 and 2019 were included. Data were collected by combining electronic and hand-held patient records, and trends and outcomes were analysed by year of delivery.

Findings

The main findings from the review included the following:

• Of the 82,669 women delivered, 525 had OUD or substance use in pregnancy (1 in every 160 women booking into the service). Some 11.6% were homeless, 20% were in full-time employment, and 91% smoked tobacco in pregnancy. Some 66.3% had a history of psychiatric disorders.
• Over the 10 years, there was a significant reduction in women delivered with OUD or substance use in pregnancy (0.8–0.4%, RR=0.55, 95% CI: 0.36–0.85) and a significant reduction in the proportion of women on opioid substitute treatment (RR=0.66, 95% CI: 0.51–0.87).
• Rates of cocaine and cannabis consumption increased (20.6%, RR=3.8, 95% CI: 1.57–9.44; 24%, RR=3.7, 95% CI: 1.58–8.86, respectively).

Conclusions

The authors noted that the study shows a change in the profile of the women with substance use in pregnancy, with significant increases seen in the numbers of women using cocaine and cannabis in pregnancy. They suggest that specialist antenatal addiction services, coordinated by the DLM, are critical in adapting care to respond to this dynamic and vulnerable patient cohort.

1    Covington CY, Nordstrom-Klee B, Ager J, Sokol R and Delaney-Black V (2002) Birth to age 7 growth of children prenatally exposed to drugs: a prospective cohort study. Neurotoxicol Teratol, 24(4): 489–496.

2    Corbett GA, Carmody D, Rochford M, Cunningham O, Lindow SW and O’Connell MP (2023) Drug use in pregnancy in Ireland’s capital city: a decade of trends and outcomes. Eur J Obstet Gynecol Reprod Biol, 282: 24–30. Available from: https://www.drugsandalcohol.ie/37901/