Busting Misconceptions Around Perinatal Substance Use

Pregnancy and the postpartum period can be especially challenging for many individuals. Mental health is the leading cause of maternal mortality in New York State with overdose and drug-related injuries making up a large portion of these deaths (New York State Department of Health, 2024). Substance use during pregnancy presents complex challenges for healthcare providers, birthing persons, and their families. Pregnancy offers a unique period of time for pregnant people and their families, especially when it comes to addressing healthcare needs. Routine appointments, as well as diagnostic testing, are often a standard of care for both that individual & the fetus. For pregnant people who use drugs, these appointments could be vital to improving the outcome of their substance use and facilitating care coordination for other barriers they may face such as housing, healthcare, food insecurity and other needs.

Due to the complex nature of pregnancy, substance use, and stigma, many pregnant people face disparities in accessing quality treatment.  Pregnant people with substance use disorders often face multiple socioeconomic challenges, including poverty, housing instability, low educational attainment, and intimate partner violence, which create significant barriers to accessing treatment (Prince, Sharon & Daley, 2023). Additionally, when compared to their white counterparts, Black and Latinx women with opioid use disorder are 60-75% less likely to receive and/or consistently use medication to treat OUD during pregnancy (National Partnership for Women & Families, 2021). The challenges faced by caregivers and pregnant people with substance use disorders highlight the need for more compassionate and understanding approaches in healthcare and community settings.

Fast Facts

Dispelling Common Myths About Treatment During Pregnancy

Myth: Medication for Addiction Treatment (MAT) is Not Safe for Pregnant People

FACT: One of the most dangerous misconceptions is that medications for opioid use disorder (MOUD) should be stopped during pregnancy to protect the fetus. Many pregnant people request discontinuation of these medications due to concerns about potential harm or fear of child protective services involvement. However, evidence consistently shows that maintaining MAT/MOUD during pregnancy leads to better outcomes (Prince, Sharon & Daley, 2023). MOUD during pregnancy reduces the risk of a fatal overdose by 97% (Krans, Kim, & Chen, et al., 2021). Current evidence supports the use of buprenorphine and methadone as safe MAT/MOUD options during pregnancy and is shown to improve delivery outcomes (Jarlenski et al., 2022). Abruptly stopping MAT can lead to withdrawal, which poses serious risks including preterm labor, fetal distress, and increased likelihood of relapse to illicit substance use. MAT, particularly when combined with comprehensive behavioral support, significantly improves maternal and infant outcomes (Prince, Sharon & Daley, 2023).

Myth: Punitive Approaches Improve Treatment Engagement

FACT: Another harmful misconception is that punitive measures effectively encourage individuals with SUD to seek treatment. In reality, fear of legal consequences often prevents pregnant people from accessing prenatal care and substance use treatment. 18 states in the US define substance use during pregnancy as child abuse, and 3 consider it grounds for incarceration (Prince, Sharon & Daley, 2023). In NYS, there are no specific laws that criminalize substance use during pregnancy, and treatment programs are required to prioritize pregnant people within their facility to provide care (Legislative Analysis, 2024). Criminalization drives many women away from the healthcare system precisely when they need it most. Many pregnant people avoid routine prenatal care due to feelings of guilt, fear of losing custody of their children, and practical barriers like lack of transportation. This avoidance of care places both mother and baby at higher risk, as babies who don’t receive proper prenatal care face increased likelihood of preventable diseases, prematurity, congenital anomalies, and infant mortality (National Partnership for Women & Families, 2021; Prince, Sharon & Daley, 2023).

Moving Forward with Compassionate, Evidence-Based Care

Addressing misconceptions about SUD treatment during pregnancy and postpartum is essential for improving outcomes for both mothers, infants, and their families. Evidence clearly demonstrates that appropriate treatment during pregnancy improves birth outcomes, while punitive approaches drive women and pregnant people away from care. Healthcare providers, policymakers, and communities must work together to create supportive environments where pregnant people with SUD can access evidence-based care without fear of stigma or legal consequences. MATTERS facilitates an accessible route to evidence-based, person-centered care while upholding individual autonomy and removing an additional burden on maternal care providers. The program does this by providing a direct link to community expertise while supporting the continuity of care through additional wrap-around services such as medication/transportation vouchers, direct follow-up, and harm reduction services. MATTERS staff can provide custom workflows on request to best integrate services into maternal health on both the clinical and community level. Below is a sample chart that provides an example of a MATTERS pathway in perinatal health. Learn more by visiting mattersnetwork.org.

References

• Hirai, A. H., Ko, J. Y., Owens, P. L., Stocks, C., & Patrick, S. W. (2021). Neonatal abstinence syndrome and maternal opioid-related diagnoses in the US, 2010-2017. JAMA, 325(2), 146–155.
• Jarlenski, M., Chen, Q., Gao, A., Rothenberger, S. D., & Krans, E. E. (2022). Association of duration of methadone or buprenorphine use during pregnancy with risk of nonfatal drug overdose among pregnant persons with opioid use disorder in the US. JAMA Network Open, 5(4), e227964. https://doi.org/10.1001/jamanetworkopen.2022.7964
• Ko, J. Y., D’Angelo, D. V., Haight, S. C., et al. (2020). Vital signs: Prescription opioid pain reliever use during pregnancy — 34 U.S. jurisdictions, 2019. MMWR. Morbidity and Mortality Weekly Report, 69, 897–903.
• Krans, E. E., Kim, J. Y., Chen, Q., et al. (2021). Outcomes associated with the use of medications for opioid use disorder during pregnancy. Addiction, 116(12), 3504–3514. https://doi.org/10.1111/add.15582
• Legislative Analysis. (2024). Substance use during pregnancy and child abuse: 50-state summary.
• National Partnership for Women & Families. (2021). Substance use disorder hurts moms & babies. https://nationalpartnership.org/report/substance-use-disorder-hurts-moms-and-babies/
• New York State Department of Health. (2024). New York State Maternal Mortality Review Report, 2018-2020. Albany, NY: New York State Department of Health.
• Prince, M., Sharon, F., & Daley, A. (2023). Substance Use in Pregnancy. In: StatPearls . Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542330/
• Substance Abuse and Mental Health Services Administration. (2024). Key substance use and mental health indicators in the United States: Results from the 2023 National Survey on Drug Use and Health (HHS Publication No. PEP24-07-021, NSDUH Series H-59). Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services