Pregnancy is an opportune time to screen and connect women to resources because of an increased motivation to change habits for the future well-being of their child. Estimates of perinatal psychiatric and substance use comorbidity range from 57 to 91%, with the most common diagnoses being depression, anxiety, and post-traumatic stress disorder. For this reason it is crucial to screen, at minimum, those with positive perinatal mood and anxiety disorder scores for substance use risk. Referral and follow up are warranted for any positive scores on any of the screens below (the NAStoolkit or the NIDA).
It is important to encourage a woman who may be reluctant to admit to substance use or to accept help. Reassure her that by enrolling in supportive services earlier, she increases the likelihood of delivering a healthy baby that can remain safely in the home.
For more resources on substance and opiate use, visit NAStoolkit.org for the Mother & Baby Substance Exposure Toolkit.
To find help with substance use and recovery in Utah during pregnancy and postpartum visit https://mihp.utah.gov/opioids or contact the Substance Use in Pregnancy Recovery Addiction
Dependence Clinic (SUPeRAD): 801-581-8425.
On the NIDA Quick Screen, if the patient says “Yes” for use of illegal or prescription drugs for nonmedical reasons proceed to the NIDA-Modified ASSIST found here: https://nida.nih.gov/sites/default/files/pdf/nmassist.pdf.
Many mothers are inappropriately advised not to breastfeed or to avoid taking essential medications due to fears of adverse effects on their infants. This advice is often not evidence-based and unnecessary in many cases (AAP, 2013).
Considerations:
- The AAP recommends exclusive breastfeeding for the first 6 months of life.
- Benefits: Improved immunity, promotion of maternal-child bonding, and improved neurodevelopmental outcomes.
- The benefits of breastfeeding outweigh the risk of exposure to most therapeutic agents via human milk.
- Anti-depressants are found in very low amounts in breastmilk.
- Benefit of treatment often outweighs the small risk of transmission in the breastmilk.
- In general, most anti-depressants are considered safe due to low or undetectable levels in infants’ serum.
- What is the mother’s breastfeeding goal? Are her symptoms interfering with achieving that goal?
- Women who have PPD and anxiety are more likely to stop breastfeeding because of their symptoms.
- The goal is to find a solution that benefits the mother-baby dyad while posing the least amount of risk to each.
- If on an effective antidepressant during pregnancy, she should continue using the same agent during the postpartum period and while breastfeeding unless contraindicated.
- All risk and benefits of continuing or initiating medication therapy should be discussed with the mother, including the risk of withholding treatment.
- Use appropriate references for information on medication compatibility with pregnancy and lactation.
Call MotherToBaby at 866-626-6874 if you have questions about medication safety during pregnancy and lactation. MotherToBaby Utah provides free, confidential, and accurate information for anyone who is pregnant, breastfeeding, or thinking about getting pregnant or having a baby and their healthcare providers. You can also call the Postpartum Support International Psychiatric Consult Line at (877) 499-4773.
Assessing Perinatal Mental Health