Cocaine and cannabis use on the rise among older women in pregnancy
A new study has revealed 525 women in the Coombe Maternity Hospital in Dublin were using drugs while they were expecting a baby from 2010 to the end of 2019.
verall, the study found a “50pc reduction in the number of women presenting with opiate use disorder or substance use in pregnancy”. However, it observed a trend in older patients showing increasing cocaine and cannabis use.
The master of the Coombe, Professor Michael O’Connell, said one of the “noteworthy findings of this study is that cocaine is the new heroin”.
“It is highly addictive and associated with significant pregnancy complications, leading to massive increases in blood pressure, followed by sudden drops, which can cause abruption, where the placenta separates from the uterus.
“There has been a change of habit and a shift in drug use in society. The heroin problems we had in the 1980s have evolved to cannabis and cocaine use.
“While the number of women attending the clinic in the Coombe Hospital has fallen, they present with more complex and chaotic circumstances.”
Although reported active heroin use in pregnancy fluctuated from 23pc of the women with substance use in 2015 to 51pc in 2017, there was “no significant change over the 10-year period”.
There was a sharp rise in cocaine use in pregnancy from 9pc of the women with substance use in 2012 to 35pc in 2019. Cannabis use had an even steeper rise from 9pc to 51pc.
There was a significant drop in the proportion of women on methadone prescribed in pregnancy from 97pc of the women with substance use in 2012 to 64pc in 2019.
The study, which has been published in the European Journal of Obstetrics & Gynecology and Reproductive Biology, observed an increase in the mean maternal age of the women from 30.7 years to 32 years.
Across the period, 504 babies were born in the Coombe to mothers with drug problems while there were eight miscarriages. Two out of three of the women had a history of psychiatric disorders, which was predominately depression, with 10pc reporting a previous suicide attempt. Just over one in 10 were homeless, while 92pc were single. One in five were in full-time employment and over 90pc smoked tobacco in pregnancy.
“Homelessness and psychiatric disorders are common factors within this group who are significantly more prone to anxiety and depression,” said Prof O’Connell.
“This is reflected in the multidisciplinary team who provide care for these vulnerable women and their babies.
“The team provides access to midwives specialising in addiction and infectious diseases, a social worker, addiction services, Cuan Dara, the Guide Team, Hepatology Team in St James’s Hospital and a dedicated obstetric and neonatology medical team.
“We aim to provide an open and non-judgmental environment, continuity of care with specialist input, ensuring women feel supported disclosing drug use and can have their care adapted accordingly with an emphasis on drug stabilisation in pregnancy.”
He added that while maternal mortality is uncommon in Ireland, two deaths in this group of women were reported over the period of the study, both drug-related.
“Half of newborns from this clinic will be admitted to the neonatal unit with withdrawal symptoms. This is approximately five times the admission rate compared to the non-addiction groups,” he said. “All women from this group are advised to remain in the hospital for five days postnatally to ensure that delayed withdrawal symptoms experienced by the baby are identified.”
The study found that prescribed antidepressants and benzodiazepines were also among the substances taken by the women.
Prof O’Connell said he would like to see more clinics for women with substance use in pregnancy like the one in the Coombe “being more readily available, and more beds for stabilisation and transition”.
“Drug use has pervaded the whole of society and no part of Ireland is untouched so this kind of care is required throughout the entire country.”
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