Management of drug misuse in pregnancy

Use of both licit and illicit drugs can lead to a range of medical, psychiatric and social problems, and the situation becomes further complicated if the user is pregnant. Prescribed and non-prescribed substances can affect a pregnancy, and substances are seldom used in isolation. In this review we focus on users of illicit drugs (including prescribed drugs used illicitly) during pregnancy and describe some of the issues in managing such cases. We consider the impact of subtance use on the foetus, the mother and the newborn child, and highlight the importance of multidisciplinary working in this area. Space precludes a detailed account of the issues surrounding the use of legal substances such as alcohol and tobacco during pregnancy, but we note their significant impact in this group. Ed Day is a senior lecturer in addiction psychiatry in the Department of Psychiatry at the University of Birmingham (Queen Elizabeth Psychiatric Hospital, Mindelsohn Way, Edgbaston, Birmingham B15 2QZ, UK. Tel: 0121 685 2356; e-mail: [email protected]) and an honorary consultant with Birmingham and Solihull Mental Health NHS Trust. He has worked with the Birmingham Mother and Baby Team, one of the longest established services for the treatment of pregnant drug-using women in the country. His research interests are focused on developing innovative pharmacological and psychological treatments for alcohol and drug dependence. Sanju George is a specialist registrar in general adult psychiatry and an honorary clinical lecturer in psychiatry, also at the University of Birmingham. His main interests and research lie in undergraduate medical education and pharmacological treatments of drug dependence.