Alcohol, smoking, and other substance use in the perinatal period
BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1627 (Published 11 May 2020) Cite this as: BMJ 2020;369:m1627
- Claire A Wilson, MRC clinical research fellow and honorary specialist registrar in psychiatry1 2,
- Emily Finch, consultant psychiatrist and clinical director of Addictions Clinical Academic Group2,
- Catherine Kerr, service user,
- Judy Shakespeare, retired general practitioner
- 1Section of Women’s Mental Health, King’s College London, London SE5 8AF, UK
- 2South London and Maudsley NHS Foundation Trust, London, UK
- Correspondence to: C A Wilson claire.wilson{at}kcl.ac.uk
What you need to know
Ask about substance use in all women who are pregnant or planning pregnancy
Early brief interventions may be effective when delivered by non-specialists in primary care
Support for women who use substances during pregnancy may involve liaison with other services such as midwifery and specialist drug and alcohol services
Case scenario
A 30 year old primiparous woman is delighted to find herself pregnant and comes to your surgery for confirmation of the pregnancy. You discover that she is smoking 20 cigarettes a day, and she is worried that she went to a friend’s wedding around the time of conception and drank so much that she couldn’t remember what had happened until the next day. She also reports occasional recreational use of cannabis.
Next steps
Advise her of the risks of smoking and of alcohol and cannabis use during pregnancy. The biggest risk for her pregnancy at present is her smoking.
Offer referral to a specialist pregnancy smoking cessation clinic.
Clarify with her how much cannabis and alcohol she is using. Brief intervention may be sufficient, but regular or heavy use of either substance may warrant referral to specialist drug and alcohol services.
Many women use substances during pregnancy. For example, the global prevalence of alcohol consumption during pregnancy is 9.8%.1 Moreover, 10.4% of pregnant women in England were known to be smoking tobacco at the time of delivery.2 Prevalence of cannabis use during pregnancy in a UK cohort has been reported as 5%3 but is likely to increase over coming years.4 Pregnancy may be a woman’s first time engaging with health services and may be a motivator to stop or reduce her substance use.5 In this article we offer an overview of assessment and interventions for substance use in the perinatal period. We focus on alcohol, tobacco, and cannabis …