Models of intervention and care for psychostimulant users, 2nd edition - monograph series no. 51

Chapter 11: Psychostimulant use in pregnancy and lactation

Page last updated: April 2004

Angela Deana and Treasure McGuireb

a Department of Psychiatry, University of Queensland
b School of Pharmacy, University of Queensland and Pharmacy Services, Mater Hospital, South Brisbane, Queensland

Key points - drug use in pregnancy and breast-feeding:
  • While many drugs can induce pharmacological effects in the foetus during pregnancy, including foetal toxicity in third trimester, the number of drugs able to cause congenital malformations is small.

  • Many factors (e.g. pattern of drug use or dose in relation to gestational age) influence potential drug effects on the foetus rather than drug use per se.

  • It is prudent to avoid binge administration of psychostimulants during pregnancy.

  • If drug use occurs once daily or less frequently, infant exposure to the drug can be minimised by breast-feeding just prior to the dose and avoiding feeding for a minimum of two to three hours after the dose.

  • If drug use occurs more frequently (many times per day or in a binge), it is sensible to avoid breast-feeding during these times. If ongoing breast-feeding is desired, milk may be expressed and discarded during times of heavier use.
Key points - cocaine use during pregnancy and breast-feeding:
  • Cocaine does not possess any specific teratogenic effects.

  • Cocaine use during pregnancy may increase the risk of abruptio placenta and premature rupture of membranes.

  • Women who use cocaine are at higher risk of a range of obstetric complications such as reduced birth weight — most of these outcomes are not specific to cocaine but influenced by other drug use and lifestyle factors.

  • Exposure to cocaine in utero may influence prenatal brain development, but the clinical significance of these changes is unclear.

  • Children who were exposed to cocaine in utero may experience cognitive or behavioural deficits during childhood, but there is insufficient evidence to attribute these deficits to cocaine.

  • Risk of neonatal withdrawal symptoms and other adverse events may be minimised by avoiding regular use in late third trimester.

  • The American Academy of Paediatrics considers use of cocaine incompatible with breast-feeding.

  • To minimise infant exposure to cocaine via breast milk, feeding should occur just prior to or as long as possible after the dose.Top of page
Key points - amphetamine use during pregnancy and breast-feeding:
  • Amphetamine use in controlled doses during pregnancy is unlikely to pose a substantial teratogenic risk.

  • Binge dosing of amphetamines during pregnancy is not recommended.

  • Women who use amphetamines are at higher risk of a range of obstetric complications such as reduced birth weight — many of these outcomes are not specific to amphetamines but influenced by other drug use and lifestyle factors in addition to amphetamine use.

  • Exposure to amphetamines in utero may influence prenatal brain development, but the nature of this influence and potential clinical significance are not well researched.

  • Risk of neonatal withdrawal symptoms and other adverse events may be minimised by avoiding regular use in late third trimester.

  • To minimise infant exposure to amphetamines via breast milk, feeding should occur just prior to or as long as possible after the dose.
Key points - ecstasy use during pregnancy and breast-feeding:
  • Existing evidence suggests that use of MDMA during first trimester poses a potential teratogenic risk. It is strongly recommended that use of MDMA be avoided during the period of organogenesis (between week two and week eight post conception or between week four and week ten using an obstetric calendar).

  • Limited information exists about the other possible pregnancy effects of MDMA.

  • MDMA will enter breast milk. Until clinical outcomes data is available, it would be prudent to avoid breast-feeding during times of MDMA use.
Key points - management of the pregnant and lactating psychostimulant user:
  • Even if psychostimulants have been used in the earlier stages of pregnancy, there are possible benefits for reducing or ceasing use in the later stages of pregnancy.

  • Reduction of other substance use, especially nicotine and alcohol, can improve neonatal and early childhood outcomes.

  • Provision of good antenatal care with interventions to improve maternal nutrition and reduced psychological distress may improve neonatal outcomes.

  • Avoid breast-feeding during periods of heavy psychostimulant use.

  • Provision of parenting interventions may have a positive impact on childhood outcomes.