An issue of substance
More Spokane women use drugs, alcohol, tobacco when pregnant, according to health district statsJune 7th, 2018
Recent data show prenatal use of marijuana, opioids, and other drugs is on the rise in Spokane County and could be a factor in increased cases of low birth weights here, say Spokane Regional Health District officials.
In 2016, the most recent year for which data are available, 11 percent of Spokane County mothers admitted to a hospital to give birth used one or more substances, including tobacco, alcohol, opioids, cannabis, sedatives, cocaine, other stimulants, hallucinogens, inhalants, and other psychoactive substances, according to Washington state Department of Health data.
“What we’ve been seeing over time is an increase of children and infants impacted by drug exposure,” says Sue Schultz, public health nurse and manager of the district’s Nurse-Family Partnership program. “Of the cases referred to us by Child Protective Services, eight of 10 have some kind of substance abuse issue that’s affecting the family.”
The Nurse-Family Partnership is a voluntary prevention program that offers home visits by nurses to first-time mothers starting early in pregnancy and continuing until a child’s second birthday.
“The partnership is a preventative program that works to address issues and get children support as early as possible,” she says. “With these wrap-around services, these mothers can be successful parents.”
The most recent data on birth weights for Spokane County show that in 2016, 7.8 percent of newborns in Spokane County and 6.4 percent in Washington state had low birth weights, an increase from 7.3 percent and 6.5 percent, respectively, when compared with 2015.
Public health nurse Melissa Charbonneau works with the SRHD’s Children and Youth with Special Health Care Needs program and is also a facilitator of the Birth Outcomes Taskforce, an organization formed by the district in 2007 to focus on pregnancy and tobacco use.
“The Birth Outcomes Taskforce has turned its attention to substance abuse, because it’s the No. 1 issue being raised by our partners time and again,” Charbonneau says.
Both Charbonneau and Schultz say they believe Spokane County’s increase in low birth weights is linked to increases in prenatal substance abuse.
“When a woman becomes pregnant, she wants to give up unhealthy habits and protect her child,” says Schultz. “The trouble is many don’t realize they’re pregnant until they’re four to six weeks along, by which point a lot of damage has already been done.”
SRHD health officer Dr. Robert Lutz says low birth weight is also impacted by socioeconomic factors.
“Spokane is an ethnically white, but lower socio-economic status, low education attainment community, which as we know are both longstanding risk factors for low birth weight,” he says. “Complicate that picture by increased substance usage, and you see why the numbers are increasing with low birth weights.”
In addition to his role at the health district, Lutz is clinical director of urgent care for MultiCare-Rockwood and currently leads the Spokane County Opioid Task Force.
Established in early January, the Opioid Task Force has been meeting regularly to organize and develop ways to make access to opioids harder, while also creating programs to help those who are already addicted, Lutz says.
Charbonneau says cases of infant opiate withdrawal syndrome after birth also are increasing here, with state data showing about 14 of 1,000 newborns born in hospitals in Spokane County had the condition last year.
“This is not a surprise to those of us who work with programs like the birth outcomes task force, and other health district programs,” she says.
While the most established tracking of prenatal substance use is for tobacco, district officials say prenatal use of alcohol, marijuana, and other substances can be more difficult to access as most users are using more than one substance.
“We see a lot of cases of what we call poly-substance use, where people are using more than one drug,” says Charbonneau. “Most users are smokers of either cigarettes or marijuana, but opioid use is also huge right now.”
State Department of Health data for 2016 show 13 percent of mothers in Spokane County reported smoking tobacco during pregnancy. Although that’s still 1.4 times higher than the rate of mothers smoking during pregnancy for all Washington state, data show rates for Spokane County have been decreasing steadily over the last 10 years.
Though prenatal smoking rates are declining, Charbonneau says new mothers increasingly have admitted to using marijuana since it was legalized in Washington state in 2012.
State Department of Health data show that in a four-year period ending with 2016, 5.3 percent of pregnant moms in Washington reported using marijuana in the past 30 days.
“We’re hearing … that new mothers are sharing openly that they use marijuana,” she says. “It’s not uncommon to hear about moms who see it as a natural plant that’s now legal and safe to use.”
Schultz says that many women who admit to using marijuana during pregnancy say they do so as a way of treating morning sickness or anxiety issues.
“Some women also need to stop taking mental health medications once they get pregnant, so their anxiety skyrockets and they begin to self-medicate with marijuana to cope,” Schultz says.
The national Centers for Disease Control and Prevention say some research shows that using marijuana while pregnant can cause health problems in newborns—including low birth weight—and might also increase the chances for developmental problems later in the child’s life.
The CDC says chemicals from marijuana also can be passed to babies through breast milk, so it’s recommended that breastfeeding mothers also avoid marijuana use. Additionally, the CDC reports that use of marijuana may affect a mother’s ability to properly care for her baby.
“We want to let people know that there is in fact research to support that using marijuana during these times isn’t necessarily safe and hopefully start more conversations,” says Charbonneau.
Schultz points out that it’s not only prenatal infants, but also children living in homes with parents who smoke or use marijuana that can be affected.
“You’ll often hear of mothers who say their infants appear to have done well despite substance use during pregnancy, but the truth is we don’t know all the potential outcomes for these kiddos yet,” she says.
Paige McGowan, a health program specialist for the district’s tobacco, vaping device, and marijuana prevention programs agrees there’s a lack of information and research on marijuana use during pregnancy.
She says that lack of information leads many providers and researchers to be hesitant in taking a stance one way or the other.
“So, we set out to create messages that would at least help advise people there may be risks associated with using marijuana during and after pregnancy,” McGowan says.
To accomplish that goal, SRHD expanded the Weed to Know program, which is aimed at preventing youth access and use of marijuana. The program now includes a component titled Weed to Know Baby and You.
The new initiative focuses on combating misconceptions on smoking marijuana during or after pregnancy, including breastfeeding and child care. She says the health district now has informational posters and pamphlets available at provider offices throughout the Spokane area.
“Both the city and county have embraced the initiative and are utilizing it, and the information has already been shared across the country, as well as presented at two national conferences,” she says.
Going forward, Charbonneau says the focus of health district programs will continue to be on education and prevention.
“We know that preventative programs are the most important, but the issue is how best to deliver that prevention,” says Charbonneau. “We know there are pockets of need in this community, but we only have so many home visit programs compared to the amount of need.”
Schultz says the Nurse Family Partnership recently was expanded to include not just first-time mothers, but also those with previous pregnancies who are still at risk for substance abuse and other limiting factors.
“The state recently increased funding for home visits,” she says. “We currently have 140 participants and a capacity of 175, but we hope to continue expanding.”
She says data show mothers who are enrolled in the program have higher success with breastfeeding and obtaining infant immunizations.
Charbonneau, McGowan, and Schultz say that as a result of SRHD programs, they’re seeing more women returning to school and work, as well as improved outcomes for infants and children’s school readiness.
“All of these issues are interconnected,” says McGowan. “The most important thing we can do is encourage kids to thrive in school and graduate, because that decreases their risk for many other things, including substance use.”