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Treating Addiction and Pregnancy

Treating Addiction and Pregnancy

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Johnson with her daughter Jenna, now 6.

At 33, Jennifer Johnson found herself in pretty dire straits – drug dependent and a step away from homelessness. Then she got pregnant, a reality that slapped her hard in the face. No more bouncing around acquaintances’ homes, no more using – she wanted a safe, healthy life for her child, which meant she had to take control and save her own life, too.

“It got to the point where I felt I had nothing and no prospects for the future,” says Johnson. “I didn’t want to continue living that life.”

But how could she alter her addictive course? What was out there that could restore her health and safely bring her baby into the world, too? Searching the Web, her sister found a comprehensive, one-stop program at Johns Hopkins Bayview Medical Center – the Center for Addiction and Pregnancy, or CAP – that appeared to fit all of Johnson’s needs. Not only would her addiction issues be addressed, but her prenatal and obstetric care, as well as the pediatric care of her unborn child.

“Obstetrics, mental health and pediatrics are all combined to meet all the needs of this very complex patient at one place at one time,” says Lauren Jansson, CAP’s director of pediatrics. “Typically, segmented care for these patients can fall apart very quickly. They need comprehensive care.”

Jansson explains that patients begin the program intensively as inpatients for the first even days in a domiciliary unit, and then transition to outpatient care. The focus is on the patient’s mental and physical health, facilitated by care in the clinic and in individual and group sessions on domestic violence, HIV education, life skills and parenting, stress management, as well as substance abuse. The potential for relapse, says Jansson point blank, is acknowledged upfront.

“Most people do not come in and begin their sobriety immediately,” she says. “It is a process that requires work and effort.”

Key to helping patients face that hurdle is providing an accepting, non-judgmental environment. Like other patients, Johnson was concerned about the stigma of being both addicted and pregnant. But rather than feeling judged, she felt embraced, engaged and supported at CAP.

“I was respected and cared for,” says Johnson. “I finally felt a little bit of peace and promise in my life.”

For patients like Johnson, the science of addiction medicine comes into play, too, explains Jansson, a researcher who focuses on neuro-developmental issues for the fetus and newborn. CAP’s approach for women unable to stop using street opioids is methadone maintenance, which poses some risk – but less than that of heroin exposure – for premature birth, low birth weight and perinatal complications like neonatal abstinence syndrome, or NAS, in which the newborn experiences drug withdrawal symptoms. Methadone poses a real risk of NAS in the infant, says Jansson. So if you’re going to have the fetus and the infant bear the risk of the methadone exposure, you have to give them the benefit of comprehensive care, including prenatal care, psychiatric care, nutrition, and a safe environment, like that offered at CAP.

The babies in CAP are being born full term with lower than average rates of neonatal intensive care admissions, and fewer complications,” says Jansson. “Only a subset of newborns have severe enough neonatal abstinence syndrome to require treatment.”

In the pediatric piece of the program, child care and immunizations are provided to patients’ children from birth to age 21, and all children in CAP receive frequent developmental testing during their first three years. The result?

“In this clinic we have 100 percent immunization rates,” says Jansson. “That alone is success.”

As is often the case at CAP, Johnson’s daughter, Jenna, now 6, was born healthy and remains healthy. Johnson has done well by herself, too, pursuing a nursing degree at the University of Maryland since leaving CAP. Her plans after graduation in December?

“I would love to work in this field,” Johnson says, “and give back.”

For more information about CAP, call 410-550-3020, or visit online.


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