Can pregnant women safely consume a small amount of alcohol or marijuana? How will prescription medicine affect the baby? Chief Medical Officer and board-certified OB/GYN Alta DeRoo, MD, sits down with host William C. Moyers to answer those questions and more, offering some really simple and thoughtful advice to moms and families who are curious about their substance use—including how to push past the stigma and find whatever help they need. Read the podcast transcript below or listen and subscribe on iTunes, Google Play, Spotify or watch on YouTube. 0:00:13 William Moyers We're back for another edition of Let's Talk. A podcast production of the Hazelden Betty Ford Foundation. I'm your host, William C. Moyers, and our topic for today: substance use and pregnancy. The risks and complications for a woman and her unborn child when alcohol and other drugs are part of the mix. My guest is Dr. Alta DeRoo, the Chief Medical Officer of Hazelden Betty Ford. Dr. DeRoo is a Board-certified Addiction Medicine Physician and OB/GYN. Before joining this organization, Dr. DeRoo served our country in the military for 24 years. Welcome, Dr. DeRoo. 0:00:54 Dr. Alta DeRoo Thank you, William! 0:00:56 William Moyers Good to be with you today. And I gotta tell you, every time we sit down I'm always amazed at your resume and your just depth and breadth of experience. Which came first for you? Your interest in addiction medicine or your interest as an OB/GYN? 0:01:10 Dr. Alta DeRoo My interest as an OB/GYN. When I joined the military, I was initially an Aviator. And met that commitment after six years. And I was fortunate enough to have the military send me to medical school and pay for it. And while I was there, I just fell in love with the OB/GYN and a lot of service surrounding treating a sometimes a misrepresented or an undertreated population. So that I found that really attractive. So I was interested in the OB/GYN part first. 0:01:45 William Moyers Well we're glad that you had that interest and glad that you came to us to bring all that passion and expertise. Let's talk today about pregnancy and substances. And I gotta ask you this right off the bat: Is there a safe way for a pregnant woman to drink alcohol? 0:02:01 Dr. Alta DeRoo No, William, there's not. You know, according to the American College of Obstetricians and Gynecologists, there is no safe amount. And so we would discourage women from drinking in pregnancy or if you are drinking in pregnancy to stop and seek help if you can't do it alone. 0:02:21 William Moyers Mmm-hmm. And what about marijuana? I mean, there was a time when we thought we wouldn't talk about that in the context of the reality of today. That marijuana is illegal in many, many states. Same message? 0:02:34 Dr. Alta DeRoo Right. So, a lot of women are thinking that marijuana may be a solution to their nausea and vomiting in pregnancy. That seems to be a trend that we're seeing with some women, especially in the first trimester when your nausea and vomiting is so bad. I would highly discourage using marijuana to treat your nausea and vomiting. At any point in your pregnancy. We have better things. We have better things [chuckles] to treat nausea and vomiting in pregnancy, safer things. Marijuana does go to the fetus. It does cross the placenta. And there are cannabinoid receptors in the fetus. And so, you will have the marijuana going to baby and so there will be an effect. So we would discourage any marijuana in pregnancy. [nods] 0:03:28 William Moyers So those are good messages for people who might be casually using substances or using them even responsibly before pregnancy and then suddenly discover they're pregnant—but let's talk now about women who develop a dependency. An addiction to alcohol or other drugs. What are the risks to their unborn baby? 0:03:48 Dr. Alta DeRoo So specifically with alcohol, that is unfortunately an irreversible damage. So it's irreversible damage that you could do to baby. So if Mom's drinking and baby is exposed to alcohol in just the right amounts, that is—that can result in brain damage. And you often see it with infants. It'll change the way their face looks. So the philtrum here will be flat [points to area under nose and above mouth]. Sometimes the ears can be low-set. The profile is flattened on the face. So, you know, especially like in a Northern European population, you may have a strong profile, but the faces meaning the way the face looks in babies, will actually be altered too. So you can have physical disfigurement with the baby so the baby's gonna look a certain way if exposed having Fetal Alcohol Spectrum Disorder or Fetal Alcohol Syndrome. And then irreversible brain damage. Can also be caused by drinking alcohol. And there's a spectrum of damage that can be done. 0:05:01 William Moyers Dr. DeRoo, if a woman is dependent on a substance, does that mean that the baby is also dependent? 0:05:08 Dr. Alta DeRoo Thanks for asking that. Boy, that's a great question. So, you know, the baby may be passively dependent on the drug that's coming through the placenta. But the baby is just along for the ride. They're the passenger. And so, they may have something like an opioid coming through the placenta, baby gets used to that. That's the only environment baby has known. And so then when baby's born, baby will be—will withdraw. And so it's passively dependent, but we really wanna avoid the term something like "addicted." The baby's not addicted to opioids or whatever that drug may be. But it's a passive passenger. It's a passive dependency that the baby can go through some withdrawal with treatment and be treated, but we really want to do a service to the mom and the baby. And use the appropriate language such as you know the baby may be dependent on a certain drug. But is certainly not addicted. So we would wanna avoid that type of language. [Moyers nods] Which could be disparaging to Mom and/or baby. 0:06:20 William Moyers Great point. So, I wanna talk about treatment while pregnant. But before we go there, you've just raised an interesting point. What about women who are taking appropriately prescribed medications for mental health issues? What should they do while pregnant? 0:06:40 Dr. Alta DeRoo Yeah, so this question comes up a lot. So you have somebody who's stabilized on a medication that's completely appropriate. And prescribed by a psychiatrist and the mom is benefitting from it. So the way we look at this is that all—every little bit or a little bit of medication is gonna go to baby. A little bit. Even in breastmilk, right? When Mom is post-partum and breastfeeding. However you have to take a look and look at Mom's function. On the medication or off the medication. If Mom cannot take care of herself and her life falls apart and she can't get out of bed to eat and she can't go to her doctor's appointment because her life is so out-of-sorts, because now this medication that previously regulated her, is now taken away. If Mom who is the vehicle for the baby, is not well-regulated, then we don't want that Mom to stop. There are very few medications in psychiatry which are going to cause an issue. The biggest ones would cause a neural tube defect. Maybe like a Dilantin or Phenobarbital. So we wouldn't want moms on something that—on an anti-seizure medication, but psychiatric medications are safe if the mom feels like she has the ability and the skills and the support to come off the medication, that's wonderful. But we wanna make sure that she's able to take care of herself and baby. And this is always a conversation that you wanna have with your psychiatrist. But that's the fundamental. Is that, you know, how's Mom gonna be off the medication? Is she worse off of it? Well then don't stop, you know, don't stop it. If you're better on it and you're gonna be a better mother and can take care of baby and yourself better, then stay on the medication. 0:08:32 William Moyers So generally speaking, if a pregnant woman is taking medication for depression or an anti-anxiety medication or bipolar, that's probably gonna be okay? 0:08:45 Dr. Alta DeRoo Yes. Yes. Especially, you know, I would say especially with the Bipolar. To where some of the symptoms can be more—can be wider-ranging. And more severe in some cases. 0:08:56 William Moyers But we know that despite their best intentions, pregnant women just like every other group in the human species, can develop a dependency. 0:09:06 Dr. Alta DeRoo Absolutely. 0:09:06 William Moyers Despite their best intentions. Okay and so we're gonna have women tuning into this podcast who are going to be struggling with the reality that they've got a dependency but they're pregnant. Or, they're got a dependency and they're pregnant. 0:09:21 Dr. Alta DeRoo Right. [nods] 0:09:21 William Moyers What's your counsel to them in terms of getting help? 0:09:25 Dr. Alta DeRoo You know, one of the biggest barriers that I see when Mom has either a substance use disorder or a dependency on a certain drug or medication, is that there's a lot of judgment out there. You know? As moms, we take a lot of people—we take a lot of grief from the people that are around us and may be judging us and thinking we should be running our lives in a certain way. And there may be some stigma associated with it that you may be feeling. And, you know, I wanna reassure the moms if they could just get past that. And come into a facility, a residential treatment facility, our facility, your physician, for help. And disclose the challenges that you're having. I think you'll find that your healthcare professionals are usually the ones that are more free of stigma than the general population. So if you let the general population sort of guide your seeking for recovery, that may not be a good test. I would say please get some help, try to push past that stigma. It is a barrier; we're trying to overcome it. But please come to see one of our treatment facilities or your personal physician to share and disclose this. Because there's help out there, there's medications, there's programs, and there's support that you may not even realize. 0:10:51 William Moyers And of course Dr. DeRoo, you're coming to us today from our facility in Rancho Mirage, California. At the Betty Ford Center. But people don't have to go to treatment to get treatment, particularly here we are on the backside we hope of the pandemic. Talk to us about the role that virtual treatment plays in services for pregnant women and others. 0:11:14 Dr. Alta DeRoo Yeah. Great. So, COVID has taught us one of the things that we can do is that we can carry on medical care remotely. We can use virtual services to check in with somebody. Counseling, therapy support, even medical services you can get from Telemedicine or remotely. There's a medication that is used for opioid use disorder called Buprenorphine or Buprenorphine-Naloxone. This can also be prescribed by Telemed. Medications for alcohol use disorder can be prescribed via Telemed. So, you're absolutely right, William. You don't have to go to a residential treatment facility. Your primary care physician can do this. Your primary care physician can also prescribe medications for alcohol use disorder or opioid use disorder. It may just be right around the corner. 0:12:04 William Moyers Mmm-hmm. On that note, and thank you for bringing it up, our organization and lots of organizations now do use appropriate medications, FDA-approved medications, to treat alcohol use disorder, opioid use disorder. You talked about Buprenorphine even methadone. We don't—I don't think we use it at Hazelden Betty Ford, but it's used to treat opioid disorder. Can pregnant women be treated with these medications? 0:12:31 Dr. Alta DeRoo Absolutely. [nods] And we highly encourage it. So both the American Society of Addiction Medicine and the American College of Obstetricians and Gynecologists, recommend first-line treatment is medications for opioid use disorder, such as Buprenorphine-Naloxone or Buprenorphine alone. So that is the standard of care. Also with alcohol use disorder, those medications are safe. There are many ones that we can use for alcohol use disorder. Some of the older ones have proven safety and then some of the newer ones are also undergoing trials with the NIH and there's a lot of good data to be shared. So absolutely, Mom can use those same medications as a non-pregnant woman can. 0:13:21 William Moyers Do women who come into treatment while pregnant, do they need to be on a special unit with other pregnant women? Or are they going to be seen as being equal to and treated with the same sort of dynamic that anybody else would be treated? [Both smile] 0:13:37 Dr. Alta DeRoo Right. So we would want the pregnant mom to come in and be among all of our women within the milieu. So we would want them to just interact normally with everybody. They're not segregated. They're not put in a special women's pregnant population. They're among the general population. Because their substance use disorder is independent of their pregnancy and everybody's gonna be getting the same care and the things that they need to treat their substance use disorder. With their pregnancy stuff of course we would make modifications to any type of medications or supplements or any needed care, but they're not segregated. 0:14:17 William Moyers Dr. DeRoo, with the few minutes that we have left, let me ask you—what is the role that the significant other, the father, the partner, of the pregnant woman plays in the treatment and recovery experience? 0:14:32 Dr. Alta DeRoo Yeah. You know, a huge part. So, the partner is this part of support that the mom can rely on. During treatment. And if for some reason the partner also is struggling, with a substance use disorder, this is an opportunity for both of them to get help. You know, one of the biggest results that we've seen is when two partners try to quit smoking. They do it together. And they establish a quit date and they decide that they're gonna stop smoking together. And they're more successful when they have the support. We often see and there's data for what I'm gonna say next, that we often see that when anybody in recovery starts seeking services, if they have family support, or they have partner support, that makes a tremendous difference. For when they may be outside of the facility or outside the doctor's office. Having that family support really increases their success for being able to live a life without drugs or alcohol. 0:15:41 William Moyers Last question before we go. Mom is seven months pregnant and she's due in eight weeks. But she knows she's got a dependency on pain meds or on marijuana or alcohol. But it's only eight weeks from now. What's your counsel, what's your message, to the mom who's hanging on until she gives birth? 0:16:04 Dr. Alta DeRoo Right. Come see us anytime. All right? Come seek treatment. When I say us I mean an OB/GYN or a provider, right? So, there's never a bad time to go. Even with eight weeks left, this still means that you can alter the outcome of baby and baby's withdrawal when baby is born. Whether it's opioids or marijuana, if you continue to use all the way through pregnancy, all the way up to the time of birth, baby's withdrawal is gonna be significant. However, if you were to stop at any point previous to that, you're giving baby the advantage of an easier withdrawal at birth. 0:16:45 William Moyers A message of hope. Thank you, Dr. Alta DeRoo, for being with us today. The Chief Medical Officer of Hazelden Betty Ford. Thank you, Alta! 0:16:52 Dr. Alta DeRoo [smiles] Thanks, William! 0:16:53 William Moyers [to camera] And thanks to all of you for joining us. Remember, addiction to alcohol and other drugs does not discriminate, but treatment does work and recovery is possible. So don't wait if you or a loved one, or your baby, needs help. And for help, you can ask now. I'm your host, William C. Moyers, I hope you'll join us for another edition of Let's Talk. See ya soon.