ADDICTION AND NEUROMODULATION IN PREGNANCY

Substance use disorders (SUDs)—particularly stimulant and nicotine use—remain major drivers of maternal morbidity and mortality in the United States, with limited evidence-based treatment options available during pregnancy. Pharmacologic interventions for stimulant use disorder lack safety data in pregnant populations, while behavioral treatments alone often produce insufficient reductions in use or relapse risk. Transcranial magnetic stimulation (TMS), a noninvasive neuromodulation modality with a robust safety profile in nonpregnant adults, is now emerging as a promising therapeutic approach for addressing addiction and co-occurring psychiatric disorders during pregnancy. The purpose of this presentation is to provide an integrated overview of the current landscape of addiction in pregnancy, synthesize emerging clinical and neurobiological evidence for TMS as a potential treatment modality, and present new feasibility, acceptability, and preliminary outcome data from pilot work that evaluates TMS safety and clinical response in pregnant patients with stimulant use disorder. This presentation will review (1) epidemiologic trends in stimulant use disorder during pregnancy; (2) neurocircuitry of addiction relevant to perinatal neurobiology; and (3) rationale for neuromodulation as a mechanistically targeted intervention. Methodology from an ongoing mixed-methods feasibility study will be discussed, including development of pregnancy-specific TMS treatment parameters, implementation of dual-target (left DLPFC and bilateral mPFC) and accelerated protocols, maternal safety monitoring, and integration of fetal ultrasound surveillance. Preliminary findings demonstrate high treatment acceptability, strong maternal engagement, and meaningful reductions in craving and depressive symptoms across the treatment course, with no observed maternal or fetal adverse events. Qualitative data further highlight perceived improvements in emotional regulation, motivation for change, and recovery-oriented behaviors. These findings represent the first prospective evidence describing TMS feasibility and therapeutic potential for stimulant use disorder in pregnancy and underscore the urgent need for safe, mechanism-based treatments for this high-risk population. The presentation will conclude with a discussion of clinical implications, ethical considerations, and key research directions—including scalable trial designs, biomarker-driven treatment personalization, and integration of neuromodulation within perinatal addiction care systems. Together, this work aims to advance the field by establishing neuromodulation as a promising and potentially transformative intervention for addressing addiction and psychiatric comorbidity during pregnancy.

References

1. Trends and Adverse Pregnancy and Birth Outcomes Associated With Stimulant-Related Disorder Diagnosis. Pippard NS, Bandoli G, Baer RJ. Addiction (Abingdon, England). 2024;119(11):2006-2014. doi:10.1111/add.16636.
2. Beyond the Efficacy of Transcranial Magnetic Stimulation in Peripartum Depression: A Systematic Review Exploring Perinatal Safety for Newborns.Miuli A, Pettorruso M, Stefanelli G, et al. Psychiatry Research. 2023;326:115251. doi:10.1016/j.psychres.2023.115251.