By Sarah E. Ludwig
It’s all over the news: Opioid use is on the rise, whether it involves powerful prescription pain relievers, such as Vicodin, codeine, Demerol or OxyContin, drugs used for maintenance therapy in opioid use disorder treatment, such as methadone or buprenorphine, or illicit drugs like heroin. This upward trend impacts many pregnant women as well. According to the National Institute on Drug Abuse, one baby is born every 25 minutes with opioid withdrawal.1 Though using opioids during pregnancy may sometimes be unavoidable, it’s important to be aware of the risks to your baby if you’re on any sort of opioid drug while pregnant.
Opioid Use During Pregnancy
According to the Centers for Disease Control and Prevention (CDC), an estimated one-third of women of childbearing age have filled a prescription for an opioid and 14-22% of pregnant women have filled an opioid prescription.2 Similarly, general heroin use has increased dramatically over the past decade, thanks to the uptick in opioid prescriptions. Almost 80 percent of heroin users say they misused prescription opioids first.3
The reasons for using opioids while pregnant vary. Some women may be unaware that they are pregnant. Some are using prescribed opioids for pain management. Others suffer from opioid use disorder and are either on maintenance therapy or are unable to break the cycle. Whatever the reason, the number of women using opioids who gave birth jumped from 1.2 per 1,000 hospital births in 2000 to 5.8 in 2012.4
How Opioids Affect Your Baby
Opioids cross over from the mother’s bloodstream into the baby’s system. This can result in birth defects, including
- Glaucoma, an eye disease
- Hydrocephaly, which is extra fluid in the baby’s brain
- Spina bifida, a neural tube defect
- Gastroschisis, which is a hole in the abdominal wall that allows the intestines to protrude
- Congenital heart defects, such as pulmonary valve stenosis, atrial septal defect and hypoplastic left heart syndrome.5
These birth defects have been shown to be particularly linked to opioid use just before and during the first trimester.6 Using opioids during pregnancy can also result in poor fetal growth, complications at birth and premature birth. The more of the drug that’s ingested, the more serious these effects can be.
The most common result of opioid use during pregnancy is the baby being born with withdrawal symptoms, called neonatal abstinence syndrome (NAS). These symptoms typically show up between 48-72 hours after birth, though they can appear before or after that timeframe. Although not every baby exposed to opioids in utero is born with NAS, 70 to 95 percent are.7
Symptoms of NAS vary depending on the amount of exposure the baby has had and to what type of drug is involved. Potential withdrawal symptoms include feeding difficulties, irritability, tremors, problems breathing, excessive and/or high-pitched crying, seizures, an inability to maintain body temperature, tight muscle tone, sleeping difficulties, sweating, fever, dehydration, stuffy nose, sneezing, vomiting and diarrhea.8 Babies may need to stay in the hospital longer or even be admitted to the neonatal intensive care unit (NICU).
Treatment for NAS depends on the severity of symptoms, which are measured by a scoring tool. Some babies can be treated with simple comfort measures, such as swaddling, skin-to-skin care, breastfeeding and dim lighting. Others may need intravenous fluids, special formula to help them gain weight and/or small doses of opioids if the withdrawal is severe.9
“We recommend that all babies are offered comfort measures before they’re treated with medication,” notes Elizabeth Welch-Carre, a neonatal nurse practitioner at Children’s Hospital Colorado. “Comfort measures can make a big difference in how much medication an infant might need.” Keeping babies with their mothers during this period has also been shown to help decrease the severity of symptoms.10 It takes most babies five to 30 days to recover from NAS.
What to Do If You’re Pregnant and Using Opioids
Do not stop taking the opioid without talking to your healthcare provider. Suddenly quitting drugs of any kind can lead to dangerous effects, such as preterm labor and fetal distress.
Be up front with your doctor about your opioid use, whether it’s prescribed, misused or illicit. This allows your doctor to work with you to find the best way to limit your baby’s exposure.
Get early and consistent prenatal care. Keep your appointments and follow your doctor’s instructions. Studies show that babies whose mothers are using opioids while pregnant have better outcomes when mothers are closely monitored by their healthcare providers and receive regular doses of opioids.11
If you have an opioid use disorder and are pregnant or want to get pregnant, seeking substance use treatment is the best course of action for both you and your baby. If you can work to become drug-free before you become pregnant, that’s the best outcome of all for both you and your baby.
If you are on an opioid for pain and want to get pregnant, talk to your doctor. You may be able to try a different type of medication or lower your dose so your baby doesn’t have as much exposure.
Find a provider and a support system who are not judgmental. A lot of women who find themselves pregnant while on opioids feel secrecy, shame and guilt, says Jennifer Wallace, MSN, RN, assistant professor in the Family Focused Nursing Practice at Lawrence Memorial Regis College and a nurse in the Special Care Nursery and Maternity Units at Melrose-Wakefield Hospital in Boston. “As the birth gets close, it’s really difficult to hide your addiction anymore,” she says. “I would say if you’re early in your pregnancy your first call should be to an obstetric provider. Your second call should be to a close friend who you trust or someone who can be in your camp and not judge and to hold your hand and go with you to your appointments, somebody who you can begin to tell your story to.”
Keep in mind that giving birth can be a step toward recovery. Having someone else to care for inspires many new moms to get into treatment, if they weren’t before. “For a lot of women, we have found that the birth of the baby can be a catalyst to them maintaining their sobriety,” says Wallace.