Heroin Use During Pregnancy: What Are the Potential Consequences?

Written by: Editorial Staff

Last updated on May 25, 2021

Individuals struggling with addiction to opioids such as heroin may develop withdrawal syndrome as soon as intake is reduced or discontinued.¹ When pregnant women addicted to heroin are concerned, these negative outcomes can affect the infants, too, one of which is neonatal abstinence syndrome (NAS).² However, comprehensive treatment specifically designed for pregnant women addicted to heroin which incorporates methadone and buprenorphine maintenance and is combined with prenatal care and can improve many of these outcomes.²

What Is Heroin?

Heroin is a highly addictive, rapidly acting opioid.¹ Abuse of prescription opioids can be a gateway for heroin abuse.² Like all opioids, heroin causes an intense sense of euphoria, which raises the risk of misuse.² With repeated exposure, the person can rapidly become tolerant to the drug, which means they need to increase intake to experience the desired effect.¹

Because of its short half-life, a person who has developed physical dependence to the drug needs to take multiple doses of the drug to avoid going into withdrawal.² All opioids come with a potential risk of respiratory depression, overdose, and a fatal outcome.² Individuals who inject heroin also face a higher risk of contracting hepatitis B, hepatitis C, and HIV.² 

Heroin Use in Women

Women face unique challenges when it comes to heroin abuse and other forms of substance abuse or polydrug abuse:³

• Women may develop substance addiction more quickly than men, and sex and gender differences may be the reason for this, and they ofen use the drug for a shorter period of time before entering treatment.
• Women typically use drugs in smaller quantities, but their reaction to the effects of drugs can be more intense and withdrawal symptoms can be more severe.
• Heroin addiction can also cause pregnancy problems. Using substances such as heroin during pregnancy can have a detrimental health effect on the pregnant woman and her fetus. Excessive and repeated maternal abuse of opioids such as heroin during pregnancy may cause NAS in newborns.
• Seeking substance use treatment during or after pregnancy can be challenging for social and legal reasons. Lack of support and assistance with child care during treatment can further aggravate the situation, which is why heroin addiction treatment and rehabilitation programs may also offer a solution for child care, parenting classes and job training.

Can Heroin Cause Problems in Pregnancy?

Heroin addiction can cause problems in pregnancy. The effects of heroin on the fetus can be devastating.² Chronic abuse of heroin can cause a range of short and long-term health risks and issues in pregnant women and their unborn or newborn babies, including:²

• Birth defects.
• Placental abruption.
• Premature birth.
• Neonatal Abstinence Syndrome (NAS).
• Stillbirth.

Heroin abuse also raises the risk of miscarriage and can have other detrimental effects on the fetus, as it can cause migraines, seizures, or high blood pressure in the mother.³

Babies born to heroin-addicted mothers may still need treatment for withdrawal symptoms even if the mother enters medication-assisted treatment. However, outcomes are improved if the mother begins treatment during pregnancy than if she continues to use opioids.³

Heroin Withdrawal During Pregnancy

Anyone who has been using heroin repeatedly over a longer period of time and develops dependance to the drug needs to go through detox. This is the process of eliminating the drug from the person’s system, in order to avoid or better manage the symptoms of withdrawal.¹ Cutting down the supply of heroin during pregnancy can cause the person to experience withdrawal, which is why withdrawal needs to be supervised and medically-assisted.¹

During opioid withdrawal, the person experiences:²

• Generalized and muscle pain.
• Nausea.
• Diarrhea.
• Sweating.
• Tearing and running nose.
• DIlated pupils.
• Tremor.
• Gooseflesh.
• Restlessness.
• Anxiety.

All these symptoms can have adverse effects on the unborn baby.²

Effects of Heroin Abuse on Babies

Substance use in pregnant mothers can lead to detrimental long-term effects, even a fatal outcome on babies born on heroin.³ 

Newborn babies can be subjected to withdrawal and different symptoms:³

• Tremors
• Seizures
• Vomiting
• Difficulty sleeping

Babies can also be born with smaller head size and low birth weight.³

Heroin and Breastfeeding

When it comes to mothers undergoing treatment for heroin addiction, breastfeeding is beneficial to the baby, as it decreases the severity of NAS, reduces the needs for pharmacotherapy, shortens the infant’s hospital stay, and provides immunity to the baby.²

However, the situation is different for women who are still using. Alcohol, nicotine, marijuana and other substances can be found in breast milk. Exposure to these substances through breast milk may cause long-term effects, although this has not been confirmed.³

However, it is certain that drugs can cause damage to the developing brain and affect the brain’s learning abilities, which may mean that drug-exposed babies can suffer lasting damage as well.³ 

For this damage potential to be eliminated, breastfeeding mothers addicted to heroin may need to take certain precautions and discuss their substance abuse with their health care providers.³

Heroin Rehab for Pregnant Women

Heroin rehab can help mitigate the potential damage of heroin abuse on the pregnant woman and the fetus. Do not hesitate to call our helpline and learn more about heroin addiction treatment options. American Addiction Centers can tailor treatment to accommodate the needs of persons struggling with heroin addiction, including that of treatment-seeking pregnant women. 

Frequently Asked Questions

What Are the Effects of Heroin on a Fetus?

Chronic untreated addiction to heroin can have fetal effects.¹ The common effects of heroin on a fetus include:²

• Lack of adequate prenatal care.
• Risk of inadequate fetal growth.
• Premature separation of the placenta from the uterus. 
• Passage of meconium or the initial stool in the uterus. 
• Preterm labor. 
• Fetal death.

Can Heroin Cause Seizures?

Heroin abuse can cause lasting brain damage. The drug puts individuals at risk of seizures, stroke and direct toxic effects on the brain. Repeated exposure to the drug over a period of time can also cause the person to develop heroin addiction, a chronic, relapsing brain disorder.⁴ 

Heroin can disrupt the function of multiple brain circuits responsible for controlling and regulating major functions such as learning and memory, decision-making, impulse control, stress management, and the ability to experience pleasure/reward in response to natural rewards such as positive social interactions.⁴

All this makes it difficult for anyone addicted to heroin to make the healthy choice to stop their drug-seeking and drug use, even if they are pregnant.⁴

How Long Does It Take to Get Heroin Out of Your System While Pregnant?

Withdrawal typically begins within 4 to 6 hours and peaks at 1-3 days of last use.² Over a period of 5 to 7 days, it begins to subside, although some individuals can experience persistent withdrawal signs for months.¹ Withdrawal can be managed using medications.¹

Why Is Heroin Abuse Bad for Developing Babies?

The key risk resulting from heroin abuse and its effects on developing babies is that of NAS. Untreated heroin addiction in pregnant women may be associated with lack of prenatal care, higher risk of restricted fetal growth and development, fetal death, premature labor, and other risks, and it can also cause mothers to engage in high-risk activities which could result in additional health risks.²

Mothers are also at a high risk of developing co-morbidity and mental health disorders, which treatment needs to address. Evaluating long-term outcomes of infants who were exposed to opioids is challenging due to potential exposure to other harmful substances such as tobacco, alcohol, and other illicit drugs, and other risk factors such as low socioeconomic status and poor and inadequate prenatal care.²

Although abuse of opioids such as heroin or methadone may not impair the cognitive development of developing babies, it is important to stage timely preventive interventions and provide continuing care and support to mothers during the early and ongoing parenting years and work on improving the children’s home environment on the whole.²

Can a Baby Be Born Addicted to Heroin/Drugs?

The unborn baby and its mother communicate through the placenta. If the mother uses heroin repeatedly, she can become dependent on the drug and develop addiction.² The substance can also pass through the placenta, causing the newborn to become dependent to the drug as well, or undergo NAS.² 

How Long Does It Take for a Baby to Go Through Withdrawal? 

Symptoms of NAS can develop immediately or up to 14 days after birth.³ The duration of withdrawal in babies depends on the type and severity of the symptoms, which depends on the  drug or drugs used by the mother, duration and frequency of substance use, how the mother’s body breaks down the drug and whether the baby was born prematurely.³

What Are the Symptoms of Neonatal Abstinence Syndrome?

Symptoms of NAS can include:³ 

• Blotchy skin.
• Excessive, high-pitched crying.
• Fever.
• Irritability.
• Seizures.
• Poor feeding. 
• Slow weight gain.
• Increased heart rate.
• Rapid breathing.
• Tremors and trembling.
• Diarrhea, 
• Vomiting.
• Sleep issues.

NAS may also cause death.³ The baby needs to be hospitalized and treated with medications to relieve symptoms. The medication is gradually tapered off so the newborn can adjust to being opioid-free. Even infants who were exposed to methadone during pregnancy may need to be treated for NAS.²

Can Heroin Impact the Psychological Growth of the Newborn?

Heroin can have a negative impact on newborns’ psychological growth and development and cause behavioral and cognitive problems.⁵ Women who use heroin and who are pregnant, considering pregnancy or breastfeeding should consult their health care provider to learn how to counteract the damage of heroin to the unborn or breastfeeding baby, and preferably seek appropriate comprehensive treatment.⁵

How Long Does Heroin Stay in Breastmilk?

Although breastfeeding is an essential component of postnatal care and it is normally encouraged, it may not be advised to pregnant women and mothers of newborns who are using heroin.² The nature, duration and frequency of substance abuse and the mother’s body’s ability to metabolize the drug or drugs affect whether the milk is safe for the baby.²

During the process of detoxification, the body gets rid of heroin, but before that happens, mothers may be advised to suspend breastfeeding.² Even if a woman has entered treatment and there are no contraindications, the risk of relapse and the risk of damage to the fetus or baby is high.² The levels of morphine in breast milk in nursing mothers who are using codeine or tramadol-containing medicines is considered to be high and unsafe, as this can potentially cause serious adverse effects or overdose in the baby.² However, for mothers who are receiving methadone or buprenorphine, breastfeeding is recommended since the transfer of these medicines into breast milk is minimal.²

Sources:

1. National Institute on Drug Abuse. (2020). Research Report Series: Heroin.
2. American College of Obstetricians and Gynecologists. (2017). Opioid Use and Opioid Use Disorder in Pregnancy. 
3. National Institute on Drug Abuse. (2020). Substance Use in Women DrugFacts.
4. National Institute on Drug Abuse. (2020). Neurological Effects. 
5. National Institute on Drug Abuse. (2020). Prenatal Effects.