Using Heroin While Pregnant

The use of opioid drugs such as heroin while pregnant can lead to neonatal abstinence syndrome, birth defects, premature birth, stillbirth, and low birthweight.

Quitting cold turkey can pose risks to the child and the mother, and the safest course of treatment is the use of medications such as methadone and buprenorphine. Pregnant mothers who are dependent on heroin should also receive counseling and prenatal care while in treatment.

Risks to Child

Heroin use during pregnancy exposes the mother and unborn child to many short-term and long-term risks.

One of the most common risks is neonatal abstinence syndrome (NAS), a set of health problems that can affect newborns exposed to heroin in the mother’s womb. As the mother ingests heroin, she passes it through the placenta to the baby, causing the unborn baby to become dependent on the drug.¹ According to the Substance Abuse and Mental Health Services Administration, NAS occurs in 70% to 95% of babies born to women who are opioid-dependent.²

Symptoms of NAS usually occur within 1 to 3 days after birth. But they may not appear for up to a week. Babies with NAS usually need to remain in the hospital for up to a week after they are born to be monitored.¹

Symptoms include:¹

• Difficulty gaining weight.
• Shaking.
• Poor appetite or difficulty feeding.
• Fever.
• A great deal of crying and high-pitched cries.
• Digestion issues such as diarrhea and vomiting.
• Patchy skin.
• Difficulty sleeping.
• Fast breathing.
• Seizures.
• Sensitive reflexes.

Symptoms of NAS vary depending on:¹

• How long the mother used the drug.
• The amount of the drug the mother used.
• Genetic factors that determine how the mother’s body breaks down and metabolizes the drug.
• How long the baby was carried in the womb before delivery.

In addition to NAS, heroin use while pregnant can also lead to:

• Placental abruption—a condition in which the placenta detaches from the uterine wall before birth.
• Sudden infant death syndrome—the unexplained death of a baby younger than 1 year old.
• Premature birth.
• Birth defects.
• Low birth weight.
• Stillbirth.³

Long-Term Effects

Children whose mothers used during pregnancy or who grew up in households where parents used heroin may also experience:

• Problems with attention, hyperactivity, and behavior.⁴
• Smaller heads and lower weight at birth.⁴
• Greater likelihood of behavioral issues in school, failing grades, and school truancy.⁵
• Greater risk of poor nutrition, poverty, and chaotic family environments.⁶
• Impaired intellectual functioning.⁶

Effects of heroin use on the mother can include:

• Heart and lung infections.
• Respiratory failure.
• Liver and kidney disease.
• The risk of acquiring blood-borne infections such as HIV and hepatitis, when the drug is injected.
• Coma.³

How Many Pregnant Women Use Heroin?

The number of babies exposed to opioids in the womb has increased in recent years. Between 2000 and 2009, opioid use among women who gave birth in the U.S. increased from 1.19 to 5.63 per 1,000 births per year.²

Women of certain age groups and socioeconomic backgrounds may be more likely to use heroin during pregnancy.

• National surveys conducted between 2007 and 2012 showed that roughly 21,000 pregnant women ages 15 to 44 years old misused opioids within the previous 30 days each year.
• Among pregnant women, those between the ages of 15 and 17 and 18 and 25 were more likely to misuse opioids including heroin in the past month than 26- to 34-year olds.
• Pregnant women living in poverty were more likely to misuse opioids (1.6%) than women living at or above the federal poverty line (0.7%).
• According to 2012 data, there were 21,553 pregnant women between the ages of 15 and 44 admitted to substance use treatment. Of those, 22.9% were admitted for heroin use and 28.1% were admitted for other opioid use.²

Going Cold Turkey

Quitting heroin cold turkey while pregnant is not recommended. It can cause both premature delivery or miscarriage.⁷

Withdrawal symptoms for heroin are commonly described as being “flu-like” and often begin 8 to 24 hours after use. They can last for as many as 10 days. Symptoms include:⁷

• Anxiety.
• Difficulty falling and staying asleep.
• Nausea.
• Vomiting.
• Diarrhea.
• Muscle cramps.
• Rapid change in body temperature.

Withdrawal for an addicted mother can be so intense that it increases the likelihood of relapse to relieve symptoms.

Additionally, vomiting and diarrhea during unmanaged withdrawal can lead to an imbalance of the body’s electrolytes and dehydration. Severe vomiting can rip the area where the esophagus attaches to the stomach, which can cause gastrointestinal bleeding.⁸

How to Quit

The safest way to quit using heroin and other opioids while pregnant is medication-assisted treatment (MAT).^2,3 MAT uses medications and counseling to help the person achieve a full recovery.⁹

Methadone and buprenorphine are the two common medications used in MAT. These medications reduce cravings and ease or prevent withdrawal symptoms.⁹ A mother who experiences a reduction in symptoms and cravings is less likely to relapse on heroin, significantly reducing her risk of acquiring HIV and other diseases associated with IV drug use.

Methadone has been the primary method of MAT for pregnant mothers for many years. However, research suggests that buprenorphine is just as effective—if not more so—as methadone for pregnant mothers who are addicted to heroin.

• In a study conducted by National Institute on Drug Abuse (NIDA), babies born to mothers treated with buprenorphine were discharged from the hospital sooner than babies born to mothers treated with methadone.¹⁰
• In another study, babies born to mothers who received buprenorphine were born with bigger heads, had milder or no NAS symptoms, weighed more, and were more likely to be delivered on or near their due date compared to babies born to mothers on methadone.¹¹
• Another NIDA study found that using sublingual buprenorphine to treat NAS symptoms in newborns led to a decrease in the number of days the babies stayed in the hospital as well a decrease in the amount of time the babies were treated for NAS symptoms compared to treatment with morphine.¹⁰

Pregnant women with substance abuse or dependence will also require specialized prenatal care to address the needs of both the mother and the baby. If the facility where they are treated doesn’t offer this care, the staff can usually refer them to another facility that does.

If you are pregnant and want to become drug-free, talk to your healthcare provider about substance abuse options or research programs online to find one that suits your needs.

If you’re looking for low-cost or free programs in your area, the Substance Abuse and Mental Health Services Administration offers a free directory that you may find helpful. Medicaid also offers substance abuse treatment coverage for low-income mothers. Visit the program’s website to see if you qualify.

Sources

[1]. U.S. National Library of Medicine. (2018). Neonatal abstinence syndrome.

[2]. Smith, K., and Lipari, R. (2017). Women of childbearing age and opioids. Substance Abuse and Mental Health Services Administration, CBHSQ Report.

[3]. March of Dimes. (2016). Heroin and pregnancy.

[4]. Ornoy, A., Michailevskaya, V., Lukashov, I., Bar-Hamburger, R., and Harel, S. (1996). The developmental outcome of children born to heroin-dependent mothers, raised at home or adopted. Child Abuse & Neglect, 20(5), 385-396.

[5]. Lester, B.M, and Lagasse, L.L. (2010). Children of addicted women. Journal of Addictive Diseases, 29(2), 259-276.

[6]. Oei, J.L., Melhuish, E., Uebel, H., Azzam, N., Breen, C., Burns, L., and Wright, I.M. (2017). Neonatal abstinence syndrome and high school performance. Pediatrics, 139(2).

[7]. World Health Organization. (2009). Clinical guidelines for withdrawal management and treatment of drug dependence in closed settings.

[8]. American College of Gastroenterology. (2012). Nausea and vomiting.

[9]. Substance Abuse and Mental Health Services Administration. (2015). Medication and counseling treatment.

[10]. National Institute on Drug Abuse. (2018). Heroin: How does heroin use affect pregnant women?

[11]. Meyer, M.C., Johnston, A.M., Crocker, A.M., & Heil, S.H. (2015). Methadone and buprenorphine for opioid dependence during pregnancy: A retrospective cohort study. Journal of Addiction Medicine 9(2), 81-86.