Opioids & Pregnancy
Prenatal substance exposure occurs when a pregnant woman uses alcohol, tobacco and/or drugs, whether prescribed or not, at any time during her pregnancy. Alcohol and other substance use during pregnancy can lead to serious long-lasting consequences for women and infants including miscarriage, still birth, fetal alcohol spectrum disorders (FASD) and neonatal abstinence syndrome (NAS).
Research & Statistics
- Drug Overdose Deaths Among Women Aged 30–64 Years — United States, 1999–2017
The drug epidemic in the United States continues to evolve. The drug overdose death rate has rapidly increased among women, although within this demographic group, the increase in overdose death risk is not uniform. From 1999 to 2010, the largest percentage changes in the rates of overall drug overdose deaths were among women in the age groups 45–54 years and 55–64 years; however, this finding does not take into account trends in specific drugs or consider changes in age group distributions in drug-specific overdose death rates.
What are Opioids?
Prescription opioids are painkillers often used for pain after an injury, surgery or dental work. They include codeine, morphine and oxycodone. Non-prescription or “street drugs” include heroin.
A prescription medication is one your medical provider gives you to treat a health condition. Some common prescriptions opioids are:
Buprenorphine (Belbuca, Buprenex, Butrans, Prouphine)
Fentanyl (Actiq, Duragesic, Sublimze)
Hydromophone (Dalaudid, Exalgo)
Methadone (Dolophine, Methadose)
Oxycodone (OxyContin, Percodan, Percocet)
Tramadol (ConZip, Ryzollt, Ultram)
The illegal drug, heroin, is an opioid. Heroin is often laced with other drugs such as fentanyl or cocaine which makes it extremely dangerous.
Opioids are highly addictive. Along with relieving pain, opioids release chemicals in the brain that make one feel calm and experience an intense feeling of euphoria. This can lead to over use and then addiction. Once addicted to a prescription opioid, people may start to buy the drug illegally and may start using heroin. Addiction to opioids is called an opioid use disorder.
Is there treatment for opioid use disorder during pregnancy?
Yes. Medicated Assisted Treatment (MAT) is the standard of care for pregnant women with opioid use disorders. MAT stabilizes the mother, prevents withdrawal and assists the mother with making connections to prenatal care. Abrupt withdrawal of the expectant mother from opioids is not recommended due to the high rates of preterm labor, fetal distress or miscarriage. MAT with methadone or buprenorphine have been shown to be safe and effective in treating opioid dependence during pregnancy. MAT should be comprehensive and include prenatal care, psychosocial therapy and support services to assist the woman in maintaining her recovery. MAT may not eliminate the risk of NAS, however, it provides the best chance for a healthy mother and newborn as well as the best chance for the mother’s continued recovery. Once the baby is born, the mother will continue with MAT and work with her health care provider about future MAT.
Another treatment that is used in conjunction with MAT is inpatient or outpatient drug use disorder treatment. This involves counseling, both individual and group as well as education and support in developing a drug free lifestyle.
Can opioids cause problems for the baby during pregnancy and after birth?
Yes. Using opioids during pregnancy could result in miscarriage, preterm labor or premature birth, birth defects, small for gestational age, low birth weight or being born weighing less than 5 pounds, 8 ounces, or neonatal abstinence syndrome.
Is it safe to suddenly quit taking opioids during pregnancy?
No. Suddenly quitting or “going cold turkey” during pregnancy can cause severe issues for the expectant mother and the unborn baby. Quitting opioids suddenly may increase the risk of placental abruption, a serious condition in which the placenta separates from the uterine wall before birth. It can cause heavy bleeding that can be life threatening to the mother and lead to premature birth. It is important that the mother speak with her prenatal health care provider prior to stopping opioid use. If the expectant mother is addicted to opioids, she may be referred for Medicated Assisted Treatment. Neonatal Abstinence Syndrome is easier to treat for babies whose moms get MAT during pregnancy.
What is Neonatal Abstinence Syndrome (NAS)?
Neonatal Abstinence Syndrome or NAS refers to a treatable condition that newborns experience after chronic exposure to certain substances, primarily opioids, while in utero. While repeated exposure to benzodiazepines, barbiturates, and alcohol have also been linked to infant withdrawal symptoms, chronic opioid use is the most common source of NAS.
Newborns may exhibit symptoms that include difficulty feeding, irritability, high-pitched cry, problems with calming/settling, and difficulty sleeping. These symptoms may last anywhere from a few days to several weeks after birth. It is recommended by the American Academy of Pediatrics that newborns with NAS initially receive treatment using non-pharmacologic means. These include rooming-in, gentle handling, swaddling, and breastfeeding also known Eat, Sleep, Console. Medication is indicated to relieve more severe symptoms of NAS when the other interventions have been unsuccessful.