ARTICLE OVERVIEW: Heroin addiction during pregnancy is associated with several significant medical and obstetrical complications and may result in both acute and chronic abnormalities. There are treatments that can help heroin addicts; however there is a controversy about treating addictions with methadone during pregnancy. If you want to know more keep reading. Then, we invite you to leave your questions at the end.
TABLE OF CONTENTS:
- Heroin and Your Health
- Problems In Pregnancy
- Infant Withdrawal
- Difficult Choices You Have To Face
- Treating Dependency
- Medical Treatments
- Quitting Cold Turkey
- Who’s Using?
- There Is Hope!
Heroin And Your Health
When you are pregnant, you are not just “eating for two.” You also breathe and drink for two, so it is important to carefully consider what you give to your baby. If you take illegal drugs, so does your unborn baby.
Heroin is an opiate drug. Heroin affects your central nervous system and how your brain works. Using heroin can cause serious health problems, including:
- Chronic constipation.
- Collapsed veins.
- Deterioration of white matter in the brain.
- Diminished sex drive.
- Heart infections.
- Kidney disease.
- Lack of stress-control skills.
- Liver disease.
- Pulmonary infections.
- Skin infections.
Problems In Pregnancy
So, can heroin cause problems in pregnancy?
Yes it does. Untreated addictions during pregnancy can have devastating consequences for the unborn baby. Fluctuating levels of opiates in the mother may expose the fetus to repeated periods of withdrawal, which can harm placenta function.
Other direct physical risks include:
Birth defects. These are health conditions that are present at birth. Birth defects change the shape or function of one or more parts of the body. They can cause problems in overall health, how the body develops, or in how the body works.
Low birthweight. This is when a baby is born weighing less than 5 pounds, 8 ounces).
Neonatal abstinence. Withdrawal happens when a baby is exposed to a drug in the womb before birth and then goes through drug withdrawal after birth.
Placental abruption. A serious condition in which the placenta separates from the wall of the uterus before birth. The placenta supplies the baby with food and oxygen through the umbilical cord. Placental abruption can cause very heavy bleeding and can be deadly for both mother and baby).
Preterm labor. In these cases, heroin triggers a birth that happens too early, before 37 weeks of pregnancy.
Stillbirth. When a baby dies in the womb after 20 weeks of pregnancy.
Sudden infant death syndrome. Also called SIDS. This is the unexplained death of a baby younger than 1 year old.
Other indirect risks to the fetus include:
- Dangers from drug seeking (e.g., violence and incarceration).
- Increased risk for maternal infection (e.g., HIV, HBV, HCV).
- Malnutrition and poor prenatal care.
If you are pregnant and using heroin, we urge you to consider quitting. However, do not stop taking it without getting treatment from your health care provider first. Cold turkey withdrawal can cause severe problems for your baby, including death. Your health care provider or a drug treatment center can treat you with drugs like methadone or buprenorphine. These drugs can help you gradually reduce your dependence on heroin in a way that is safe for your baby.
Complications for the child are inevitable, whether or not the addicted mother stops using: withdrawal symptoms affect the unborn child if the mother stops; continued use can result in giving birth to an addicted infant. Additionally, health and lifestyle issues related to drug use have a high likelihood of adverse effect on a fetus.
If the unborn child is exposed to heroin to the extent that it develops dependency, upon birth it will face withdrawal, known as Neonatal abstinence syndrome. This type of withdrawal occurs primarily among infants shortly after birth, often manifested by central nervous system irritability, autonomic overreactivity, and gastrointestinal tract dysfunction. The symptoms include:
- Blotchy skin coloring (mottling).
- Excessive crying or high-pitched crying.
- Excessive sucking.
- Hyperactive reflexes.
- Increased muscle tone.
- Poor feeding.
- Rapid breathing.
- Sleep problems.
- Slow weight gain.
- Stuffy nose, sneezing.
- Trembling (tremors).
Withdrawal symptoms usually begin 24 and 72 hours after birth and can last up to five days, although symptoms can be present much earlier. Pharmacological intervention is required for 50 to 70% of infants. In fact, sustained symptom escalation often requires pharmacological intervention with methadone or morphine. Once symptoms remediate, treatment medication is weaned on a modified protocol that can extend for three weeks or more.
Whether or not an infant requires treatment is affected by genetic factors, other drug exposures, gestational age, breastfeeding, and rooming-in. On the other hand, if the mother stops using heroin abruptly while still pregnant, the result can be fetal distress, preterm labor, or even the death of your baby.
Difficult Choices You Have To Face
If you are an expectant mother and face heroin addiction, you have a difficult choice. Hopefully, protecting your unborn child will tilt the scales in favor of getting clean. The issue is finding a way to abstain that promotes maximum protection for the child. Another concern, of course, will be about minimizing your own discomfort during the inevitable withdrawal episode.
However, you are not alone. Treating heroin addiction is not easy, but it isn’t impossible, it can save your life and that of your baby.
Treating Heroin Dependency
Professional treatment is always indicated for drug dependency, but is especially recommended during pregnancy. In fact, treatment centers exist that have special programs tailored for pregnant women. What are the core treatment options?
Medically supervised detox is a critical component that ensures optimum outcome for mother and child. Appropriate medication to alleviate withdrawal symptoms, hydration and nutrition, monitoring for life-threatening events, examination for and treatment of other health issues. Plus, it helps to be in an environment where you are safe and supportive. Post-Acute Withdrawal Syndrome, or PAWS, leave you vulnerable to relapse unless you continue a longer term treatment.
A caring and understanding environment is especially important for a newly abstinent expectant mother, as the temptation to leave treatment and resume drug use is powerful after detox.
Counseling is necessary to prepare the addict for the responsibilities of life and motherhood after discharge. Mental and emotional issues, coping methods, and relapse triggers and their avoidance are discussed at depth. Counseling also is critical in instilling an appropriate understanding of the dynamics of addiction and the likelihood of relapse in order to motivate the addict to cooperate in an aftercare program.
Q: Do medicines help?
1. Methadone has been used to treat pregnant women with opioid use disorder since the 1970s and was recognized as the standard of care by 1998. Using methadone improves outcomes! Maintenance therapy with methadone or buprenorphine provides a steady concentration of opioids in your blood, preventing the fetus from repeatedly experiencing cycles of opioid toxicity and withdrawal.
2. Researchers are investigating the potential to use buprenorphine and naloxone (i.e., Suboxone) instead of methadone in pregnancy. Research is still emerging, and one study found that babies born to mothers who were treated with buprenorphine and naloxone had less incidence of Neonatal abstinence abuse and shorter hospital stays.
Pregnant women who receive maintenance therapy with methadone or buprenorphine often require comprehensive medical treatment, including routine prenatal care. For example, research has shown that pregnant women admitted to substance use treatment for opioid misuse often need referrals to routine prenatal medical care.
It’s not recommended that you stop heroin, “cold turkey.” This sudden stoppage can cause the brain to try and restore balance, and lead to both physical and psychological withdrawal symptoms. There are potential concerns and symptoms to be aware of when the individual detoxing is pregnant.
Sudden withdrawal for unborn babies can cause respiratory depression, which can lead to the fetus not getting enough oxygen and may be fatal. Plus, psychological symptoms can also induce anxiety and depression in mothers, which may be heightened by the stress of pregnancy and hormones.
Heroin use has increased sharply across the United States among men and women, most age groups, and all income levels. Some of the greatest increases occurred in demographic groups with historically low rates of heroin use: women, the privately insured, and people with higher incomes.
With the rising use of opiates in the U.S., heroin use in pregnancy is on the increase, as well. The past decade has seen a rise in the proportion of infants who have been exposed to opioid drugs, inclusive use of heroin at childbirth. Between 2000 and 2009, opioid use among women who gave birth increased in the United States from 1.19 to 5.63 per 1,000 hospital births per year. A tandem increase has been seen in the incidence of Neonatal abstinence abuse among newborns during the same period (from 1.20 per 1,000 hospital births.
The 2007 to 2012 National Surveys on Drug Use and Health (NSDUHs) indicate that an annual average of about 21,000 pregnant women aged 15 to 44 misused opioids in the past month. NSDUH data also indicate that, among pregnant women, past month opioid misuse was more common among those aged 15 to 17 and 18 to 25 than among those aged 26 to 34 (2.8 and 1.5 percent vs. 0.5 percent) and more common among those living below the federal poverty level than among those living at or above the federal poverty level (1.6 vs. 0.7 percent).
According to the 2012 Treatment Episode Data Set, 21,553 female substance use treatment admissions aged 15 to 44 were pregnant at treatment entry. Of these 21,553 admissions, 22.9 percent reported heroin as a substance of misuse.
The findings suggest that outreach and educational resources targeting younger pregnant women and women living below the federal poverty level about the dangers of misusing heroin may be especially beneficial. The health insurance gap among pregnant treatment admissions suggests that these women may need assistance in navigating the health insurance and health service opportunities provided by the Affordable Care Act to ensure critical access to the health care system.
There Is Hope!
Heroin use in pregnancy is tough on both mother and child. But treatment is the best hope for troubled mothers-to-be, and the alternatives, continuing drug use or attempting to stop unsupervised, are dangerous and untenable.
If you, or someone you love, have this problem and have some questions about being pregnant and being on heroin, please leave us your questions in the comments section at the end. We will do our best to respond to you personally and promptly. We can help you!
Reference Sources: CDC: Morbidity and mortality weekly report (MMWR): Incidence of neonatal abstinence abuse
MedlinePlus: Pregnancy and Substance Abuse
MedlinePlus: Neonatal abstinence syndrome
NCBI: Buprenorphine VS methadone treatment: A review of evidence in both developed and developing worlds
NCBI: Methadone maintenance treatment
NCBI: Heroin addiction and pregnancy
NIH: Buprenorphine treatment in pregnancy: less distress to babies
NIH: Treating opioid use disorder during pregnancy
SAMHSA: Women of childbearing age and opioids
All of the information on this page has been reviewed and verified by a licensed medical professional.