Opioid abuse affects millions of Americans and is responsible for more than six out of every ten drug overdose deaths in the U.S. However, these numbers do not reflect the number of infants who are born struggling with opioid dependence. The nation’s ongoing opioid epidemic contributes to an increase in drug addicted babies, due to being exposed to substances in utero — a serious condition known as neonatal abstinence syndrome. Learn more about the substances most often linked to severe dependence in our Guide to treatment & recovery.
The incidence of neonatal abstinence syndrome in the U.S. increased substantially by 383% from 2000 to 2012, and affects roughly six out of every 1,000 hospital births. Some states have higher rates of neonatal abstinence syndrome than others. For example, in West Virginia, roughly 33.4 of every 1,000 infants are born physically dependent on opioids. These numbers are continuing to climb, and driving the expansion of addiction treatment for pregnant women in the U.S. healthcare system.
Here’s a closer look at neonatal abstinence syndrome, along with available addiction treatments that can help both pregnant women and infants who suffer from opioid dependency.
What is Neonatal Abstinence Syndrome?
Neonatal abstinence syndrome, or NAS, is a group of health conditions a baby suffers when he or she is born physically dependent on drugs their mother used during pregnancy. These health conditions are highly similar to the withdrawal symptoms teens and adults go through when quitting drugs and alcohol abruptly. This can put a baby’s life at risk. In the U.S., NAS is most commonly caused by a pregnant woman’s use of heroin, oxycodone, hydrocodone, and other opioids, or painkillers.
When a pregnant woman uses drugs and alcohol, these substances pass directly from the mother’s bloodstream to the fetus via the placenta. The fetus then becomes physically dependent on these substances, just like the mother. The baby experiences withdrawal, or NAS at the time of birth when the substances are withdrawn. Signs and symptoms of NAS usually begin within 24 to 48 hours of birth, but can occur as late as 10 days after birth. Common symptoms of NAS:
- High-pitched, excessive crying
- Tremors/trembling
- Sneezing
- Stuffy nose
- Excessive yawning
- Gagging
- Hiccupping
- Sweating
- Vomiting
- Diarrhea
- Dehydration
- Rapid breathing
- Hyperactive reflexes
- Feeding problems
- Sleep problems
- Seizures
- Fever
On average, one baby is born physically dependent on opioids in the U.S. every 19 minutes, according to a special report on NAS and opioid addiction conducted by Reuters. Also, admission rates of babies affected by NAS into neonatal intensive care units nearly quadrupled from 2004 to 2013, according to a study published in the New England Journal of Medicine. Symptoms of NAS can last between one week and six months, depending on the severity of the mother’s and/or baby’s addiction.
Treatment Options for Babies Born with Addiction
Ideally, pregnant women who suffer from substance abuse should seek addiction treatment immediately to avoid risking their life and that of their unborn baby’s. This allows doctors to develop customized treatment plans for babies that can help them overcome NAS shortly after birth. Unfortunately, pregnant women who struggle with addiction are less likely to seek treatment.
Medication Assisted Treatment
Most babies affected by opioid NAS are treated using morphine and other FDA cleared medications that mimic the effects of opioids, such as methadone and buprenorphine. Buprenorphine is the top opioid treatment of choice for infants born affected by NAS, according to another recent study published in the New England Journal of Medicine. The study reveals that treating NAS using buprenorphine instead of morphine dramatically reduces the amount of time babies spend in the hospital recovering from addiction.
When babies are affected by opioid addiction, they are provided with the lowest possible dosage of morphine or buprenorphine so they can eat, sleep, and comfortably interact with their mothers or caregivers. Babies are then weaned, or tapered off medications, throughout recovery and before being discharged from the hospital.
Specialized Recovery and Bonding Strategies
Babies affected by NAS are often irritable due to drug withdrawal symptoms and often experience difficulty being comforted. Research demonstrates that babies fare best when they spend time with their mothers, and usually require lower doses of medications as a result. Babies who bond with their mothers also spend less time recovering in neonatal intensive care.
Other factors that play an important role in a baby’s recovery from NAS are high caloric intake, intravenous fluids, and a dark, quiet environment. Babies often need more milk and formula due to increased activity during withdrawal, and require intravenous fluids to counteract dehydration caused by vomiting and diarrhea. A dark, quiet environment is often necessary to prevent overstimulation, which can overload a baby’s senses and lead to irritability.
Long-Term Effects of Babies Being Born with Addiction
Since the opioid epidemic has grown substantially worse in recent years, many cities, counties, and states lack substance abuse facilities with the resources needed to treat both mothers and infants affected by addiction. For instance, despite improvements in treatment options, many rural communities lack substance use facilities that are capable of treating mothers and babies. In 2020, nearly 1 in every 12 newborns was exposed to at least one type of substance before birth. This increases the risk of premature birth, low birth weight and a variety of other mental and physical disabilities.
Though infants born with NAS usually overcome physical dependence on drugs and alcohol before leaving the hospital, these babies are often at higher risk for addiction due to factors including genetics and environment. Having a family history of addiction increases a child’s risk for substance abuse and addiction later in life, while an unhealthy home environment can also influence alcohol and drug abuse.
Children with parents who struggle with addiction are often exposed to violence and drug abuse, and may face health problems triggered by poor nutrition. These children are also at higher risk for physical health problems, as well as psychological health conditions, including depression, anxiety and bipolar disorder. Many times, babies born addicted to drugs go on to suffer cognitive and behavioral problems, as well as problems that range from poor concentration and focus to developmental delays in motor control.
Long-term effects of commonly abused substances on babies:
Many addiction treatment experts believe children born affected by NAS have the opportunity to thrive emotionally, physically, and behaviorally when their mothers maintain sobriety. However, ongoing addiction treatment and aftercare are often needed to help moms avoid relapse and stay sober.
Alcohol
Alcohol addiction can lead to newborns with a Fetal Alcohol Spectrum Disorder, a classification with three main disorders: Fetal Alcohol Syndrome, Fetal Alcohol Effects, and Alcohol-Related Neurodevelopmental Disorder. These disorders can lead to physical abnormalities, cognitive delays, poor motor skills, and emotional and behavioral issues.
Cocaine
Cocaine addiction leads to brain chemistry changes in dopamine and serotonin in utero, which can correct naturally as the child ages. However, babies born addicted to cocaine are at higher risk for mental health disorders, hyperactivity disorders, and heart disease later in life.
Marijuana
Regular marijuana use during pregnancy increases the risk for premature birth, low birth weight, and behavioral issues later in life.
Heroin and painkillers
Opioid abuse during pregnancy is linked to numerous cognitive impairments, low birth weight, and small head circumference. Studies show that heroin use in particular is more likely to negatively affect a child’s home environment and increase the risk for addiction later on.
Risks of Not Seeking Addiction Treatment While Pregnant
Stigma is a major barrier for pregnant women who suffer from addiction and need treatment. Many pregnant women who show up at hospitals and clinics for addiction treatment report feeling judged and unwelcome, and tend to avoid staying with the treatment program as a result. Some pregnant women even tend to avoid seeking addiction treatment for fear of losing their children or facing other legal consequences, even though addiction is officially declared a chronic, relapsing brain disease in the U.S.
Failing to seek addiction treatment while pregnant increases both the mother’s and the baby’s risk for serious health complications that can lead to death. For instance, a severe heroin addiction can lead to an overdose or coma, which may trigger miscarriage or stillbirth, or maternal death. Heart defects, HIV, hepatitis C, and NAS are among the most common complications associated with drug and alcohol abuse during pregnancy.
Pregnant women who suffer from addiction often display the same symptoms and signs of drug abuse as those who are not pregnant. Many times, pregnant women will go out of their way to hide their addiction due to the stigma surrounding drug use during pregnancy. Certain symptoms, such as changes in eating and sleeping patterns, can be difficult to pinpoint as addiction, since these are also common pregnancy symptoms.
Common signs of addiction during pregnancy include:
- Hiding alcohol and drug use from others
- Lying and secretive behavior
- Decline in personal hygiene
- Changes in sleeping patterns
- Changes in appetite
- Loss of interest in favorite hobbies and activities
- Sudden changes in behavior
- Decline in performance at work or school
- Shaking and tremors
- Red, bloodshot eyes
- Constricted or dilated pupils
If you are pregnant and suffer from addiction, or know someone who is pregnant and needs help fighting addiction, there are many safe, effective treatment options available. Seeking addiction treatment while pregnant lowers the risk for serious health complications that can affect both the mother and baby.
Available Addiction Treatment Options for Pregnant Women
Pregnant women who need help overcoming addiction often require specialized treatment plans that won’t put them or their unborn babies at further risk. Treatment plans are normally based on the mother’s health and psychiatric history, the substance used, and the lifespan of the addiction. Pregnant women who seek addiction treatment will usually undergo a professional assessment at the time of intake so doctors can identify the safest treatment methods based on these factors.
Substance abuse is commonly treated using detoxification and counseling. Detox helps pregnant women overcome physical dependency on drugs and alcohol, while counseling helps women overcome mental health conditions and other psychological problems that may be driving addiction. These treatments are offered at most inpatient and outpatient treatment facilities throughout the U.S.
Pregnant women suffering from addiction may need help and guidance when researching their options for treatment facilities. Not all facilities have services that cater to pregnant women. It’s important to help pregnant women find facilities that offer free or low-cost addiction treatment due to the high-risk nature of substance use during pregnancy. For more on evidence-based recovery methods and what makes treatment effective, see our Guide to treatment & recovery.
Common addiction treatment services that can benefit pregnant women include:
- Inpatient care with lodging for mothers and children
- Facilities located near hospitals and birthing centers
- Medication maintenance therapies proven safe for use during pregnancy
- Detox therapies proven safe for use during pregnancy
- On-site obstetricians and maternity nurses
- Prenatal care
- Individual, group, and family therapy
- 12-step support groups
- Sober living facilities overseen 24/7 by medical staff
- Women-specific addiction therapies
- Parental education
- Pregnancy education
- Transportation services
Inpatient rehab facilities are often the better choice for pregnant women since they typically offer 24/7 care and safe, controlled environments away from negative influences. Some facilities offer behavioral counseling and similar therapies that teach pregnant women how to control cravings following pregnancy, and how to improve their home environments to lower their children’s risk for addiction later in life. When researching facilities, ask about the services offered which are geared toward pregnant women, and about the facility’s experience in treating babies affected by NAS.