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 come out of the womb struggling with an opioid dependence. The nation’s ongoing opioid epidemic is contributing to an increase in babies born addicted to drugs, due to being exposed to them in utero — a serious condition known as neonatal abstinence syndrome.
The incidence of neonatal abstinence syndrome in the U.S. has increased substantially by 383 percent 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, such as West Virginia, in which 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 among U.S. healthcare systems.
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 the drugs their mother used during pregnancy. These health conditions are highly similar to the withdrawal symptoms one goes through when quitting drugs and alcohol abruptly, and 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, and experiences withdrawal, or NAS at the time of birth when they are no longer being exposed to these substances. Signs and symptoms of NAS usually begin within 24 to 48 hours of birth, but can occur as late as 10 days after birth, in rare cases.
Common symptoms of NAS:
- High-pitched, excessive crying
- Tremors / trembling
- Stuffy nose
- Excessive yawning
- Rapid breathing
- Hyperactive reflexes
- Feeding problems
- Sleep problems
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. NAS can last anywhere 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 would allow doctors to develop customized treatment plans for babies that can help them overcome NAS shortly after being born. Unfortunately, pregnant women who struggle with addiction are less likely to seek treatment.
Most babies affected by NAS in the form of opioid addiction are treated using morphine and other FDA-approved 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.
For instances in which babies are affected by opioid addiction, babies 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 these medications throughout recovery prior to being discharged from the hospital.
Babies affected by NAS are often irritable due to drug withdrawal symptoms, and often experience difficulty with achieving a sense of comfort. But research shows that babies fare best with recovery when spending time with their own 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 lend to irritability.
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, there are 40 counties in the Ohio Valley that lack substance abuse facilities, and in counties that do have facilities, not all are equipped to treat postpartum women and their infants. This is concerning for families and communities throughout the Ohio Valley, considering both Ohio and Kentucky have some of the country’s highest rates of opioid addiction. In Kentucky alone, only 32 percent of substance abuse facilities are available to pregnant women who suffer from addiction.
Long-Term Effects of Babies Being Born with Addiction
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 kids 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:
Alcohol addiction can lead to children being born 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 addiction leads to brain chemistry changes in dopamine and serotonin in utero, which often correct themselves 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.
Regular marijuana use throughout pregnancy increases the risk for premature birth, low baby 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.
Many addiction treatment experts say that children born affected by NAS have the opportunity to thrive emotionally, physically, and behaviorally as long as their mothers maintain sobriety. However, ongoing addiction treatment in the form of aftercare is often needed to help moms avoid relapse and stay sober for life.
Risks of Not Seeking Addiction Treatment While Pregnant
Stigma remains 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 sticking with treatment 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 and baby’s risk for serious health complications that can lead to death. For instance, a severe addiction to heroin 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 more 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 on addiction, since these are also common pregnancy symptoms.
Common signs of addiction during pregnancy:
- 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 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 unique health and psychiatric history, as well as on the substance being 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, since many facilities lack services that cater specifically to pregnant women due to funding, staffing, and aftercare barriers. However, many rehab facilities do offer free or low-cost addiction treatment to pregnant women due to the high-risk nature of these pregnancies.
Common addiction treatment services that can benefit pregnant women:
- 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 more ideal for pregnant women since these facilities 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 urges to use 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 services geared toward pregnant women, and about the facility’s experience in treating babies affected by NAS.