Women who struggle with heroin addiction and become pregnant often want to stop using for the health of their unborn child. While well-intended, suddenly stopping heroin use can put the fetus at great risk, and may do more harm than good. However, with proper treatment, it is possible to increase the odds of a successful pregnancy and the delivery of a healthy baby.
In the past decade, there has been a rise in the number of infants who have been exposed to heroin at birth. Roughly 21,553 female substance use treatment admissions (ages 15 to 44) in 2012 were pregnant when they started treatment. Of those admitted, 22.9 percent reported heroin as their primary substance of misuse, according to the Treatment Episode Data Set (TEDS) from that year.
Risks Of Heroin Abuse During Pregnancy
When a woman struggles with heroin addiction, they are not able to control or monitor their impulse to use the drug. This can cause the level of heroin in their system to fluctuate from one extreme to the other, and may also expose the fetus to repeated periods of withdrawal. The more frequently this happens, the more likely the placenta will become damaged which may result in miscarriage or premature birth.
Possible physical risks to the fetus include:
- neonatal abstinence syndrome
- stunted growth
- preterm labor
- fetal convulsions
- fetal death
Some indirect risks to the fetus can also be the result of how heroin is affecting the mother. This can include increased risk of maternal infection (HIV, HBV, HCV) with needle administration of heroin. Chronic abuse of the drug may also result in maternal malnutrition and poor prenatal care. Drug-seeking behavior can also increase the risk of pregnant individuals participating in violent behaviors or becoming incarcerated.
What Is Neonatal Abstinence Syndrome?
Neonatal abstinence syndrome (NAS) happens when an infant becomes dependent on opioids, such as heroin, used by the mother during pregnancy. When the infant experiences withdrawal from the drug, it may also suffer withdrawal symptoms. These symptoms may include tremors, diarrhea, fever, irritability, seizures, and difficulty feeding. The number of infants born with NAS has increased fivefold in the U.S. between 2000 and 2012, in tandem with the increased rate of opioid-prescribing to pregnant women.
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While it is dangerous to suddenly stop using heroin in the midst of an addiction, there are treatment options pregnant women may begin during their pregnancy. These include methadone maintenance and buprenorphine (Suboxone, Subutex) replacement therapy.
Methadone Vs. Buprenorphine Treatment
Methadone has been used to treat pregnant women struggling with heroin addiction since the 1970s and was officially recognized as the standard of care by 1998. Since that time, buprenorphine has also been shown to be an effective treatment option.
Recent research showed that methadone is associated with higher treatment retention, although the medication carries a high potential for abuse. However, buprenorphine treatment resulted in 10 percent lower incidence of neonatal abstinence syndrome, decreased neonatal treatment time by about eight days, and less morphine needed to treat NAS.
Both medication-assisted treatments are supported by the American Society of Addiction Medicine. To determine the best option for individual situations, it is best to discuss it with a healthcare professional who ensures all factors are considered.
Benefits Of Treatment During Pregnancy
When compared to untreated pregnant women, those who receive treatment were found to have a lower risk of neonatal abstinence syndrome, less severe NAS, shorter treatment times, and higher gestational age, weight, and head circumference at birth.
Treatment with either medication can improve health outcomes for mom and child by:
- stabilizing fetal levels of opioids, which reduces repeated prenatal withdrawal
- providing mothers with infectious disease (HIV, HBV, HCV) treatment, reducing the likelihood of transmitting them to the unborn baby
- potentially providing better prenatal care
- improving long-term health outcomes for both mother and child
Breastfeeding During Treatment
Usually, breastfeeding rates are low among mothers with heroin use disorder. However, studies have shown that breastfeeding can reduce the length of hospital stay and the need for morphine treatment in infants.
Unless there is a specific medical concern such as maternal HIV infection, encouraging new mothers to breastfeed and swaddle their newborns may help ease uncomfortable NAS symptoms and improve mother-child bonding.
Pregnant Women And Barriers To Heroin Addiction Treatment
Research findings suggest that the ongoing attempts to criminalize substance use during pregnancy can greatly discourage women from seeking addiction treatment, as well as prenatal care. Pregnant women who abuse substances, especially women of color or lower socioeconomic standing, were found to be more subject to increased surveillance and may face punishment, such as arrest, prosecution, conviction, and/or child removal.
Treatment For Heroin Addiction In Pregnant Women
Safely withdrawing from heroin can be a lengthy process, especially when an unborn baby must also be considered. Inpatient addiction treatment is often the most effective way to administer either methadone maintenance or buprenorphine therapy to mother and fetus.
Residential treatment programs require an individual to live at the treatment facility, giving them a new, stigma-free environment to aid in their recovery. These treatment programs also provide round-the-clock medical supervision so that if any adverse symptoms arise, they can be addressed right away.
For more information on treating heroin addiction in pregnant women, contact a specialist today.
For more information be sure to check out these additional resources from DrugRehab.org:
- Drug Addiction And Babies: Long-Term Effects
- Are Babies Predisposed To Drug Addiction?
- What Helps With Heroin Withdrawal?
Sources
National Institute on Drug Abuse — Treating Opioid Use Disorder During Pregnancy
Substance Abuse and Mental Health Services — Women of Childbearing Age And Opioids
