Heroin’s Effects on Pregnancy
Heroin is an illegal and highly addictive substance that may be injected, smoked, or snorted. This powerful opiate drug can easily harm any user, and it can cause numerous problems for a pregnant mother and her developing baby. Unfortunately, heroin use is all too prevalent; the 2015 National Survey on Drug Use and Health report showed that 329,000 people in the US reported using heroin in the past month 1. This includes women of childbearing age. The survey found that approximately 79,000 women aged 15-44 in the US reported using heroin in the past month. 1.
Because unintended pregnancies are common in the United States, women may be using heroin and other substances without realizing that they are pregnant 2. Heroin can cause serious harm to a woman’s body, and it can also significantly harm her baby.
If you are a woman of reproductive age and you are either pregnant or not actively preventing pregnancy through birth control and using heroin, consider getting help. You deserve to be healthy and so does your child. Call 1-800-980-3927
Effects of Heroin Use on the Mother
Heroin use during pregnancy is a major public health concern, with the potential to result in serious maternal and neonatal health issues. Using a drug like heroin can eventually compel a person to prioritize the drug over important issues like hygiene and proper nutrition, which can give rise to numerous issues during pregnancy.
Heroin-addicted mothers also tend to have poor attendance rates at prenatal visits 8. Prenatal care is vital for any expectant mother, and may be even more essential for women using heroin due to the high risk for pregnancy complications, such as 3 4 5:
- Antepartum hemorrhage (bleeding).
- Low birth weight.
- Higher neonatal mortality.
- Sexually transmitted infections (STIs).
- Respiratory failure.
Additionally, heroin is a dangerous drug because it is associated with serious physical, mental and social repercussions that negatively impact the mother and, consequently, the fetus or developing child. These include 3:
- Poor dental hygiene.
- Infections, such as HIV and hepatitis viruses.
- Relationship problems.
- Domestic violence.
- Criminal activity.
Effects of Heroin on a Developing Fetus
Heroin can easily cross the placental barrier. This means that when a woman injects, inhales, or smokes heroin, the drug is passed along to the baby, presenting numerous risks and the strong possibility the baby will become dependent on the drug.
Taking drugs such as heroin can lead to a number of health issues related to pregnancy, including but not limited to 6:
- Problems with the placenta: The placenta is an important part of pregnancy since it provides a steady supply of blood through the umbilical cord—rich in oxygen and nutrients. When a woman has problems with her placenta, her baby may become oxygen- or nutrient-deprived. Placental abruption, or the separation of the placenta from the uterus, can be can be very serious for both the mother and the baby.
- Increased risk of preterm birth: “Preterm” is a term used to define babies who are born before 37 weeks of pregnancy are completed. There are categories of preterm birth, including extremely preterm (<28 weeks), very preterm (28 to <32 weeks), and moderate to late preterm (32 to 37 weeks) 7.
- Low birth weight: Low birth weight is defined by the World Health Organization (WHO) as weight at birth less than 2,500 grams or 5.5 lbs. Low birth weight is associated with neonatal mortality, inhibited cognitive development, and chronic disease as the child grows up 10.
Heroin use can also be deadly to the developing fetus or the newborn baby. Aside from increased miscarriage risk due to complications like placental abruption, illicit drug use during pregnancy increases the risk of stillbirth (death of a baby in the womb after 20 weeks of pregnancy) by 2 to 3 times 13.
Illicit drug use also increases the chances of sudden infant death syndrome (SIDS, or crib death) 6,13. This refers to the unexplained death of a baby who is younger than 1 year old 11.
Neonatal Abstinence Syndrome (NAS)
When a woman uses an opioid like heroin during pregnancy it can cause her baby to develop neonatal abstinence syndrome (NAS). NAS is a set of behavioral and physical signs in the newborn that result from abruptly cutting off a baby’s opioid supply once the child is born. Studies show that anywhere from 48-94% of babies exposed in utero to heroin will experience withdrawal at birth 3.
- How much heroin the mother used.
- How well her body clears the drug from her system.
- How long she used heroin.
- Whether the baby was born full-term or premature.
Symptoms of NAS
Symptoms of NAS usually occur within the first 1-3 days after birth; however, they may appear up to a week after birth 12.
Characteristics of NAS include but are not limited to 12:
- Excessive crying.
- Mottled (blotchy) skin.
- High-pitched cry.
- Slow weight gain.
- Poor ability to breastfeed.
In the most severe cases, NAS can cause seizures and death. When a baby is born with NAS, they will usually need to be hospitalized and treated with medication (typically, another opioid medication like morphine or methadone) to relieve the withdrawal symptoms 13. The medication is gradually tapered as the baby adjusts to not having heroin in their system.
Although the effects of heroin use in utero have been well documented, less is known about the long-term effects on the developing child. However, some studies show that exposure to heroin in utero is associated with the following characteristics later in life 14 15 16:
- Behavioral disorders.
- Difficulties with concentration and attention.
- Lack of social inhibition.
If you are pregnant and use heroin, call your doctor to find out the best way to keep you and your baby safe. If you are interested in treating your substance use disorder, give us a call 1-800-980-3927 and a rehab placement specialist can help you.
Quitting Heroin While Pregnant
When a woman quits opiates cold turkey while pregnant, her fetus goes through a period of withdrawal. The fetus is not able to tolerate the effects of withdrawal as well as the mother and this may result in the death of the fetus 17. Because of this risk, it is important to talk to your doctor before attempting to quit using heroin on your own.
Pregnancy offers a window of opportunity to enter treatment and live drug-free. Data collected by the Substance Abuse and Mental Health Services Administration (SAMHSA) found that pregnant women use lower amounts of drugs, such as heroin, during the third trimester than they do the first and second trimesters (2.4 percent vs. 9.0 and 4.8 percent) 1. This data suggests that by their last trimester, more women have stopped using harmful substances.
While therapeutic options may vary on an individual basis, many women quit using heroin during pregnancy through a combination of medication-assisted treatment and counseling.
Medication-Assisted Treatment During Pregnancy
Used since the 1970s, methadone is a time-tested method of medication-assisted treatment during pregnancy. Although methadone is the standard of care in most of the world and most doctors will prescribe it to women who are using heroin during pregnancy, it is important to note that methadone is still an opioid, and there are risks of using methadone when pregnant.
Methadone can easily cross the placenta and enter the baby’s bloodstream, increasing the risk that the baby will be born with neonatal abstinence syndrome. Researchers are investigating the potential to use buprenorphine and naloxone (i.e., Suboxone) instead of methadone 18 19. Research is still emerging, and one study found that babies born to mothers who were treated with buprenorphine and naloxone had less incidence of NAS and shorter hospital stays 20.
It is important to talk to your health care provider about your options for treatment. Give us a call today at 1-800-980-3927 to speak with a rehab treatment specialist and learn more about your options.
- Substance Abuse and Mental Health Services Administration. (2015). Results from the 2015 National Survey on Drug Use and Health: Detailed Tables (HHS Publication No. SMA 16-4984, NSDUH Series H-51).
- Centers for Disease Control and Prevention. (2015). Unintended Pregnancy Prevention.
- Namboodiri, V., George, S., Boulay, S., & Fair, M. (2010). Pregnant heroin addict: what about the baby?. BMJ case reports, 2010, bcr0920092246.
- Giordano, R., Cacciatore, A., Cignini, P., Vigna, R., & Romano, M. (2010). Antepartum Haemorrhage. Journal of Prenatal Medicine, 4(1), 12–16.
- Semba, R. D. (2010). Psychiatric Disorders in Pregnancy and the Postpartum: Principles and. Humana.
- March of Dimes. (2015). Heroin and pregnancy.
- World Health Organization. (2015). Preterm birth.
- World Health Organization. (2001). WHO Regional Strategy on Sexual and Reproductive Health.
- March of Dimes. (2015). Stillbirth.
- World Health Organization. (2004). Low birth weight.
- March of Dimes. (2015). Sudden Death Syndrome.
- National Institutes of Health. (2015). Neonatal abstinence syndrome.
- National Institute on Drug Abuse. (2015). Substance Use While Pregnant and Breastfeeding.
- Ornoy, A., Michailevskaya, V., Lukashov, I., Bar-Hamburger, R., & Harel, S. (1996). The developmental outcome of children born to heroin-dependent mothers, raised at home or adopted. Child abuse & neglect, 20(5), 385-396.
- Ornoy, A., Segal, J., Bar‐Hamburger, R., & Greenbaum, C. (2001). Developmental outcome of school‐age children born to mothers with heroin dependency: Importance of environmental factors. Developmental Medicine & Child Neurology, 43(10), 668-675.
- Messinger, D. S., Bauer, C. R., Das, A., Seifer, R., Lester, B. M., Lagasse, L. L., … & Langer, J. C. (2004). The maternal lifestyle study: cognitive, motor, and behavioral outcomes of cocaine-exposed and opiate-exposed infants through three years of age. Pediatrics, 113(6), 1677-1685.
- Chasnoff, I. J. (Ed.). (2012). Drug use in pregnancy: Mother and child. Springer Science & Business Media.
- Lund, I. O., Fischer, G., Welle-Strand, G. K., O’grady, K. E., Debelak, K., Morrone, W. R., & Jones, H. E. (2013). A comparison of buprenorphine+ naloxone to buprenorphine and methadone in the treatment of opioid dependence during pregnancy: maternal and neonatal outcomes. Substance abuse: research and treatment, 7, 61.
- Kraft, W. K., Dysart, K., Greenspan, J. S., Gibson, E., Kaltenbach, K., & Ehrlich, M. E. (2011). Revised dose schema of sublingual buprenorphine in the treatment of the neonatal opioid abstinence syndrome. Addiction, 106(3), 574-580.
- Wiegand, S., Stringer, E., Seashore, C., Garcia, K., Jones, H., Stuebe, A., & Thorp, J. (2014). 750: Buprenorphine/naloxone (B/N) and methadone (M) maintenance during pregnancy: a chart review and comparison of maternal and neonatal outcomes. American Journal of Obstetrics & Gynecology,210(1), S368-S369.