For many women, finding out they are pregnant is a time of great joy and sometimes mixed with feelings of anxiety about the upcoming nine months, labor and delivery, being a good parent, etc. For women who are using opioids during pregnancy, there are increased risks for both mother and baby that women need to be aware of. They should also be made aware of all treatment options for opioid use disorder (OUD), so they can seek treatment and stop using opiates safely.
Effects of Untreated OUD on a Fetus
The idea of seeking treatment for OUD might seem daunting and frightening to anyone, especially a woman who is also facing the huge responsibility of becoming a parent. However, taking that step to seek treatment is one of the healthiest actions a pregnant woman using opioids can do for herself and her baby. Untreated OUD can have devastating direct physical effects on a fetus, including:
- Repeated episodes of withdrawal, causing impaired placenta function
- Neonatal abstinence syndrome (NAS)
- Stunted growth
- Birth defects
- Preterm labor
- Fetal convulsions
- Fetal death
OUD can increase indirect risks to the mother as well:
- Lack of prenatal care
- Increased risk of maternal infections such as HIV, Hepatitis B and Hepatitis C
- Maternal malnutrition
- Dangers related to attempting to obtain opioids, such as violence and incarceration
Neonatal Abstinence Syndrome (NAS)
Women who are pregnant and using opioids can cause their newborns to have NAS. NAS is a withdrawal syndrome that can occur in newborns exposed to certain substances, including opioids, during pregnancy. It can occur due to opioid use or medication-assisted treatment (MAT) during pregnancy. When a newborn experiences opioid withdrawal within the first 28 days of life, this is referred to as neonatal opioid withdrawal syndrome (NOWS). Babies start to experience symptoms within 72 hours after birth and symptoms include:
- Tremors
- Irritability including excessive high-pitched crying
- Hyperactive reflexes
- Increased sweating
- Loose stools
- Vomiting
- Sleep disturbances
- Yawning, stuffy nose or sneezing
- Seizures
The signs a newborn will experience, and their severity will depend on a variety of factors, such as:
- Type and amount of substance the newborn was exposed to before birth
- Whether the baby was born full-term or premature
- The last time the substance was used
- If the newborn was exposed to other substances while in utero
Not all babies exposed to opioids in utero will experience NAS, but they may experience long-term outcomes that are not evident at birth. Unfortunately, there is not much information regarding these long-term outcomes for children exposed to opioids prenatally. Recent research indicates that children with NAS were more likely to experience language or speech impairment or developmental delay. However, it is unknown if these issues were caused by opioid exposure or other factors such as environmental factors or other substances. More research is needed in this area to understand possible long-term outcomes of prenatal opioid exposure.
Medication-Assisted Treatment (MAT) during Pregnancy
Some pregnant women living with OUD consider withdrawing from opioids completely, but according to the Substance Abuse and Mental Health Services Administration (SAMHSA), seeking treatment is more helpful. Trying to withdraw completely from opioids can lead to using opioids again and possibly an overdose.
The safest OUD treatment medications to use during pregnancy are methadone and buprenorphine. A look at recent meta-analysis showed that the MAT retention rates were higher with methadone. Buprenorphine, however, resulted in:
- A lower rate of NAS
- Less morphine needed for NAS treatment
- Decreased neonatal treatment days
While treatment with methadone or buprenorphine does pose the risk of NAS, it can be treated. The benefits of treatment outweigh the risks. Compared to those who did not have MAT, women who used MAT during pregnancy had babies who:
- Less severe NAS
- Shorter treatment time
- Higher gestational age, weight, and head circumference at birth
Other improved infant outcomes when their mothers received MAT were:
- Stabilized opioid levels and decreased prenatal withdrawals
- Increased linking of mothers with treatment for infectious diseases like HIV and hepatitis leading to decreased transmission to the infant
- Opportunities for better prenatal care
- Improved long-term outcomes for mother and baby
Of course, it is important for pregnant women searching for OUD treatment to speak with their providers to determine if MAT is right for them and which medication is the right choice.
The Importance of Continuing Treatment
MAT is just one aspect of treatment for women who are pregnant and trying to overcome OUD. It should be accompanied by therapy to learn how to address triggers and learn coping skills. Any mental health disroders such as depression or anxiety should be addressed and treated as well. Efforts should be made to assist pregnant women with obtaining safe housing, building a sober support system and applying for any other assistance programs they could use to give them a better chance of remaining abstinent. The importance of aftercare appointments and helping these women to address the social issues that contribute to continuing substance use cannot be underestimated.
Breaking Down Barriers to Treatment for Pregnant Women
Unfortunately, pregnant women seeking treatment for OUD often encounter barriers. A major barrier is stigma from healthcare providers. As a result, some will not seek care due to fear of being judged. It is necessary for all healthcare providers to receive adequate training regarding substance use disorders and to suspend personal judgment. That will allow the provider to focus on providing the best care possible for the mother and baby rather than judging the mother.
Another barrier is fear of Child Protective Services (CPS) involvement. According to SAMHSA, “All hospitals must report to state child welfare agencies when a mother who is using substances gives birth. This report is used to make sure that a safe care plan is in place to deal with both your and your baby’s well-being. It is not used to remove your baby from your care. Participating in OUD treatment before and after the birth of your baby shows your commitment to providing a safe, nurturing environment for your baby.”
Fear of the criminal justice system is a valid fear for pregnant women who have OUD. Substance use while pregnant is considered child abuse in 17 states. It is grounds for civil commitment in three states. These fears can deter a woman from seeking the treatment she and her baby need.
Finally, the lack of providers and treatment facilities accepting and treating pregnant women with OUD is another barrier to accessing treatment. Studies have shown us that pregnant women need more treatment options, better access to the treatment of their choice, and more support for staying in treatment. Substance use during pregnancy is a highly emotionally charged issue, and it requires compassionate, evidence-based solutions.
Opiate use disorder is complex, let alone for someone who is pregnant and wanting to get on the road to recovery. At Casa Palmera, we offer multiple levels of care and are dedicated to being the industry leader in holistic treatment. While you are here, expect the best evidence-based treatment available complimented with ancient eastern intuitive techniques. Every service you receive is provided by experienced, empathetic, highly trained staff. Call Casa Palmera at (855) 508-0473 to learn more.
About the author
