Opioids and Pregnancy

Opioids and PregnancyThe United States is facing a medical crisis — as youth and adults from all walks of life are affected by opioid use and misuse.

Let’s start with the basics: What are opioids? Opioids are a class of drugs that include prescription pain relievers — oxycodone, hydrocodone, codeine, morphine, fentanyl and others — as well as the illegal drug heroin.

Many factors have contributed to the growth of opioid use in our nation. First, there are hereditary traits. Some people are genetically predisposed to addiction. Then, there are social issues. Individuals struggling with various personal, professional, financial and psychological issues may begin to “self-medicate” in an effort to feel better. What’s more, starting in the late 1990s, pain relievers were prescribed liberally. Many individuals dealing with opioid addiction were initially exposed through the use of a prescription drug. Over time, they may no longer have access to the prescription pills, or they can no longer afford them, and they resort to the less expensive street drug — heroin.

Of great concern is the dramatic increase in pregnant women with opioid use disorder. Let’s look at the impact that opioids have on mother and baby.

This issue is complex and influenced by many social factors. Women who are addicted to opioids may be living in challenging social environments, and as a result, they are less likely to have regular prenatal care; to eat a balanced, nutritious diet; and to take prenatal vitamins. They are also more likely to use other harmful substances, such as alcohol and tobacco, and to be exposed to infections, sexually transmitted diseases and HIV.

In cases where the mother has an opioid addiction and does not receive treatment, there are potential health risks for the baby, such as preterm birth and low birth weight. Treatment improves birth outcomes.

Some infants of women who use opioids during pregnancy develop neonatal abstinence syndrome (NAS). NAS refers to the period of withdrawal experienced by a newborn baby born to a mother who uses opioids. In 2000, there were only 72 babies suffering from NAS in Virginia. By 2015, the number increased to 542.

The symptoms of NAS typically do not appear until 24 to 72 hours after birth, meaning that some babies with NAS may already be home before anyone realizes there is a problem. Symptoms may include:

  • Excessive crying
  • Poor feeding/sucking
  • Difficulty sleeping
  • Fast breathing
  • Stuffy nose / sneezing
  • Fever
  • Vomiting
  • Diarrhea

Some babies with NAS require treatment with a low-dose opioid until the baby is weaned from the drug and is no longer dependent. Recent research shows that babies with NAS also may be soothed and comforted through increased mother-baby attachment — a bond that can be supported by encouraging rooming in and breastfeeding.

Important things to know

If you are pregnant and using opioids — prescription or street drugs — or taking methadone or buprenorphine, tell your health care provider. Your doctor or midwife can refer you for treatment as well as educate and prepare you for the unique health care issues you and your baby may face. They will assist you with pain management during and after delivery and connect you with resources for ongoing support.

Drug addiction is a problem facing people from all socioeconomic levels — and it affects us all. It’s easy to see the cascading benefits if we all work together to address this crisis — healthy mothers have healthy babies, which, in turn, leads to healthy families and a healthy society. The more we bring this topic out into the open and treat it as a medical problem, not a character flaw, the better able we will be to give all babies a healthier start in life.

For a list of substance abuse resources, visit vcumom.com/resources.


This article has been written by Mishka Terplan, MD, and Sabastian Tong, MD.

Mishka Terplan, MD, MPH, FACOG, FASAM
Professor, Departments of Obstetrics & Gynecology and Psychiatry
Associate Director in Addiction Medicine
Medical Director MOTIVATE Clinic
Virginia Commonwealth University

Sebastian Tong, MD, MPH
Assistant Professor, Family Medicine and Population Health
Virginia Commonwealth University

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