The Opioid Epidemic’s Effect On Pregnancy and Newborns

As reported by CNN Health, “According to a recent study, the cost of treating infants in U.S. hospitals exposed to opioids increased by more than $250 million in four years”. Another staggering statistic included in the report,   “In 2012, the total hospital costs associated with neonatal abstinence syndrome amounted to $316 million. By 2016, this figure had surged to $572.7 million, as reported in the Journal of the American Medical Association Pediatrics.” This directly relates to the opioid crisis that is sweeping the nation affecting mothers and their newborn babies. More babies are being born with the neonatal abstinence syndrome and maternal opioid use rates around the country, particularly in rural communities.

What is the Opioid Epidemic?

The opioid epidemic is characterized by the extensive misuse of both prescription and non-prescription opioids, such as oxycodone, hydrocodone, fentanyl, and heroin. This crisis began in the 1990s due to excessive prescribing practices and has resulted in a dramatic increase in addiction rates, overdoses, and fatalities. Pregnant women, in particular, encounter distinct challenges and risks associated with this epidemic.

How Opioids Affect Pregnancy

Misusing opioids during pregnancy can lead to serious physical and mental health issues for both the mother and the developing baby.

Maternal Health Risks:

• Complications: Using opioids raises the chances of preterm labor, placental abruption, and maternal infections like hepatitis C or HIV.
• Dependency and Withdrawal: Pregnant women who use opioids may develop a dependency, making it challenging to quit without medical help due to intense withdrawal symptoms.

Fetal Risks:

• Growth Restrictions: Babies born to mothers who use opioids are at a higher risk of being born with low birth weight.
• Developmental Delays: Exposure to opioids in the womb can result in long-lasting cognitive and developmental challenges.
• Stillbirths and Miscarriages: Ongoing opioid use greatly heightens the risk of losing a pregnancy.

What is Neonatal Abstinence Syndrome?

Neonatal abstinence syndrome, also known as NAS, is when a baby is chronically exposed to narcotics during pregnancy and experiences drug withdrawal after birth. These can be illegal drugs or prescribed medicines, such as heroin or methodone and other opiates. Because opioids block the release of norepinephrine, once the baby is born and not exposed to the opioids from the mother, they are physically overwhelmed with the spike in norepinephrine. Opiates cause withdrawal in more than half of babies exposed to opioids during pregnancy.

Withdrawal Symptoms of NAS

Symptoms of withdrawal for affected infants can include:

• Extreme Irritability
• Tremors
• Fever
• Seizures
• Feeding difficulties and poor weight gain
• Respiratory problems
• Vomiting and diarrhea

These babies may require medications, operations and treatment for months in the NICU to safely and gradually be weaned off opioids.  Babies can still experience high amounts of stress while in the NICU from the loud environment of other babies and medical machines and especially from being separated from their mothers. Longer term effects include developmental issues involving motor skills, cognitive abilities and social engagement.

According to a study published by the Centers For Disease Control and Prevention “The prevalence of NAS increased dramatically, rising from 1.5 cases per 1,000 hospital births in 2004 to 8 cases per 1,000 by 2014. By 2016, the incidence had slightly decreased to 6.7 cases per 1,000 hospital births, the study noted”.

It also reported that mothers who abuse drugs or have addiction are less likely to seek general healthcare, especially prenatal care, increasing the risk during pregnancy. These mothers are also more prone to be malnourished themselves and experience hardships like violence, incarceration and homelessness.

Diagnosis and Treatment:

Diagnosing NAS requires evaluating the mother’s medical history and drug use, along with monitoring the baby for specific symptoms. Treatment typically focuses on supportive measures, including swaddling and skin-to-skin contact, and in more severe instances, medications such as morphine may be used to alleviate withdrawal symptoms.

Changes

More hospitals and medical centers are making changes to deal with the influx of babies with NAS. Besides implementing methods to better identify pregnant women at risk for delivering opioid-exposed babies, improvement to quieter, calmer NICU settings are also being prioritized. Training to hospital staff to be more supportive to vulnerable mothers and provide them with specialized care and the helpful resources.

Unfortunately, many pregnant women with opioid dependence don’t seek the treatment for their drug abuse in fear of being punished rather than helped. They leave their opioid abuse disorder untreated during pregnancy and postpartum.  Many fear of losing custody of their children if they divulge their drug dependence. Read here for more information on opioid treatment and recovery.