How Does Heroin Affect Pregnancy?

Heroin use during pregnancy can have many negative effects on a mother and poses potential risks to the developing baby. It may also result in the child being born opioid-dependent and experiencing withdrawal at birth.^1,2

Expecting mothers can help to prevent serious pregnancy complications and minimize newborn withdrawal and potential future child development complications by getting help for heroin addiction as early as possible.¹

Effects and Risks of Heroin Use while Pregnant

Prenatal opioid misuse is associated with significant problems in a woman’s pregnancy and may contribute to serious harm to the fetus. Potential problems associated with the use of heroin during pregnancy include:^2,3,4,5

• Slowed fetal growth.
• Fetal convulsions.
• Placental abruption (detachment of the placenta from the uterus).
• Premature birth.
• Passage of meconium (newborn’s first bowel movement) in the uterus.
• Birth defects.
• Stillbirth.

Indirect risks to the child arise from the behaviors and risks associated with opioid addiction. These include:^4,6

• Maternal infection with a bloodborne disease such as HIV or HCV.
• Inconsistent or poor prenatal care.
• Maternal malnutrition.
• Dangers linked to a drug-seeking lifestyle, such as prostitution, trading sex for drugs, and violence.

The long-term impact of heroin exposure on a developing fetus is largely unknown. Studies suggest that prenatal exposure to opioids is linked with behavioral dysregulation (e.g., conduct disorders, hyperactivity) and attentional difficulties that could interfere with a normal development trajectory. However, use of opioid agonists during treatment outweighs the potential risks.^5,7

Neonatal Abstinence Syndrome

Babies exposed to opioids in-utero may experience a withdrawal syndrome at birth, called neonatal abstinence syndrome (NAS). The first signs of withdrawal typically appear in the newborn within 12-72 hours of birth and resolve by 7 days.⁶ These symptoms may include:^4,6,8

• Excessive crying and irritability.
• High-pitched crying.
• Insomnia.
• Tremors.
• Runny nose, congestion, and sneezing.
• Fever.
• Problems feeding.
• Loose stools or diarrhea.
• Vomiting.
• Dehydration.
• Sweating.
• Seizures (rare but noted to occur in 2-11% of infants withdrawing from opioids).

How severe NAS will be for the newborn may depend on the following factors:⁵

• How much heroin the mother used during pregnancy.
• The date of the last heroin use.
• Whether the child is born prematurely (prior to 37 weeks).
• If the fetus was exposed to polysubstance abuse (heroin and other drugs, e.g., , alcohol, other medications like benzodiazepines or certain antidepressants, or tobacco).

Detoxing from Heroin while Pregnant

Proper treatment for opioid dependence prior to pregnancy and certainly prior to the baby’s birth may result in better outcomes for both the mother and the child.⁴

How to Safely Detox from Heroin while Pregnant

Rather than detoxing from opioids completely (even under medical supervision), the CDC and ASAM recommend the use of which will keep the mother stabilized on safer opioid agonists such as methadone or buprenorphine for the duration of the pregnancy, and potentially longer.^4,10

MAT for expecting mothers with opioid use disorder has many potential benefits. It can:⁴

• Help to prevent the repeated periods of fetal withdrawal that often occur with illicit opioid use during pregnancy and that may harm the placenta.
• Provide a linkage to treatment for infectious diseases (e.g., HIV) and reduce the probability of transmission from mother to baby.
• Improve the chances of better prenatal care.
• Result in better health outcomes for both mother and child.
• Reduce the risk of NAS in the newborn or, should NAS occur, reduce the severity.
• Increase the weight, gestational age, and head size of the fetus.

Babies born to mothers who have been prescribed methadone or buprenorphine may still experience withdrawal symptoms; however, neonatal abstinence syndrome is expected and treatable, and the withdrawal is likely to be less severe than if the mother did not receive MAT medications.^4,5

Given that the mother receives ongoing MAT treatment and prenatal care until the time of her child’s birth, her medical providers can coordinate to ensure the child receives appropriate treatment for NAS when born and referral for necessary medical services.⁵

Mothers receiving treatment with methadone or buprenorphine can reduce the severity of NAS by:^4,11

• Avoiding smoking during pregnancy.
• Avoiding benzodiazepines.
• Consulting with a pediatrician to learn how the hospital assesses and treats NAS, as well as their suggestions to help soothe a baby with NAS.
• Requesting the newborn be in the same room after the birth.
• In the first week after birth, keeping lights low, speaking softly and avoiding too much stimulation except for frequent skin-to-skin contact, which can help prevent or limit NAS symptoms.
• Breastfeeding.

Treatment for Heroin Addiction

There is a range of substance abuse treatment services across a care continuum that varies in level of intensity. All levels are available to mothers who struggle with heroin addiction, with inpatient programs offering the most intensive level of support and outpatient programs varying in services and intensity.

Some programs offer childcare, which may be a good option for new moms who need a great deal of support. Outpatient treatment options include:^12,13

• Partial hospitalization program. A close match to the intensity of inpatient programs, this level of care offers treatment during the day paired with the freedom of returning home at night.
• Intensive outpatient program. One step down from the intensity of a PHP, this program type offers an intensive treatment course with slightly fewer hours of care during the day/week.
• Outpatient therapy. This level of care is the lowest in the spectrum of outpatient services and best serves patients who are stable and primarily need support and motivational enhancement to continue their recovery efforts.

Many heroin rehab treatment programs will include MAT as part of the overall program when appropriate for its patients.

If you’re pregnant and you need help for heroin addiction, call us at today. In addition to our inpatient drug and alcohol rehab in Orange County, CA, American Addiction Centers has locations across the country with robust outpatient programs designed to meet your needs.

For example, Desert Hope Treatment Center in Las Vegas offers a full spectrum of care and services, including:

• Partial hospitalization.
• Intensive outpatient.
• Sober living.

The sooner you get help, the better the chances of good outcomes for you and your baby. We’re here to help you at any time at .

Post-Partum Support

Continuing treatment and support for the mother after the baby is born is critical. Caring for a newborn can bring immense stress to the family, and especially to the mother, who is recovering from a major medical event, losing sleep, and is newly responsible for another life.

These stressors may increase the mother’s risk of relapse and overdose.⁵

Substance abuse treatment, including continuing MAT, may help the mother to weather the changes brought by this major life event. The CDC and ASAM recommend that women prescribed MAT medications during pregnancy continue their MAT program as prescribed after birth.^5,9