Treating Heroin Addiction In Pregnant Women

Medically reviewed by

Joseph Sitarik, DO

March 26, 2019

Heroin Addiction And Pregnancy

Heroin is an opioid made from morphine. It enters the body quickly and binds to receptors within the central nervous system. Heroin causes the body to perceive pain differently and can have a euphoric effect.

When heroin is used during pregnancy, it can pass through the placenta and affect the fetus. This can cause the baby to become dependent on the drug as the mother does, resulting in neonatal abstinence syndrome (NAS).

The frequency of NAS diagnosis has increased with the massive increase in use of opioids from 2002 to 2015. Untreated, heroin addiction during pregnancy can have devastating effects on the mother and fetus, which can include stillbirth.

Treatment For Heroin Addiction In Pregnant Women

Treatment of heroin addiction in pregnant women can be a difficult process. Methadone maintenance treatment and buprenorphine (Suboxone) treatment are both used to treat opioid use disorder in pregnant women.

Methadone maintenance has been used to treat opioid addiction in pregnant women since the 1970s and has been the standard treatment since 1980. Although buprenorphine is a newer treatment option, some studies show that it may be a better treatment option than methadone.

Treatment from both drugs during pregnancy has been shown to stabilize fetal opioid levels, (reducing repeated withdrawal periods), improve overall neonatal outcomes, and link mothers to better prenatal care.

Another study reported by the New England Journal of Medicine showed that compared to methadone treatment, buprenorphine resulted in:

• 10 percent lower chance of NAS
• shorter neonatal treatment time, by an 8.4-day average
• lower amounts of morphine used for NAS treatment by an average of 3.6 mg
• higher gestational age, weight, and head circumference at birth

Even with these improved clinical results, methadone treatment is associated with a higher retention rate of patients than buprenorphine treatment. Methadone is considered to be relatively safe for newborns, and larger comparison studies are needed to understand if split methadone dosing treatment during pregnancy could result in better outcomes.

A transition from methadone treatment to buprenorphine treatment can be difficult, so if an expecting mother is already undergoing methadone treatment, it is not recommended that she try to switch to buprenorphine treatment. Many doctors are uncomfortable starting pregnant women on buprenorphine because there is less evidence of its effects on pregnant women specifically.

There is no exact answer to which treatment is better. The results are still inconclusive and doctors must take into consideration individual factors when deciding a course of treatment for heroin addiction for their pregnant patients. These factors can include: the severity of the addiction to heroin, the tolerance rate of both treatments, and the likelihood of the individual to complete treatment.

The Effects Of Heroin Addiction On The Mother

Abuse of heroin during pregnancy has become a major public health concern. The disease of addiction can cause individuals to prioritize the drug over everything else in their lives, including basic self-care. Yet self-care and attention to health during pregnancy are very important to ensure the health of the mother and the baby.

Women suffering from heroin addiction often have poor attendance when it comes to prenatal visits, and prenatal care is vital for any expectant woman. However, prenatal care can be even more important to women misusing heroin because of the high risk of complications with their pregnancy.

Complications from heroin addiction during pregnancy can include:

• preeclampsia (a dangerous pregnancy complication characterized by high blood pressure)
• infection of the heart’s lining (Endocarditis)
• respiratory failure
• low birth weight
• higher risk of miscarriage and stillborn baby
• increased risk of HIV and Hepatitis B or C
• increased risk of bleeding (antepartum hemorrhage)

Testing for these conditions can greatly reduce the risk of complications during pregnancy, as using heroin can have unpredictable outcomes for the baby as it is developing.

How Abusing Heroin Impacts A Developing Fetus

When a pregnant woman uses heroin, levels of the drug in the mother’s blood can fluctuate dramatically due to heroin’s short-acting nature. This causes the baby to experience multiple periods of withdrawal while in the womb as opioid levels range from very high (just after use) to very low (within a few hours of use). Depending on the amount of the drug taken and the mother’s tolerance to it, the effects on the baby can be extreme and volatile.

Heroin can easily cross the blood barrier (placenta) between mom and fetus, resulting in NAS—a syndrome reflecting the many side effects of withdrawal in the baby. Because the baby is still growing and developing in the womb, it is very susceptible to becoming dependent on any substance to which it is exposed.

Symptoms of NAS can include fever, vomiting, not eating or sleeping, and trembling/restlessness. Although the first year of life can be rough for NAS-born babies, afterwards their development tends to be normal.

The use of drugs, including heroin, can result in a lot of different health issues related to pregnancy, including:

• Low birth weight—when a baby’s weight is less than 5.5lbs at birth, it can mean that their systems are not fully developed yet, and may lead to neonatal mortality, inhibited brain development, and higher risk of chronic diseases later on in life.
• Issues with the placenta—the barrier that the placenta provides is vital in supplying the fetus with oxygen, nutrients, and blood. If there are issues with the placenta, the fetus may be deprived of oxygen or nutrients, causing serious damage.
• Increased risk of premature birth—when a baby is born prematurely (before 37 weeks of pregnancy are complete), their lungs, brain, or other vital organs may not be completely developed yet. This can lead to death and/or other life-long issues.

Increased Likelihood Of Pregnancy After Starting Methadone Treatment

When women abuse drugs like heroin, they may experience irregular or absent menstrual cycles. This leads many women to mistakenly believe that they have become infertile. When treated for opioid addiction, regular hormone levels and menstrual cycles typically resume. This can lead to unintended pregnancy.

Heroin Withdrawal In Pregnant Women

Going through opioid withdrawal while pregnant can greatly increase the risk of a miscarriage. Suddenly stopping heroin on one’s own is never recommended. While the mother may be able to tolerate the withdrawal symptoms, the fetus is less likely to be able to tolerate it. Sudden withdrawal can result in death of the fetus.

The Substance Abuse and Mental Health Services Administration (SAMHSA) found that pregnant women are less likely to use illicit drugs like heroin compared to women who are not pregnant. SAMHSA also noted that pregnant women currently using illicit drugs were less likely to still be using them when entering into their third trimester of pregnancy. This could be a sign that pregnancy gives women the time and opportunity to become drug-free.

While treatment plans will vary by individual need, many women are able to break their addiction to heroin with a combination of medical-assisted treatment and counseling.

To learn more about treatment for heroin addiction in pregnant women, contact us today.