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Credit: NJ Health, March of Dimes

What are some of the risks of drug and alcohol use during pregnancy?

Using drugs, alcohol, or tobacco during pregnancy exposes not just the woman, but also her developing fetus to the substance and can have potentially harmful and even long-term effects after the baby is born. Drinking during pregnancy can lead to the child developing fetal alcohol spectrum disorders, characterized by low birth weight and enduring cognitive and behavioral problems. Prenatal use of some drugs, including opioids, may cause a withdrawal syndrome in newborns called neonatal abstinence syndrome (NAS). Babies with NAS are at greater risk of seizures, respiratory problems, feeding difficulties, low birth weight, and even death.

What is neonatal abstinence syndrome?

Neonatal abstinence syndrome (NAS) occurs in a newborn who was exposed to opiate drugs while in the mother’s womb and is now facing withdrawal symptoms. Although NAS is associated the most with opiate drugs, babies exposed to alcohol and other drugs can also have symptoms of withdrawal.

Heroin is an opioid. 

Prescription opioids include: 

  • Codeine
  • Hydrocodone (name brand Vicodin®)
  • Morphine (name brands Kadian®, Avinza®) 
  • Oxycodone (name brands OxyContin®, Percocet®)
  • Tramadol

Other prescription drugs that can cause NAS include:  

  • Antidepressants (used to treat depression) 
  • Benzodiazepines (sleeping pills)

If you’re pregnant or trying to get pregnant and taking any of these drugs, tell your healthcare provider right away. 

Why should I tell my healthcare provider if I am using during my pregnancy?

It is important to be honest with your obstetrician (OB) or nurse midwife and with your baby’s pediatrician about what you were taking during your pregnancy (prescription medications, illicit drugs, or alcohol), how much you were using and how often so the doctor can be prepared to treat your baby’swithdrawal symptoms. Because symptoms may not show up for days after delivery, it is important to watch your baby closely and call your pediatrician right away if you notice any of the symptoms of withdrawal. 

What are the symptoms my baby may experience if he/she goes through withdrawal?

Symptoms of withdrawal depend on the substance involved. Symptoms can begin within one to three days after birth, or may take up to 10 days to appear. Symptoms include:

  • Body shakes (tremors), seizures (convulsions), overactive reflexes (twitching), and tight muscle tone
  • Fussiness, excessive crying, or having a high-pitched cry
  • Poor feeding or sucking or slow weight gain
  • Breathing problems, including breathing really fast
  • Fever, sweating, or blotchy skin
  • Trouble sleeping and lots of yawning
  • Diarrhea or throwing up
  • Stuffy nose or sneezing

What can I do to help prevent NAS in my baby? 

Tell your provider right away.

  • If you’re pregnant and you use any of the substances that can cause NAS, tell your provider right away, but don’t stop taking the drug without getting treatment from your provider first. Quitting suddenly (sometimes called cold turkey) can cause severe problems for your baby, including death. If you need help to quit using these substances, talk to your provider about treatment. Getting treatment can help you stop using and is safer for your baby than getting no treatment at all. 

Ask about medication-assisted treatment (MAT).

  • If you’re pregnant and addicted to opioids, ask your provider about medication-assisted treatment (also called MAT). Addicted means you can’t stop using the drug without having problems. NAS in babies may be easier to treat for babies whose moms get MAT during pregnancy. Medicines used in MAT include methadone and buprenorphine.

Talk to your providers.

  • If you’re pregnant and you go to a provider who prescribes medicine to treat a health condition, make sure that provider knows you’re pregnant. You may need to stop taking certain medicines or change to medicine that’s safer for your baby. Ask all your healthcare providers if the medicine you take—even prescription drugs—can cause NAS. Even if you use a prescription drug exactly as your provider tells you to, it may cause NAS.
  • If you’re pregnant or thinking about getting pregnant, tell your provider about any drugs or medicine you take. Your provider can make sure that what you’re taking is safe for you and your baby. They can also help you get treatment for using street drugs or abusing prescription drugs if you need it. If you abuse prescription drugs, it means you take more than has been prescribed for you, you take someone else’s prescription drug, or you get the drug from someone without a prescription. 

Birth control.

  • If you’re not pregnant and you use any drug that can cause NAS, use birth control until you’re ready to get pregnant. Birth control (also called contraception or family planning) helps keep you from getting pregnant. Examples include intrauterine devices (also called IUDs), implants, the pill, and condoms. 

How is my baby tested for NAS?

Your baby’s provider can use these tests to see if he/she has NAS:

  • Neonatal abstinence scoring system. This system gives points for each NAS symptom depending on how severe it is. Your baby’s provider uses the score to decide what kind of treatment your baby needs.  
  • Meconium test. Meconium is your baby’s first bowel movement. 
  • Urine test

How is NAS treated?

Your baby’s treatment may include:

  • Taking medicines to treat or manage severe withdrawal symptoms. Once withdrawal is under control, your baby gets smaller doses of the medicine over time so their body can adjust to being off the medicine. Medicines used to treat severe withdrawal include morphine, methadone, and buprenorphine. 
  • Getting fluids through a needle into a vein (also called intravenous or IV) to prevent your baby from getting dehydrated. Dehydrated means not having enough water in the body. Babies with NAS can get dehydrated from having diarrhea or throwing up a lot. 
  • Drinking higher-calorie baby formula. Some babies with NAS need extra calories to help them grow because they have trouble feeding or slow growth.

When will my baby’s treatment be complete?

Most babies with NAS who get treatment get better in five to 30 days. While your baby is being treated for NAS, they may be fussy and hard to soothe. Doing these things can help calm your baby: 

  • Swaddle your baby (wrap them snuggly) in a blanket.
  • Give your baby skin-to-skin care (also called kangaroo care). It’s when you put your baby, dressed only in a diaper, on your bare chest. 
  • Keep your baby in a quiet, dimly lit room.
  • Breastfeed your baby.
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