Neonatal Abstinence Syndrome

As a general rule, obstetricians advise their pregnant patients to avoid most over-the-counter and prescription medications. Of course, the potential benefits to the mother (and, by extension, the fetus) are carefully weighed against the risks to fetal development.  Controlled substances are also categorized in terms of their risk during pregnancy with substances that have been proven safe through research on one end of the continuum and substances that are clearly detrimental and unjustifiable under most circumstances. Clearly, a problem emerges when a woman who is addicted to one or more substances discovers that she is pregnant.

Fetal Addiction

A fetus can develop an addiction to any substance that the mother is also addicted to.  Like the mother’s body, the fetus adapts to functioning with the foreign substance present in its system.  In fact, also like the mother, being able to function normally depends on continuing to receive regular doses, which is called dependence.   A substance can cause physical dependence, psychological dependence, or both.  Even though drugs like cocaine do not cause physical dependence (determined by physical withdrawal symptoms upon cessation of use), they can still lead to problems for both mother and fetus if the mother suddenly stops using.  Especially problematic are opiates like heroin; going through withdrawal while pregnant can be dangerous for both mother and baby.  For this reason, the woman must discuss the options with her physician who may recommend substitution therapy until after birth.

Neonatal Abstinence Syndrome

During pregnancy, the fetus is exposed to substances through the umbilical cord and placenta. Following birth, the baby begins to experience withdrawal because the substance is no longer present.  Physicians call this event neonatal abstinence syndrome (NAS).  A NAS diagnosis is often determined through urine tests and/or blood work that includes a toxicology screening.  Depending on the substance(s) that the mother was using, the symptoms related to NAS usually begin within the first three days but could take more than a week to appear.  Babies who are going through withdrawal will, again depending on the substance of abuse, exhibit some of the following symptoms or behaviors: convulsions, spotted skin, fever, difficulty sleeping, vomiting, irritability, diarrhea, fast breathing, sweating, insufficient weight gain as a result of poor eating/appetite, overly sensitive reflexes, prolonged periods of crying, and sucking excessively.  Among the substances that can cause NAS of varying degrees of severity are heroin, cocaine, marijuana, amphetamines, barbiturates, methadone, codeine, alcohol, nicotine, diazepam, and even a few reported cases of caffeine.

For Addicted Women and Their Loved Ones
Addicted women who are considering pregnancy should discuss treatment options with their physicians long before attempting to get pregnant; optimizing your body for pregnancy may require that you abstain from the substance for months or longer.  If you or someone you know is struggling with addiction during pregnancy, getting help as soon as possible is important for the health of  both the addict and the baby.  Stopping “cold turkey” can be equally dangerous so it is best to contact your doctor and be completely honest about your use.  For those who must first overcome the hurdle of an addict’s denial, scheduling an intervention should be an urgent priority.