Heroin & Pregnancy: Effects of Heroin Use During Pregnancy

Using opioids during pregnancy can impact an unborn fetus, however the abrupt discontinuation of opioid use during pregnancy comes with its own risks as well and shouldn’t be attempted without the medical advisement of a physician.

This page explores the risks that accompany heroin use when you’re pregnant, the risks associated with illicit opioid use in general, and how to manage a heroin use disorder during pregnancy. It will also address how a baby born to a mother with opioid use disorder (OUD) may face certain associated issues and how a medical team may effectively manage the health of the mother and baby in these situations.

Again, it is possible to recover from heroin use during pregnancy, as well as to recover after giving birth to a child. However, issues of compulsive heroin use during pregnancy and beyond may be most safely addressed under the guidance and care of medical professionals with experience in managing what is no doubt a delicate situation.

What Is Heroin? A Brief Overview of Heroin

Heroin is an opioid drug made from morphine, an opiate alkaloid extracted from the opium poppy.¹ Heroin is a Schedule I controlled substance, which means that it has a high risk for abuse and is not approved for any medical use.² The adverse effects of heroin use can pose dangers for anyone, but may present certain additional risks during pregnancy.

Impact of Heroin Use During Pregnancy

Heroin use can impact a person’s behavior, physical health, and mental health. If someone is pregnant, heroin use can also negatively impact their pregnancy. Heroin is associated with a pleasurable, rewarding rush or high after use. However, there are several other potentially adverse short-term effects of heroin use, including:^1,3

• Profound drowsiness.
• Fluctuating levels of consciousness.
• Mental clouding.
• Severely slowed breathing.
• Reduced heart rate.
• Dry mouth.
• Nausea and vomiting.
• Flushed skin.
• Severe itching.

Chronic heroin use can lead to certain long-term health consequences as well. Long-term heroin use may be associated with some functional brain changes as well as some neurohormonal alterations which could lead to issues such as:⁴

• Impaired decision-making abilities.
• Difficulty regulating behavior.
• Challenges managing stress.

Long term or chronic heroin use can place an individual at increased risk of developing a substance use disorder, as well as significant physiological dependence and withdrawal.^1,4

Heroin use poses additional risk factors depending on the route or method in which someone is using the drug. Non-sterile or contaminated needles in association with injection routes of heroin use (intravenous, intramuscular, or subcutaneous use) can increase the risk of:¹⁰

• HIV (human immunodeficiency disease).
• Hepatitis B and C.
• Endocarditis (bacterial heart infection).

In addition to some of the more widely recognized, acutely adverse effects of opioid misuse, the patterns of heroin use left to continue in cases of an untreated opioid use disorder could themselves be additionally harmful. In such instances, the fluctuating levels of opioids in people who use a drug like heroin could repeatedly expose the unborn baby to withdrawal, potentially harming placental functioning and increasing the risk of:¹¹

• Placenta abruption.
• Early labor.
• Fetal convulsions.
• Fetal demise.
• Intrauterine passage of meconium.

Can a Baby be Born Addicted to Heroin?

It is important to note that while babies may be born to a heroin using parent with some level of opioid dependence, these babies are not born addicted to heroin. Addiction is disorder recognized as a chronic, relapsing brain disease characterized by compulsive drug seeking and continued use despite negative consequences.¹²

Neonatal opioid withdrawal syndrome (NOWS) can occur when a mother uses heroin during pregnancy and the heroin is passed through the placenta into the fetus, resulting in both the mother and unborn baby developing physiological opioid dependence.

The severity of NOWS symptoms depends on unique factors such as the type and amount of opioids the fetus was exposed to, whether the baby was born pre-mature or born full-term, the fetus’s exposure to other substances during pregnancy, and the last time the mother used heroin.⁵

Medical Management of Neonatal Opioid Withdrawal

There are a variety of treatment interventions that can help improve the symptoms of NOWS. The symptoms of NOWS can be treated using medications as well as non-pharmacological methods, but none should be performed solely without the advisement of a caring physician. In many cases, babies may be first managed with several non-pharmacological methods may include:¹⁴

• Swaddling.
• Breastfeeding.
• Parental presence and skin-to-skin contact.
• Acupuncture.
• Modifying environmental factors such as using quiet and dimly lit rooms and certain bed types.

Beyond these supportive, non-pharmacological measures, medications that can be used to help manage relatively persistent and/or severe symptoms of NOWS include:^{14(Box 2)}

• Morphine.
• Buprenorphine.
• Methadone.
• Clonidine.
• Phenobarbital

Heroin Addiction Treatment While Pregnant

[If you are currently pregnant and looking to recover from addiction, help is available to you. Keep in mind that stopping drug use cold-turkey (without medical help) can be very dangerous for you and your unborn baby.⁵

If you want to recover from heroin addiction while pregnant, talk to your doctor immediately to understand your best course of action. Your doctor can create a treatment plan that is safe for both you and your child that accomplishes your treatment goals.

Though treatment settings and levels of care may vary. treatment at a substance abuse rehabilitation program can help provide the monitoring and medical care needed while pregnant. Someone’s treatment plan will ideally include interventions and services that are based on their unique needs. Treatment settings for pregnant people may include:¹⁵

• Inpatient rehab—The patient will receive medical monitoring 24 hours a day, 7 days a week and live in the facility during the length of their stay.
• Outpatient treatment—The patient will live either at home or in a sober living environment and receive services at a treatment facility.

If someone is pregnant and using opioids, as the current standard of care, their doctor may recommend that they initiate medication for opioid use disorder to improve recovery outcomes and reduce someone’s risk of relapse.⁵

It’s important to choose a rehab for pregnant women that understands the unique needs of pregnant women, can minimize risk, and offers special programs for pregnant women who struggle with opioid addiction. Not all treatment programs are the same and choosing a program that addresses the need of a patient and their recovery goals is critical for long-term success.Addiction Medications & Pregnancy

While there are medications and other treatment options available to pregnant people, it is important to remember that only a licensed physician can determine what treatment interventions are right for a patient. Fortunately, medications are approved to help treat opioid use disorder in pregnant women and they include methadone and buprenorphine.¹¹ Methadone and buprenorphine are both examples of medications for opioid use disorder (MOUD) or medication-assisted treatment (MAT), and both have been shown to do the following in people who are pregnant:¹¹

• Improve neonatal outcomes.
• Stabilize fetal levels of opioids.
• Reduce repeated prenatal withdrawal.
• Allow for connecting patients with better prenatal care.

Methadone has been used to treat opioid use disorder in pregnancy since the 1970s and has been the standard of care in these situations for more than 20 years.¹¹ Buprenorphine for OUD treatment in pregnancy has become increasingly common in more recent years.¹¹ If you are struggling with heroin use and are wondering if methadone and/or buprenorphine are right for you, speak to your physician or contact American Addiction Centers at .

If you are pregnant, you can absolutely recover from substance abuse issues and there are ways to help yourself and your unborn remain safe and healthy during and after your pregnancy. Don’t wait to get help; heroin addiction treatment is available to you.

Sources:

1. National Institute on Drug Abuse. (2021). Heroin DrugFacts.
2. United States Drug Enforcement Administration. (n.d.). Drug scheduling.
3. National Institute on Drug Abuse. (2018). Heroin research report-What are the immediate (short-term) effects of heroin use?
4. National Institute on Drug Abuse. (2018). Heroin research report- What are the long-term effects of heroin use?
5. Centers for Disease Control and Prevention. (2021). About opioid use during pregnancy.
6. Centers for Disease Control and Prevention. (2022). Preventing pregnancy-related deaths.
7. Centers for Disease Control and Prevention. (2021). Preterm birth.
8. The American College of Obstetricians and Gynecologists. (2018). Opioid Use Disorder and Pregnancy
9. Centers for Disease Control and Prevention. (2020). What is stillbirth?
10. Centers for Disease Control and Prevention. (2021). Infectious diseases, opioids and injection drug use.
11. National Institute on Drug Abuse. (2021). Medications to treat opioid use disorder research report- What treatment is available for pregnant mothers and their babies?
12. National Institute on Drug Abuse. (n.d.). The science of drug use and addiction: The basics.
13. National Institute on Drug Abuse. (2018). Heroin research report: How does heroin use affect pregnant women?
14. Mangat, M.K. & Schmolzer, G.M. (2019). Pharmacological and non-pharmacological treatments for neonatal abstinence syndrome (NAS). Seminars in Fetal and Neonatal Medicine, 24(2), 133–141.
15. National Institute on Drug Abuse. (2018). Principles of drug addiction treatment: A research-based guide (third edition)-Types of treatment programs.