Heroin and Pregnancy: Effects of Heroin Use During Pregnancy

What Is Heroin? A Brief Overview of Heroin

Heroin is an opioid made from morphine, an opiate alkaloid extracted from the opium poppy.² Heroin is a Schedule I controlled substance, which means that it has a high risk for abuse and is not approved for medical use.³ The adverse effects of heroin use can pose dangers for anyone but may present certain additional risks during pregnancy.

How Does Heroin Use Affect Pregnant Women?

Heroin use can impact a person’s behavior and physical 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:^2,4

• 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 that can lead to issues such as:⁵

• 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.^2,5

Heroin use poses additional risk factors depending on the route or method of use. Nonsterile or contaminated needles in association with injection heroin use (intravenous, intramuscular, or subcutaneous) can increase the risk of:⁶

• 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 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:⁷

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

Can Heroin Cause Problems in Pregnancy?

Overdose and death are possibilities each time you use heroin.² If someone is pregnant, the risks of using heroin while carrying a fetus include the risks mentioned above as well as additional risks such as:^1,8-11

• Maternal death. Substance use can increase the risks of death shortly after delivery, during delivery, or during pregnancy.
• Poor fetal growth. Since a fetus goes through important growth milestones, especially during the final months and weeks of pregnancy, heroin use can impact fetal growth.
• Preterm birth. Preterm birth is when a baby is born before 37 weeks.
• Stillbirth. The loss of a baby before or during pregnancy is called stillbirth.
• Neonatal opioid withdrawal syndrome (NOWS). NOWS, also historically referred to as Neonatal Abstinence Syndrome (NAS), includes a cluster of potential symptoms seen in some newborns after exposure to certain substances, including opioids, prior to birth.

The risks of these complications during pregnancy can be minimized by seeking the proper medical treatment as soon as possible. Call an admissions navigator to learn about your treatment options.

Can a Baby Be Born Addicted to Heroin?

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 a disorder recognized as a chronic, relapsing brain disease characterized by compulsive drug seeking and continued use despite negative consequences.¹²

What is Neonatal Opioid Withdrawal Syndrome (NOWS)?

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.

What Are the Signs of NOWS?

NOWS may arise in opioid dependent newborns, with symptoms including:¹

• Irritability.
• Excessive or characteristically high-pitched crying.
• Sleep problems.
• Poor feeding and sucking.
• Vomiting and loose stools.
• Dehydration.
• Hyperreflexia.
• Sneezing, yawning, and stuffy nose.
• Tremors or trembling.
• Seizures.

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 full-term, the fetus’s exposure to other substances during pregnancy, and the last time the mother used heroin.¹

Neonatal Abstinence Syndrome (NAS)

The term neonatal abstinence syndrome (NAS) is sometimes used interchangeably with NOWS. As a more general term, NAS may refer to a withdrawal syndrome that can occur in newborns exposed to certain substances, which can include opioids. However, given that neonatal drug withdrawal is so prevalently associated with opioid exposure, either in isolation or in combination with other substances, an opioid-specific term—i.e., NOWS—has been developed to describe the condition and its common causes more accurately.¹³

Medical Management of Neonatal Opioid Withdrawal Syndrome

A variety of treatment interventions can help improve the symptoms of NOWS, such as medications as well as nonpharmacological methods. However, all treatment should be performed with the advisement of a caring physician. In many cases, babies may be first managed with several nonpharmacological methods that can 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, nonpharmacological measures, medications that can be used to help manage relatively persistent and/or severe symptoms of NOWS include:¹⁴

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

Heroin Addiction Treatment While Pregnant

If you are currently pregnant and want to recover from addiction, help is available. Keep in mind that stopping heroin use cold-turkey (without medical help) can be dangerous for mothers and their unborn babies.¹

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.

Together, you and a physician can determine the most suitable course of treatment that may include a combination of interventions such as medications for opioid use disorder, therapy, and community support. Again, trying to quit heroin cold-turkey on your own during pregnancy is not recommended.¹

Though treatment settings and levels of care may vary, treatment at a substance use disorder rehab can help provide the monitoring and medical care needed while pregnant. Treatment plans ideally include interventions and services that are based on each individual’s unique needs. Treatment settings for pregnant women may include:¹⁵

• Inpatient rehab—The patient lives in a supportive facility where they receive medical monitoring 24 hours a day, 7 days a week.
• Outpatient treatment—The patient lives at home or in a sober living environment and receives 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 risk of relapse.¹

It’s important to choose a rehab for pregnant women that understands the unique needs of this population, 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 and Pregnancy

While medications and other treatment options are available to pregnant women, it is important to remember that only a licensed physician can determine what treatment interventions are right for each individual. Fortunately, medications including methadone and buprenorphine are approved to help treat opioid use disorder in pregnant women. Methadone and buprenorphine are both examples of medications for opioid use disorder (MOUD) or medication-assisted treatment (MAT).⁷ They have been shown to offer the following benefits for pregnant women:⁷

• Improved neonatal outcomes.
• Stabilized fetal levels of opioids.
• Reduced repeated prenatal withdrawal.

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. Buprenorphine for OUD treatment in pregnancy has become increasingly common in more recent years.⁷ 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.

Frequently Asked Questions

Getting Help for Heroin Addiction While Pregnant

Even if you are pregnant, you can recover from substance misuse issues. In fact, multiple heroin addiction treatment options are available to help you and your unborn baby remain safe and healthy during and after pregnancy.

Don’t wait. Reach out to American Addiction Centers now. Sign up for text messages or contact AAC via phone to take your first steps toward recovery today.