Substance Use Disorders and the Unborn

She quietly cried while speaking of her young son’s suicide. “It’s my fault. He was born addicted because of me. He never did well in his life. Not from day one. I think about it every day, sometimes all day. How can I explain to women how dangerous drug use is?”

Drug addiction is a powerful brain disorder that can drive our behavior in spite of personal distress and negative consequences. We know drugs are powerful, partly because the brain does not have any way to control their levels or actions, and drugs overpower the brain.

They affect the part of our brain that is the controllers of our behavior. These parts contain neurotransmitters and circuits that affect personal and species survival; they are the circuits associated with feeding, sex and other life-sustaining processes.

Prior articles have focused on the brain, how it works and what drugs do to the brain and so forth. But those articles have not described or addressed the emotional misery that drugs cause.

While these articles are written for Soul’s Harbor – A Recovery Community for Homeless Men, many men have crossed paths with addicted women. You may have impregnated a woman while one or both of you were actively using. This article sheds light on the horrible consequences that this child, you both created while in active addiction, must bear. Sometimes these consequences may be for the child’s lifetime. Perhaps you are the child of an addicted mother and/or father.

Remember, addictions or substance use disorders are no respecter of persons.

Consider the Baby

If a woman is pregnant and has a substance use disorder, the drugs can pass through the placenta and reach the fetus and the developing brain. This results in babies being born with drug dependence and withdrawal, and with other drug-related toxicities. Because of the serious danger to the unborn, pregnant mothers who use drugs or alcohol must get help and direction from doctors as soon as possible.

Babies’ drug withdrawal syndromes include neonatal abstinence syndrome (NAS) which is mostly about opioids, neonatal opioid withdrawal syndrome (NOWS) and others.

Babies and Signs of NAS

A baby cannot act on its own and do self-harm behavior. Some avoid the word addicted and refer to such babies as being passively dependent. Dependence means there will be withdrawal symptoms, as we have discussed.

Neonatal abstinence syndrome (NAS) can be difficult to quantify, since the number of cases continues to increase each year. One study suggests there is one newborn diagnosed with NAS every 25 minutes, which equals between 2 to 7 newborns out of every 1,000 births.¹

The signs occur within the first day of life to 48 to 72 hours of birth and can last from days to months. This depends on which drugs the mother has taken, how much, and for how long. The actual signs can include the following ¹:

• Fussiness, crying with a high-pitched sound.
• Muscle problems such as tremors, seizures, twitching.
• Trouble sleeping with much yawning.
• Poor breast feeding.
• Diarrhea or vomiting.
• Low birth weight or slow weight gain.
• Stuffy nose, sneezing or rapid breathing.
• Fever, sweating or blotchy skin.

Long Term Effects of NAS

Management of NAS must also address ² :

• Maternal issues such as coexisting mental illness.
• Intimate partner violence.
• Limited healthcare access to support the mother-infant relationship is necessary for the infant’s normal development.

NAS is associated with long-term consequences, including, but not limited to neurodevelopmental delays, behavioral problems and when left untreated, death.²

How is NAS prevented?

The most obvious answer is avoiding drugs if you are in a position to get pregnant. If possible, use birth control until you have given up drugs. If you are pregnant and a drug user, talk to a doctor at once. Find a program that specifically cares for drug dependent mothers. This will give you and the baby a better chance of doing well.

Babies and Signs of NOWS

The current opioid epidemic has resulted in a similarly large increase of pregnant women using opioids, which has led to an epidemic of newborns with neonatal opioid withdrawal syndrome (NOWS).³

Acute neonatal opioid withdrawal syndrome (NOWS) symptoms⁴ :

• High-pitched cry
• Irritability
• Difficulty sleeping
• Increased muscle tone
• Tremors
• Skin excoriation due to excessive movement
• Hyperthermia (high body temperature)
• Loose stools
• Yawning
• Sweating
• Nasal stuffiness
• Sneezing

NOWS is a condition seen among infants born to mothers who have used opioids during the course of their pregnancy; it occurs because opioids readily cross the placenta causing the fetus to become dependent on opioids

The term NOWS is often used interchangeably with the more established term, neonatal abstinence syndrome (NAS). More recently, the term NOWS has been used to refer to infants born to opioid-using mothers, whereas NAS has been used by some professionals to refer to infants born to mothers with polysubstance use.^5-7

Long Term Effect of NOWS

Infants with NOWS, as they develop, should be assessed for ⁸:

• Growth and behavioral milestones to identify failure to thrive.
• Neurodevelopmental assessments are necessary to identify cognitive and motor deficits.
• Psychological and behavioral assessments look to find any learning difficulties or attention-deficit/hyperactivity disorder (ADHD) symptoms when they enter school.

Alcohol and Babies

I have explained NAS and NOWS. But problems with other drugs are significant. Fetal alcohol spectrum disorder (FASD) is associated with alcohol use by the pregnant mother and causes profound consequences for the child.

Alcohol use is prevalent in society and FASD is well recognized. It is deemed, in many ways, more serious than NAS and NOWS.

There is NO CURE for fetal alcohol syndrome.
Children born with this syndrome experience the symptoms throughout their entire lives. A healthcare provider can manage some symptoms with treatment, but they won’t go away.⁹