Pregnancy and Opioid Use Disorder

Treatment for addiction during pregnancy is a sensitive issue, as it involves addressing the mother's addiction and ensuring the safety and well-being of the unborn child.

Pregnant women with opioid use disorder can face unique challenges and stigma when seeking treatment and recovery. For some, fear of legal repercussions can hinder seeking help. However, pregnant women must get the healthcare they need for maternal and fetal health. One of the primary goals in treating opioid use disorder during pregnancy is to minimize harm, improve maternal and neonatal outcomes, and support the mother's recovery.

Medication-Assisted Treatment and Pregnancy

Medication-assisted treatment (MAT) is safe for addressing OUD during pregnancy. Medications like methadone or buprenorphine can help stabilize the mother's opioid cravings and reduce withdrawal symptoms. People who stay sober through MAT also have a lower risk of overdose.

MAT can be administered under medical supervision and with prenatal care, which enhances maternal and fetal safety. Women on MAT have experienced better outcomes with OUD and pregnancy, including reduced preterm births and improved neonatal health.

Recovery with MAT still takes work. Treatment for pregnant individuals with OUD should be comprehensive and involve a combination of MAT, behavioral therapy, and support services.

Therapy is an important component of MAT and should be robust. Therapists can address the psychosocial aspects of addiction, helping individuals develop coping skills and strategies to maintain abstinence.

MAT's Safety Profile For Pregnancy

For pregnant women with SUD, access to MAT is complicated by several factors, including where they live, healthcare facilities, whether or not they are covered by private or public insurance, and their jurisdictions' child abuse and neglect laws. Additionally, the criminal justice, healthcare, and social services systems often struggle to appropriately respond to the needs of pregnant and postpartum women struggling with SUD. Fear of being arrested, losing custody of their child(ren), and other consequences further prevent pregnant and postpartum women with SUD from accessing MAT.

The North Carolina Opioid Exposure Project has guidelines that help healthcare providers decide when and if MAT is appropriate for a pregnant or new mother.

Preventing Neonatal Abstinence Syndrome

For many babies who are born to a mother struggling with opioid use, there are health consequences. One of the most immediate worries is neonatal abstinence syndrome (NAS). NAS is most commonly associated with the use of opioids, such as heroin or prescription painkillers. It can also be diagnosed with other addictive drugs like benzodiazepines.

Babies that have been exposed to opioids regularly in their mother's womb often have symptoms of NAS. These symptoms usually appear within the first few days after birth but can vary in intensity and duration. Common symptoms include irritability, feeding difficulties, vomiting, diarrhea, fever, sweating, tremors, and excessive crying. It can be very distressing for a mother to see her child go through withdrawal, and it can cause a lot of guilt. MAT is a first line of defense in preventing NAS. If the mom can stay sober, the baby will not be vulnerable to these symptoms.

Healthcare providers use a scoring system to assess the severity of NAS symptoms. The Finnegan Neonatal Abstinence Scoring System is a commonly used tool. Depending on the total score, medical treatment and interventions may be recommended.

Infants with moderate to severe NAS may require hospitalization. In extreme cases, symptoms can be life-threatening if not managed properly.

Treatment may include Medication-assisted treatment to manage symptoms, such as morphine or methadone. The goal is to wean the infant off these medications with minimal discomfort gradually. The duration of treatment for NAS can vary widely, from a few days to several weeks, depending on the severity of symptoms and the specific substance(s) involved.

Other Dangers of Pregnancy With OUD

For babies exposed to opioids in the womb, there are other concerns past NAS. While most babies with NAS can recover with appropriate care, there is a concern about potential developmental and long-term effects. Some infants may be at an increased risk of developmental delays or behavioral issues in the future, especially if they experienced NAS because their mother was a heavy opioid user.

Medication-assisted treatment should be offered as early in pregnancy as possible to help avoid adverse outcomes.

Opioid Use Disorder during pregnancy presents unique challenges and risks, but recovery is possible with the appropriate treatment and support. Medication-assisted treatment, behavioral therapy, and comprehensive prenatal care offer mothers with OUD a path toward improved health and a healthier start for their infants. It is essential to remove stigma, provide access to care, and support these individuals on their journey to recovery for the benefit of both mother and children.

Getting Help For OUD In North Carolina

If you or somebody you love is experiencing opioid use disorder, we're here to help. We offer outpatient OUD treatment and Medication-Assisted Treatment when appropriate. We also have options for people seeking help with chronic pain who don't want to use opioids. Get in touch to learn more about our services. All calls are confidential.