Kratom and pregnancy: neonatal withdrawal (NAS) risk

At a glance: kratom and pregnancy

Key Takeaways

• Regular kratom use in pregnancy can cause neonatal abstinence syndrome. Its opioid-like alkaloids cross the placenta, and the baby can be born physically dependent.
• A 2023 literature review published in Research Reports in Neonatology examined 10 kratom-in-pregnancy case reports involving 12 mother-infant pairs. Most of the exposed infants developed NAS, and more than half required pharmacological treatment.
• Most cases were not identified until after delivery. Kratom does not appear on standard prenatal or neonatal drug screens, so without disclosure from the parent, the clinical team does not know to watch for it.
• Do not stop kratom abruptly during pregnancy. Supervised treatment is the established standard and produces better outcomes for both parent and baby than attempting unsupported withdrawal.
• Telling your OB is the most protective step available. It enables monitoring, planning, and access to evidence-based care.

What neonatal abstinence syndrome is and why kratom causes it

Neonatal abstinence syndrome (NAS) is a withdrawal syndrome in a newborn caused by exposure to a physically dependence-producing substance during pregnancy. It is most commonly associated with opioid exposure, including both illicit opioids and prescribed medications such as methadone and buprenorphine used to treat opioid use disorder.

Kratom's alkaloids, principally mitragynine and 7-hydroxymitragynine, activate mu-opioid receptors. These alkaloids cross the placenta and reach the fetus. With regular maternal use, the baby's developing system adapts to the opioid receptor stimulation in the same way an adult body would: through neuroadaptation. When the baby is born and the placental supply stops, the adapted system is left without the substance it had come to depend on, and withdrawal begins.

A 2018 case in the International Journal of Clinical Pediatrics described a newborn who began showing significant withdrawal signs on the first day of life, including high-pitched crying, facial grimacing, and irregular respiration, after the mother's urine drug screen was negative and no exposure had been disclosed. The kratom connection was identified only after the clinical picture did not fit any screened substance.

What the evidence shows

The case literature on kratom and pregnancy is growing. A 2023 literature review in Research Reports in Neonatology (Dove Press) searched three major databases and identified 10 published case reports involving 12 mother-infant pairs.

Key findings from that review:

A pediatric review published in Pediatric Research Journal noted that "reports of NAS due to maternal kratom use are increasing" and that "kratom cannot be detected on routine toxicology screening," underscoring why disclosure from the parent is the only reliable mechanism for early identification.

What NAS looks like in a newborn

NAS symptoms in a kratom-exposed newborn follow the same general pattern as opioid NAS, though the profile may vary. The Finnegan Neonatal Abstinence Scoring System is the standard clinical tool used to assess severity and guide treatment decisions.

Common signs include:

Symptoms typically appear within the first several days of life. In some cases with shorter-acting opioid exposures, onset can be within the first 24 hours. For longer-acting exposures, onset may be delayed.

NAS is a known, treatable neonatal condition that care teams are trained to manage. The baby is monitored, and when symptoms meet a clinical threshold, medication is started and then slowly weaned. This process takes time, often several weeks of hospital stay, and the baby is not in danger from NAS itself when managed appropriately. The care team guides everything.

Why it often goes unrecognized until after delivery

The 2023 Dove Press review noted that the majority of kratom-using mothers in the published case literature were not identified until after delivery, when their infant displayed withdrawal symptoms. This happened for two reasons:

Kratom does not appear on standard drug screens. Prenatal and neonatal urine toxicology panels screen for morphine-class opioids, cocaine, amphetamines, and a limited set of other substances. Mitragynine and 7-OH are not included. A person using kratom regularly throughout pregnancy could test negative on every standard prenatal screen while the fetus is being continuously exposed.

The risk is not widely known. Kratom is marketed as a natural supplement. Many users, including healthcare providers who are not familiar with its pharmacology, do not recognize it as a substance with opioid-like effects that cross the placenta and can cause neonatal withdrawal.

The result is a significant identification gap. Babies born dependent on kratom arrive without a flag, and without a clinical plan, which delays the monitoring and care that would help them.

Telling your OB about kratom use before delivery changes this picture. It gives your care team time to prepare, increases monitoring for NAS after delivery, and lets you access treatment during pregnancy rather than after the fact.

What supervised treatment during pregnancy looks like

If you are pregnant and using kratom, please talk to your OB before making any changes. Stopping kratom abruptly during pregnancy is not the recommended approach. In the same way that abrupt opioid withdrawal can cause stress to a pregnancy, unsupported kratom withdrawal during pregnancy carries risks that supervised treatment does not.

The established standard for opioid-type dependence in pregnancy is opioid agonist treatment (OAT), typically with buprenorphine or methadone, provided under the joint care of an OB and an addiction medicine specialist. The specific medication, dosing, and monitoring plan are individualized decisions made by your care team based on your health history, the stage of your pregnancy, and your circumstances. This article does not make medication recommendations; those decisions belong to your clinician.

What you can expect from supervised treatment:

• Medical monitoring of your pregnancy alongside your substance use treatment
• A clinical plan for the baby after delivery, including monitoring for NAS
• Support to address the underlying dependence in a medically managed way
• No judgment from a properly trained care team; this is a medical situation, not a moral one

Even with appropriate treatment, a baby may develop NAS. Buprenorphine and methadone, both used to treat opioid use disorder in pregnancy, can themselves cause neonatal withdrawal. NAS in this context is expected and managed, not a treatment failure. The goal is a monitored delivery with a prepared care team, not zero risk of any NAS.

Reaching out early is the strongest thing you can do. Earlier care means more time for treatment to stabilize your system, more time for the care team to plan, and more time for the baby to benefit from that stabilization.

Frequently Asked Questions

Can kratom cause problems during pregnancy?

Yes. Regular kratom use during pregnancy exposes the developing baby to opioid-active alkaloids that cross the placenta. The baby can become physically dependent on those alkaloids and go into withdrawal after birth, a condition called neonatal abstinence syndrome. A 2023 literature review of published case reports found that most kratom-exposed infants developed NAS, and more than half required medication to manage it.

Does kratom show up on prenatal drug tests?

No. Kratom alkaloids (mitragynine and 7-OH) are not included in standard prenatal or newborn drug toxicology panels. A person using kratom throughout pregnancy will typically test negative on standard screens. This is why disclosure to your OB is the only way your care team can know to monitor for NAS after delivery.

What should I do if I am pregnant and using kratom?

Tell your OB as soon as possible. Do not stop kratom abruptly on your own; unsupervised withdrawal during pregnancy carries risks. Your OB can connect you with an addiction medicine specialist who can help develop a treatment plan appropriate for pregnancy. Disclosure enables your care team to monitor the baby after delivery and prepare a clinical response. Getting care early is the most protective step available.

Is it safe to stop kratom when pregnant?

Stopping kratom abruptly on your own is not the recommended approach during pregnancy. Supervised treatment, typically with an OB and an addiction medicine specialist, is the established standard for opioid-type dependence in pregnancy. The specific plan is individualized and should be determined by your care team. Do not make changes to your kratom use during pregnancy without first speaking with a clinician.

What happens to a baby born after kratom exposure?

The baby is monitored after delivery for signs of neonatal abstinence syndrome. If NAS develops, the clinical team uses a standardized scoring tool (the Finnegan scale or equivalent) to assess severity and determine whether medication is needed. Medications used to treat NAS in this context are weaned gradually. The hospital stay may be extended until the baby is stable. With appropriate monitoring and care, NAS in a kratom-exposed baby is a manageable neonatal condition.