Neonatal abstinence syndrome (NAS) is a broad term that refers to a syndrome in newborns born to mothers who have been exposed to various substances, including opioids. After the birth, the baby can experience withdrawal symptoms from these substances. The types of substances can vary and the expected side effects in the newborn likewise vary.
NAS is very treatable and rarely life-threatening. Most doctors advise that women with a history of substance use disorder who are on treatment maintain that treatment during pregnancy, as the risks of harm to newborns are quite low compared to the risk of active drug use during pregnancy.
If you need to use any kind of medication during your pregnancy — including opioids or Suboxone — talk with your doctor about what to expect after delivery and how to help your baby during the transition.
What Is Neonatal Abstinence Syndrome?
Some medications move freely from a pregnant woman’s body to her unborn baby through the umbilical cord. If those medications cause physical dependence, the baby can develop either mild or more severe dependence, and con have symptoms of NAS after the birth.
If mom has been on opioids or Suboxone during pregnancy, the baby can feel uncomfortable withdrawal symptoms soon after the birth.
Key Facts About Neonatal Abstinence Syndrome
- Between 1999 and 2014, the prevalence of opioid use during pregnancy rose by 333%.
- The number of women with opioid-related diagnoses at delivery time increased 131% between 2010 and 2017.
- Every 25 minutes, doctors diagnose a baby with NAS.
- NAS can be caused by several different types of drugs, including antidepressants, nicotine, and alcohol. However, when we refer to NAS we are usually referring to the syndrome caused by opioids.
What Are NAS Withdrawal Symptoms?
You can think of the symptoms of Opioid related NAS as similar to those that you would see in an adult patient. Babies develop symptoms such as these:
- Difficulty feeding
- Reflux or vomiting
- Stuffy nose
Main Types of Opioids That Cause NAS
NAS can occur when a pregnant woman regularly takes opioid-based medications, including illicit drugs, prescription medications, and/or medications to treat opioid use disorder. Suboxone can also cause NAS, although usually to a lesser extent than full opioid agonists.
Drugs associated with NAS include the following:
- Buprenorphine/naloxone (Suboxone)
NAS symptoms may be more severe if a woman also uses nicotine, SSRIs (treatment for depression), or benzodiazepines (like Klonopin, Xanax, Valium, and Ativan).
How Is NAS Treated?
NAS is usually treated with supportive care – close monitoring, fluids, and a tincture of time.
The staff in the hospital will monitor your baby very closely. Your baby may need to stay in the hospital for a few additional days to make sure that they are feeding and gaining weight appropriately.
When your baby shows signs of withdrawal, you can use supportive care techniques, including these:
- Skin-to-skin contact
- Frequent feedings to reduce stress
In more severe cases, medications like methadone are used to help infants with severe NAS symptoms. These medications will help your infant feel more comfortable, and your baby’s doctor will develop a tapering schedule to help your baby wean off drugs before going home.
Suboxone in Newborns
Suboxone contains buprenorphine, an opioid drug that is milder than most opioids that are misused. Babies can develop NAS if their moms take buprenorphine products throughout the pregnancy, although these symptoms are usually much less severe than those taking full opioids like methadone or even illicit drugs like heroin or fentanyl. 
Most NAS symptoms appear a few days after the birth, and they can last more than two weeks. Doctors can treat NAS, and babies can recover from the illness before heading home.
Researchers aren’t sure about the long term effects on development for babies whose mothers are on Buprenorphine during pregnancy, but overall the risks seem to be low.  In the medical community, most agree that the benefits of taking Suboxone during pregnancy are greater than the risks – particularly if the alternative is reverting to illicit drug use while pregnant. Most obstetricians therefore recommend that women with a history of substance use stay on or even initiate Suboxone therapy while pregnant in order to avoid relapse to drug use.
Should You Take Suboxone During Pregnancy?
Suboxone (buprenorphine/naloxone) and methadone are good options for pregnant patients with opioid use disorder.
There is a potential and very small risk of birth defects associated with medications like this. However, the risk of not being on Medication for Addiction Treatment (MAT) and continuing to use or relapse on illicit opioids can cause destabilization for moms and lead to terrible outcomes, including:
- Overdose/death for the mother
- Spontaneous abortion
- Intrauterine growth retardation (IUGR) for baby
For these reasons, treatment with Suboxone or methadone is recommended for optimal health for both mom and baby by the American College of Obstetricians and Gynecologists (ACOG), a physician group that promotes evidence-based medicine.
If you’re already using Suboxone, your doctor will likely suggest you keep taking your medication. If you’re not using Suboxone but are misusing opioids, your doctor may suggest starting Suboxone during pregnancy.
Summary & Take-Home Message
Neonatal abstinence syndrome is rarely life-threatening, and very treatable. It includes symptoms of opioid withdrawal that occur when babies are born to moms on opioids.
Babies with NAS symptoms are monitored and treated with supportive care and sometimes medications in severe cases when a child is really unable to consume enough calories to gain weight in the first few weeks of life.
Moms with opioid dependency should get on or stay on MAT for optimal outcomes for both mom and baby. And moms should seek comprehensive support before, during, and after pregnancy that allows them to address their physical and mental health care needs.
Opioids, Suboxone & Neonatal Abstinence Syndrome FAQs
If I have an addiction to opiates, should I take Suboxone or methadone during pregnancy?
Both medications are considered appropriate, but the choice is yours.
While buprenorphine/naloxone (Suboxone) is usually prescribed in an outpatient setting and with weekly to monthly prescriptions, moms attending a methadone program may benefit from the added structure and routine of daily attendance.
Regardless of which medication is chosen, pregnancy can be a particularly stressful time in a woman’s life. It will be very important for moms to take care of their physical and mental health.
Moms should seek out a comprehensive program that supports their mood symptoms (such as anxiety and depression) with therapy and medications and provides access to other resources and programs, like parenting and birthing classes, to help build a sense of confidence and best prepare for life after delivery.
I have heard that if I am on Suboxone or methadone during pregnancy, I will be reported to my local child welfare organization. Is that true?
It depends. Some states have laws requiring that hospitals notify the authorities when babies have NAS. But several states don’t require this notification.
The role of child protective services is – at least in theory – not to punish you or to take away your child, but to help make sure that your baby is as well taken care of as possible and that you have the support you need to care for that child, including resources for treatment of OUD.
If child protective services are involved after your delivery, ask about their requirements and what you need to do from a legal perspective in order to ensure the best outcomes for you and your newborn.
Header Photo by Eric Froehling on Unsplash
Medically Reviewed By Elena Hill, MD, MPH
Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where ... Read More
- Neonatal Abstinence Syndrome. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK551498/. May 2022. Accessed December 2022.
- Data and Statistics About Opioid Use During Pregnancy. Centers for Disease Control and Prevention. https://www.cdc.gov/pregnancy/opioids/data.html. November 2022. Accessed December 2022.
- Neonatal Abstinence Syndrome (NAS). March of Dimes. https://www.marchofdimes.org/find-support/topics/planning-baby/neonatal-abstinence-syndrome-nas. June 2019. Accessed December 2022.
- Buprenorphine. Mother To Baby. https://mothertobaby.org/fact-sheets/buprenorphine/. October 2021. Accessed December 2022.
- Opioid Use Disorder and Pregnancy. American College of Obstetricians and Gynecologists. https://www.acog.org/womens-health/faqs/opioid-use-disorder-and-pregnancy. June 2022. Accessed December 2022.
- Plans of Safe Care for Infants with Prenatal Substance Exposure and Their Families. Children's Bureau. https://www.childwelfare.gov/pubPDFs/safecare.pdf. August 2019. Accessed December 2022.
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