Neonatal Abstinence Syndrome is a common condition that occurs when a baby becomes used to opioids during pregnancy and inside mom’s body. A few days (2-4 days) after being born and outside of mom’s body, the baby will experience withdrawal symptoms, similar to symptoms adults feel when withdrawing from opioids--irritability, difficulty feeding, reflux or vomiting, diarrhea, sneezing, stuffy nose, or yawning. This is common, occurring in 30-80% of babies exposed to opioids during pregnancy.
This can occur when the mom takes any type of opioid on a regular basis, including illicit drugs, prescription medications, and/or medications to treat opioid addiction. A list of these opioids is below.
→ NAS is considered EXPECTED, VERY COMMON, and TREATABLE.
The staff in the nursery will monitor your baby very closely. Your baby will need to stay in the hospital for at least 5-7 days after birth for monitoring. Different nurseries use different monitoring tools. Examples include the Finnegan NAS tool and the Eat Sleep Console (ESC) tool.
When your baby shows signs of withdrawing, there a lot of things that mom can do to support her baby. These include supportive care, like:
Sometimes medications will be used when infants have more severe symptoms, such as morphine or methadone. These will help your infant feel more comfortable and will be slowly tapered off.
**NAS symptoms may be more severe if mom also takes/uses: nicotine, SSRIs (a treatment for depression), and benzodiazepines (medications like Klonopin, Xanax, Valium, and Ativan).
Yes! Medications for addiction treatment (MAT), including buprenorphine/naloxone (Suboxone) and methadone, are considered first-line treatment and standard of care for pregnant patients with opioid addiction.
For any choice, patients should weigh the risks and benefits. There is a potential and very small risk of birth defects associated with MAT. However, the risk of not being on MAT and continuing to use or relapse on illicit opioids can cause destabilization for mom and lead to terrible outcomes, including overdose/death for mom, spontaneous abortion, and intrauterine growth retardation (IUGR) for baby.
For these reasons, treatment with buprenorphine/naloxone (Suboxone) and 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.
This is certainly an individual choice and should be up to mom.
Both medications are considered evidence-based, first-line and standard of care for treating addiction and dependence to opioids during pregnancy.
Recent evidence suggests that taking buprenorphine/naloxone (Suboxone) during pregnancy can lead to shorter hospital stays and less use of medications to treat babies for neonatal abstinence syndrome (NAS).
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, and it will be very important for mom to take care of her physical and mental health. Mom should seek out a comprehensive program that supports her 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 her.
Yes, despite the benefits of being on MAT during pregnancy, since the infant is considered “substance exposed,” health care providers are mandated to report being on this medication to child welfare organizations. This means that the organization will be involved to ensure that mom remains in recovery and creates a safe, loving environment for her baby.
If you or someone you know are pregnant and interested in learning more about the success rates and safety of Bicycle Health’s telemedicine addiction treatment in comparison to other common treatment options, call us at (844) 943-2514 or schedule an appointment here.
Boston Medical Center. Project Respect: Substance use disorder in pregnancy treatment program at BMC. Guidelines for the treatment of opioid use disorder in pregnant and parenting patients. 2019.
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