Pregnant heroin addict: what about the baby?

Abstract

Heroin misuse in pregnancy is a significant health and social problem, and it can have an adverse effect on the mother and the baby. Although heroin and methadone have no specific teratogenic potential, 48-94% of children exposed in utero will have neonatal abstinence syndrome (NAS). The primary aim of this case report is to raise awareness of NAS among clinicians and to remind them that although very common, it is not inevitable. The risk of NAS can be further minimised by offering comprehensive and co-ordinated antenatal care that addresses the various biopsychosocial needs of the pregnant woman. Further, a brief description of NAS and a review of evidence in the field of management of opioid misuse in pregnancy, as relevant to this case, are provided. We have also included the patient's own reflections on her pregnancy and treatment.

Opioid Use in Pregnant Women and Neonatal Abstinence Syndrome—A Review of the Literature

“…Heroin, which is mostly used as an illicit drug for recreational use, is a morphine derivative responsible for a large number of NAS cases. It is a highly addictive drug; therefore, addicted women will likely continue using this drug throughout pregnancy, resulting in NAS in most of the cases [19]. Furthermore, even if its use is stopped, a period of substitution treatment with buprenorphine or methadone follows, exposing the infant to them throughout pregnancy [10].…”

“…The information presented in Table 1 is crucial in establishing a diagnosis in the newborn as soon as possible. These symptoms develop from 24 to 72 h post-partum, although in some exceptional cases they may appear up to 10 days after birth [19].…”

“…These are methods of diagnosis applied to the neonate; however, focusing on the pregnant woman may also be a reliable way of predicting and/or diagnosing NAS as well. For instance, the use of heroin is an indicator of high probability of NAS, as 48% to 94% of infants born with NAS were reported in women taking heroin or methadone during pregnancy [19]. One of the most important factors and prevention measures that should be taken to avoid NAS in the newborn is improving the mother’s awareness of the consequences of using opioids during pregnancy, may they be illicit or not.…”

“…Urine or saliva tests can be used throughout pregnancy to obtain information on whether the opioids are being used or not [19], and this may be a very important measure to take when women are at risk of opioid consumption. This refers mostly to known drug addicts, as sporadic opioid consumption is usually unknown to the health professionals, which means that only by regular routine tests can NAS be predicted and/or prevented.…”