Heroin use in pregnancy
How does heroin abuse affect pregnancy?
The spectrum of adverse effects to the fetus range from premature delivery, through growth restriction to stillbirth. Nor does the problem stop at delivery, as such babies suffer serious withdrawal symptoms, needing treatment which may last several days, even weeks. More than half of heroin addict babies are born prematurely; a substantial proportion of these do not make it.
What is the alternative to heroin?
If you are already addicted to heroin and you find yourself pregnant, the advice is to switch to methadone, which is a related drug. Methadone is administered at scheduled intervals (as opposed to haphazard heroin use) which helps to keep blood levels of the drug relatively stable. This helps minimise withdrawal, which is the scourge of heroin addiction for both mother and baby.
If I am already on methadone, should I wean myself off when pregnant?
Preferably not. If you do this, you are likely to unleash withdrawal in the fetus, which could be disastrous. Continue taking methadone as per schedule and, with expert help, careful attempts to reduce the amounts taken could be started, if this is desired. Attempts to quit altogether, though noble, should ideally be made after delivery.
If I use methadone in pregnancy, will my baby not suffer from withdrawal when he or she is born?
This is inevitable. The degree of withdrawal symptoms will depend on the dose of methadone you were maintained on i.e. the higher the dose, the more severe the withdrawal symptoms. About one in five babies (20%) of such mothers have withdrawal symptoms mild enough not to require any treatment; for the rest, some kind of treatment will be required.
What about Subutex as a heroin substitute in pregnancy?
Subutex is the brand name of an opiate Buprenorphine. The use of Subutex in pregnancy remains a matter of controversy. This is mainly because safety cannot be guaranteed. So far, there has been no reports of adverse effect in humans as a result of use of Subutex in pregnancy. However, animal studies suggest risk of toxicity and possible delay in neurological development.
If a woman is already on Subutex when she becomes pregnant, a careful evaluation needs to be made whether she should continue on regulated use of this. Subutex should not be started for the first time during pregnancy. More details on this is found here:
Does withdrawal occur immediately after the baby is born?
Unfortunately not. Methadone withdrawal in the baby will occur several days - sometimes more than a week - after delivery. This means it may all happen after the mother has been discharged from hospital. It is therefore important that the mother should be able to recognise the withdrawal symptoms, to enable her to seek medical attention quickly and in time.
What are the methadone withdrawal symptoms in babies?
a high-pitched cry
refusing to feed,
rapid and laboured breathing
These are similar to heroin withdrawal symptoms, except that with heroin, the symptoms appear within a day or two after delivery.
Can I breast-feed if I am on heroin or methadone?
Small amounts of both these drugs cross into the milk. If you are unable to stop the drug habit, you should consider bottle feeding.