What Happens to Newborns Who Test Positive for Drugs?

Why Does Using Drugs Impact Babies After Birth?

As a fetus develops in the womb, it receives oxygen and vital nutrients from the mother. When the mother ingests drugs, the chemical components pass through the placenta barrier and into the developing fetus, causing many of the same reactions the mother has. Additionally, these substances interfere with healthy brain growth and development, leading to cascading effects on other systems.

Which Drugs Have Detrimental Impacts?

Though there is much concern surrounding the use of illicit drugs on babies, legal medicines can also cause issues. When women first find out they are pregnant, they often receive directions from their doctors, friends and relatives about what they should and should not take into their bodies.

Alcohol and nicotine are two legal substances that most women realize they need to abstain from during pregnancy and while nursing. However, several prescription drugs may also have serious consequences for fetuses, newborns and the children and adults they grow into. Many of these have illicit counterparts or are used for recreational purposes rather than medical ones. Drugs that have potentially harmful effects include:

• Nicotine
• Alcohol
• Cannabis
• Prescription and recreational opioids
• Stimulants
• Sedatives
• Hallucinogens

Often, people use more than one of these drugs, which may create additional and more complex impacts.

What Are the Risk Factors?

Women who habitually use any of the above substances increase the risks to their babies. The level of risk depends on the drug type, dose and frequency of use. Additionally, some substances are more detrimental at different stages of pregnancy. Ingesting more than one substance regularly increases the likelihood that a newborn will face multiple short- and long-term issues.

Drug addiction poses a more substantial danger. Addiction leads to tolerance and increased consumption. Women with substance use disorder usually need professional treatment to come off the drug safely. The same issue extends to the unborn child. If the fetus has multiple exposures, it is not safe for the child if the mother suddenly stops using.

There is always a potential risk that a woman will be unaware of her pregnancy and consume drugs harmful to her fetus before she knows she’s pregnant. In these instances, even those who occasionally binge drink, smoke marijuana or take prescription painkillers may inadvertently pass those drugs onto their developing fetuses.

Prevalence of Substance Use Among Pregnant Women

Rates of legal and illegal drug use among the general population are a growing concern in many countries, including the U.S. More alarming is the number of pregnant women who use harmful substances during pregnancy, even after they know they are expecting. Research finds the following rates of substance use in pregnant women:

• Alcohol consumption: An estimated 10% globally
• Cigarette smoking: 2% of women who gave birth in 2016
• Cannabis: Self-reported use in 7% of pregnant women in 2017
• Opioid use: Self-reported use in 7% of pregnant women in 2019

Over half of all pregnant women consume some type of drug (prescription, over-the-counter, social and illicit) at some point while pregnant. Not all have adverse effects, and some are necessary for an individual mother’s health. However, women who wish to conceive or are already pregnant should discuss the potential impact of any drugs they take on their baby’s health.

What Are the Impacts of Neonatal Drug Exposure?

Drug exposure in the womb can produce various adverse health, cognitive and developmental effects. Different drugs have different postnatal effects, and the impacts of each drug type also vary across individuals. Some of these impacts are short-term when the baby receives treatment, while others may last the rest of the newborn’s life.

Short-Term Impacts

Neonatal drug exposure can result in issues at birth. In some cases, proper treatment resolves the problems within infancy, while other short-term challenges last the first few years of the child’s life. If the infant does not receive the care needed, there may be ongoing concerns and complications.

Alcohol

Alcohol consumption during pregnancy significantly impacts the fetus, leading to readily apparent symptoms at birth. A newborn whose mother is intoxicated at birth has a similar blood-alcohol level as the mother. Drinking throughout pregnancy can lead to an alcohol-dependent newborn. When alcohol is no longer available after birth, the infant experiences withdrawal symptoms characteristic of neonatal abstinence syndrome.

Nicotine

Cigarettes contain thousands of chemicals, but nicotine is the most significant psychoactive compound. Nicotine molecules are small enough to readily cross the placenta barrier, leading to higher concentrations in the fetus than in the mother. At birth, newborns experience withdrawal symptoms.

Neonatal nicotine exposure increases the likelihood that a newborn will require intensive care upon birth. Additionally, these infants may experience sensitivity to sounds, increased startle responses and a poor self-regulating ability. Some of these initial challenges may lead to long-term impacts.

Cannabis

With the legalization of cannabis in many states, women have increased access to the drug. There is a general assumption that cannabis is a “safe” drug, so women may not think there is any harm in consuming it while pregnant. Currently, there isn’t much research on the impacts of neonatal exposure to marijuana or hashish.

Opioids

Opioid use is a public health crisis in the U.S. In 2020, an estimated 2.7 million Americans over 11 had an opioid use disorder, and 2.3 million of those had prescriptions. Furthermore, according to the Centers for Disease Control, the number of pregnant women with OUD more than quadrupled between 1999 and 2014. Opioid drugs include:

• Morphine
• Methadone
• Oxycodone (OxyContin)
• Hydrocodone (Vicodin)
• Fentanyl
• Heroine

Prescription opioids are often given to alleviate pain.

Neonatal exposure to prescription and illicit opioids is more likely to lead to severe NAD symptoms than most other drugs. Other short-term impacts may include low birth weight, damage to the nerves responsible for automatic body functions, central nervous system issues, gastrointestinal problems and respiratory concerns.

Stimulants

Psychostimulants are another class of drug that comes in prescriptive and illicit forms. Doctors often prescribe psychostimulants — such as Adderall and Ritalin — to treat ADHD. Methamphetamine and cocaine are the two most common illicit psychostimulants.

Like many other newborns who test positive for drugs, those exposed to psychostimulants have low birth weight and withdrawal symptoms. These infants may also have a condition known as necrotizing enterocolitis, a severe disease impacting the digestive tract that often results in emergency medical treatment and surgery.

Long-Term Impacts

Several types of drugs lead to serious long-term impacts from neonatal exposure. Some of these effects are permanent.

Alcohol

People have long known that drinking alcohol during pregnancy has detrimental effects on the fetus that often persist throughout life. No “safe” level of consumption has been identified. However, the frequency, amount and pattern of drinking matter. A single binge-drinking incident can have a more severe outcome than consuming the same total amount in small quantities over multiple days.

Alcohol consumption at moderate levels can lead to premature birth, low birth weight and fetal alcohol spectrum disorder. FASD causes a wide range of long-term physical, cognitive and behavioral impacts, including:

• Physical disabilities
• Slow growth
• Central nervous system disorders and damage
• Cognitive delays and disabilities
• Attention deficit and hyperactivity disorder
• Behavioral disorders and social issues

The most severe form of FASD is fetal alcohol syndrome. Babies born with FAS have more pronounced challenges. They also tend to have physical characteristics not present in milder forms of FASD, including distinct facial features such as wide-set eyes, small eye openings, flat faces and small upper lips.

Alcohol use during pregnancy presents one of the most severe risks to newborns. The consequences can exceed those of exposure to illicit drugs like cocaine and methamphetamine.

Nicotine

At birth, newborns exposed to nicotine in the womb tend to have a smaller head circumference, lower body weight and shorter heights. Fetuses exposed during the second and third trimesters are more likely to display these physical characteristics. Developmentally, neonatal nicotine exposure may cause speech, language and learning delays.

The cognitive challenges may continue into adulthood. Neonatal nicotine exposure can also increase the risk that the individual will become a cigarette smoker. The dangers of developmental and cognitive deficits exist throughout pregnancy, making it imperative for women to quit smoking before becoming pregnant. The paths to neonatal nicotine exposure extend beyond the mother smoking cigarettes.

Second-hand exposure can also negatively impact the growing fetus and resultant issues after birth. E-cigarettes are often thought safer; however, the mother still ingests nicotine. The same is true for other nicotine products, including gums and patches. The fetus may have reduced exposure, but these products do not eliminate the risks.

Cannabis

With little data on cannabis exposure, information about the long-term effects is scarce. However, some evidence suggests it may lead to low birth weight, an increased risk of developmental issues during adolescence and potentially higher chances of developing some cancers. People who consume cannabis are more likely to also partake in other drugs that have known adverse effects.

Opioids

The long-term effects of neonatal opioid exposure are less understood than the short-term impacts. However, what is known suggests that these babies may continue to have challenges throughout their lives. At birth, babies tend to have smaller head circumference and may experience ongoing autonomic nervous system issues. They may also have an increased risk of heart defects.

Children exposed to opioids in the womb tend to experience cognitive delays and motor impairments, hyperactivity and inattention during their school years. They are also more prone to behavioral issues. Those exposed to heroin are also more likely to have ADHD.

Ceasing opioid use without assistance is dangerous for the mother and child. Pregnant women with OUD or taking prescription opioids should contact their healthcare providers or seek help from addiction professionals before quitting.

Stimulants

The long-term impacts of neonatal psychostimulant exposure include the potential for moderate impairments in growth, language, cognition and self-regulating behaviors, especially for cocaine and amphetamine exposure. The long-term effects of neonatal meth exposure are currently being investigated. However, there are indications that these individuals have a higher risk of heart abnormalities and impaired brain development.

Risk of Miscarriage, Stillbirth and Sudden Infant Death

Women who use drugs during pregnancy increase the risk of a miscarriage or stillbirth. According to the National Institutes of Health, using prescription or illegal opioids and smoking marijuana or tobacco during pregnancy can double the risk of stillbirth. Furthermore, smoking cigarettes and drinking increases the risk of sudden infant death syndrome.

What Is Neonatal Abstinence Syndrome?

NAS occurs in many newborns exposed to drugs in the womb. Though the condition is often associated with opioid exposure, it also happens with exposure to other drugs, most often tobacco, alcohol and other sedatives. NAS occurs when newborns withdraw from the drugs they were exposed to for any length of time during fetal development. The most significant risk of the condition is to those who have exposure within a week of delivery.

Symptoms of NAS

When drug-exposed neonates are born, exposure to the drug is either eliminated or reduced (nursing newborns may still ingest some of the drugs if the mother continues use). Without access to the drug, the newborn experiences withdrawal symptoms as it leaves the system. The severity of symptoms depends on numerous factors, including genetic factors, drug type, length and quantity of use and whether the baby was born prematurely. The following NAS symptoms are common:

• Mottled skin
• Excessive, high-pitched crying
• Irritability
• Diarrhea
• Fever
• Excessive sucking
• Hyperactive reflexes
• Tremors
• Rapid breathing
• Poor feeding
• Sleep disturbances
• Increased muscle tone
• Seizures
• Sneezing and stuffy nose
• Slow weight gain
• Sweating
• Vomiting

Withdrawal symptoms generally begin within one to three days, though it can sometimes take up to a week. When a mother’s drug use is known or suspected, the newborn may be tested for drugs in the system. Infants likely to experience NAS usually need to remain in the hospital for treatment.

Treatment for NAS

Treatment measures depend on what type of drug the newborn was exposed to and how severe the infant’s symptoms are. The baby’s overall health and gestational length also impact the treatments used.

Tender Loving Care

One of the primary steps to help drug-exposed babies is providing them with extra “tender loving care.” TLC can alleviate some of the discomfort and irritability these newborns experience. This form of treatment can include:

• Skin-to-skin contact with the mother
• Swaddling in a blanket
• Reduced noise and light exposure
• Gentle rocking
• Breastfeeding (only if the mother is not using)

Drug-exposed newborns may also need extra feeding to increase the calories they ingest and help with weight gain. Many can’t handle a large food intake at once, so they receive high-calorie foods and smaller quantities provided more frequently throughout the day. Newborns who have difficulty keeping food down may also be fed intravenously until they can handle oral ingestion.

Medications

Newborns with severe NAD may require medications to help them through withdrawal. If the child was exposed to barbiturates, the doctor might give small doses to the newborn to reduce symptom severity and assist the infant wean off the drug. Opioid-exposed newborns with severe withdrawal may need to take therapeutic drugs such as methadone.

Drug treatment generally involves giving drug-exposed newborns medications from the same class of drug they ingested in the womb to alleviate some NAD symptoms. The concentration is reduced over time, allowing for a gradual withdrawal.

In particularly severe cases, doctors may prescribe phenobarbital or clonidine in addition to the primary drug treatment. Polydrug exposure may also require additional medications.

NAD Treatment Duration

As with treatment measures, the duration depends on the newborn’s health and the severity of symptoms. Often, babies with NAD need to remain in the hospital for weeks, but in severe cases, hospitalization may last months.

How Do You Care for a Drug-Exposed Baby?

Some drug-exposed infants recover well with the treatment they receive in the hospital. However, these babies often require extra TLC and nurturing for months after leaving the hospital. Those with more severe impacts may need additional ongoing therapies and support. Some may require surgery.

It is essential that mothers and other family members also get support through addiction treatment, mental health treatment and caregiving education. Depending on the severity of the child’s issues, the child and family may require assistance throughout the child’s life.

Where Can You Get Help With Substance Use Disorders Before or During Pregnancy?

If you suspect you have a substance use disorder, Clean Recovery Centers is here to help. Whether you plan to conceive or are already pregnant, our team of professionals provides the support you need to recover and give your newborn the best chances for a healthy life. We offer holistic, individualized inpatient and outpatient treatment options. Contact us today to learn more about our programs.

Sources:

• https://onlinelibrary.wiley.com/doi/full/10.1111/dar.13425
• https://www.cdc.gov/nchs/products/databriefs/db305.htm
• https://www.cdc.gov/pregnancy/opioids/basics.html
• https://jamanetwork.com/journals/jama/fullarticle/2736582
• https://www.merckmanuals.com/home/women-s-health-issues/drug-use-during-pregnancy/drug-use-during-pregnancy
• https://pubs.niaaa.nih.gov/publications/arh22-1/47-53.pdf
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4262892/
• https://www.cdc.gov/reproductivehealth/maternalinfanthealth/substance-abuse/substance-abuse-during-pregnancy.htm
• https://www.who.int/teams/mental-health-and-substance-use/alcohol-drugs-and-addictive-behaviours/drugs-psychoactive/cannabis
• https://nida.nih.gov/publications/research-reports/medications-to-treat-opioid-addiction/overview
• https://www.cdc.gov/mmwr/volumes/67/wr/mm6731a1.htm?s_cid=mm6731a1_w
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3139193/
• https://www.nichd.nih.gov/health/topics/nec
• https://www.nichd.nih.gov/newsroom/releases/121113-stillbirth-drug-use
• https://medlineplus.gov/ency/article/007313.htm

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