Maternal substance abuse and neonatal abstinence syndrome

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JULIA, A YOUNG college student from middle class America, was involved in a car accident during her freshman year in college. As a result of the car accident, Julia hurt her back and experienced severe pain. As her back healed, she found that she needed more and more pain medicine to feel normal. But taking her pain medicine caused a problem. Julia could not do the work required to stay in school. Unfortunately, Julia soon found herself out of school, unemployed and uninsured. A “friend” told her about heroin. Heroin, from Mexico, was readily available on the street and it cost less than the cost of her current pain medicine. Heroin made Julia feel good. Soon Julia was “hooked” and her life spun out of control.

There has been a significant increase in the use or abuse of illegal or prescribed opioid drugs. Opioids are medications that relieve pain. They reduce the intensity of pain signals reaching the brain and affect those brain areas controlling the emotion. Medications that fall within this class include: hydrocodone (e.g., Vicodin), oxycodone (e.g., OxyContin, Percocet), morphine (e.g., Kadian, Avinza), codeine and other related drugs. Heroin is an opioid that is roughly 2-3 times more potent than morphine. 

The increased use of opioid drugs began in the 1990s when it was first thought that doctors were doing an inadequate job treating pain. In 2001, the Joint Commission that performs accreditation for most hospitals issued guidelines calling for more aggressive treatment of pain. Purdue Pharma responded by distributing coupons for a free trial of OxyContin. Thirty-four thousand were redeemed and sales of OxyContin soared from $44 million in 1996 to $1.54 billion in 2002.

More people are using or abusing legitimately prescribed medication or illegal drugs due to chronic pain, depression, mood disorders or mental health disorders. Innocent individuals who have slowly drifted into substance abuse can be found in your families, in the workplace, on college campuses and within your community. From someone who may have gotten injured at work, to an individual who is trying to cope with severe depression or mental issues; using prescribed opioids is becoming more prevalent. 

Given the widespread opioid use in the United States and the fact that many pregnancies are unplanned, some women of childbearing age (15-44) are at risk for adverse pregnancy outcomes associated with opioid use. Among women of childbearing age, from 2008-2012, 27.7% of women with private insurance and 39.4% of women with Medicaid filled a prescription for an opioid each year. The most commonly prescribed opioids were hydrocodone, codeine and oxycodone. Among women enrolled in Medicaid, opioid prescriptions were nearly 1.5 times higher among non-Hispanic white women than non-Hispanic black or Hispanic women.

One day Julia collapsed on the street. When EMS arrived, they took her to a local emergency room where she was treated for an overdose on heroin. In the emergency room, Julia was found to be pregnant. She was not alone. From 2000 to 2009, the number of mothers found to be using opioids during pregnancy increased from 1.19 to 5.77 per 1,000 U.S. hospital births per year. 

The use or abuse of either illegal or legitimately prescribed drugs during pregnancy can have serious health consequences for both the mother and baby. When a substance abuse mother goes through withdrawal, her baby also goes through withdrawal and even if the mother survives the withdrawal, her baby may not. In pregnancies that survive, babies may experience improper growth or may be delivered early due to premature labor or placenta abruption. Pregnancies complicated by opioid dependence end in preterm birth 30% of the time. This rate is three times the national rate.

Unlike many women addicted to opioids, Julia gained access to comprehensive treatment. She received treatment that included: transitioning to methadone, psychiatric care, social services assistance and nutritional assistance. Julia’s transition to methadone, a drug that can be used to prevent addictive cravings and has a less ill effect on the baby, increased her chances of having a better pregnancy outcome for herself and the baby. After several days in the hospital, Julia went into labor and delivered a little baby girl. 

The neonatologists knew of Julia’s history and watched her child closely for signs of neonatal abstinence syndrome. Neonatal abstinence syndrome (NAS) refers to cases in which newborns experience drug withdrawal shortly after birth due to drug exposure in the utero. From 2000 to 2009, NAS diagnoses increased from 1.20 to 3.39 per 1,000 hospital births per year. Identifying a newborn with NAS can propose a challenge. Symptoms of NAS in the baby may not occur for days after birth. If the obstetrician is not made aware of the mother’s addiction, the baby may suffer withdrawal after discharge from the hospital. Even if the obstetrician knows of the mother’s substance abuse history, insurance companies often do not cover the baby’s hospital stay if there are no signs of withdrawal. 

Caring for NAS babies requires intensive use of hospital resources and may cost five times or more than that of a healthy baby. The average length of hospital stay for an infant with NAS is 16 days, compared to 3 days for infants born without NAS.

Substance abuse and maternal and child health is of major concern to the March of Dimes. The mission of the March is to improve the health of women of childbearing age and infants by preventing birth defects, premature births and infant mortality. The March of Dimes supports policy initiatives aimed at providing care for both moms and babies in order to promote a healthy pregnancy and build a healthy family. 

• Access to comprehensive services: Pregnant women who abuse drugs, such as opioids, should have access to comprehensive services, including prenatal care, drug treatment and social support services. These women often have other psychosocial risk factors that need to be addressed in order to ensure they successfully stop abusing drugs.

• Priority access and flexible treatment: Drug treatment programs should be tailored to pregnant or parenting women, taking into account the woman’s family obligations, and should provide priority access to pregnant women.

• Immunity during prenatal visits: Research has shown that obtaining prenatal care, staying connected to the health care system, and being able to speak openly with health care providers about drug use creates a healthy environment for mothers at risk of drug abuse to seek treatment that can improve birth outcomes.

• Provider education: Provider education and public awareness efforts can increase the patient-provider discussion on the risks and benefits of various medications, including opioids, and potential risks to the unborn child. Additionally, providers should be educated on the most updated substance abuse screening tools and the standard of care for all obstetrics patients. 

In some states, policymakers have proposed punitive measures for women whose infants experience NAS. The March of Dimes believes that targeting women who used or abused drugs during pregnancy for criminal prosecution or forced treatment is inappropriate and will drive women away from seeking proper prenatal care and substance abuse treatment vital for both mom and their unborn baby.

States should ensure the safety of their most vulnerable populations by ensuring access to treatment facilities for all pregnant women. 

March of Dimes commends the Louisiana State Legislature for passing a study resolution during the 2015 Legislative Session requesting the Commission on Perinatal Care and Prevention of Infant Mortality to study and make recommendations related to the prevention, screening and treatment of neonatal abstinence syndrome. March of Dimes is engaged in this initiative with a host of stakeholders to address maternal substance abuse and neonatal abstinence syndrome in Louisiana. 

Symptoms of NAS include:
• persistent or prolonged high-pitched crying
• central nervous system hyper-irritability
• gastrointestinal dysfunction such as vomiting or diarrhea (which can lead to weight loss)
• excessive sucking reflex
• sleeping problems
• frequent yawning

March of Dimes is the leading nonprofit organization for pregnancy and baby health. With chapters nationwide, March of Dimes works to improve the health of babies by preventing birth defects, premature birth and infant mortality. For the latest resources and information, visit or For free access to national, state, county and city-level maternal and infant health data, visit PeriStats, at Learn more about the Louisiana Chapter by visiting or call (225) 295-0655.

AmeriHealth Caritas Louisiana is one of five Medicaid managed care plans that participate in Louisiana’s Bayou Health program. AmeriHealth Caritas Louisiana helps Louisiana families get proper care and stay well. AmeriHealth Caritas Louisiana works with communities in need to achieve positive health outcomes throughout the state. For more information, go to





March of Dimes  |  225.295.0655  |





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