Most women who are addicted to opioids are in their peak childbearing years. Back in the 1980s, the big drug was crack cocaine. The big pregnancy fear was that “crack babies” were doomed to a life of abnormal behavior and mental disability. That turned out to be a myth.  Today, the big drugs are opioids. The big pregnancy fear is that babies will be born addicted to opioids. That is not a myth. [2,3]
The good news is that obstetricians and addiction specialists have learned how to handle opioid use during pregnancy. Babies born to mothers on opioids may have opioid withdrawal, a condition called “neonatal abstinence syndrome” or NAS. But pregnancy and NAS can be managed. In fact, pregnancy may be an opportunity for an addicted mom to get better maternal care, addiction treatment, counselling, and a new start. [2,3]
Effects of Opioids on Pregnancy
Studies suggest that about 1 to 3 percent of women use opioids while pregnant. Opioids include heroin and prescription opioid drugs. Opioids can be injected, smoked, snorted, or swallowed. The end result is the same: euphoria, followed by a need for a higher dose, and a miserable withdrawal syndrome if the drug is stopped. Opioids can be dangerous to a pregnancy. They can cause restricted growth of a baby, preterm birth, miscarriage, and fetal death. 
Treatment of Opioid Addiction During Pregnancy
Doctors have learned that the worst thing to do is to stop opioids during pregnancy. Stopping or even tapering down the opioid can send the mother and the baby into withdrawal and may trigger a miscarriage. The recommended treatment is to have the mother go on opioid maintenance treatment right through pregnancy. The obstetrician must work with an addiction specialist. [2,3]
In the past, the maintenance opioid was usually methadone. Today, the opioid buprenorphine is another option. Buprenorphine has some advantages, including lower risk of overdose, fewer drug interactions, and less neonatal abstinence. Buprenorphine can also be given as an outpatient, as opposed to methadone, which requires a daily visit to a treatment center. 
Along with the usual prenatal care, the mother can receive addiction counselling, and family counselling, or nutrition counselling if needed. Opioid maintenance therapy also increases the chance of a mother showing up for prenatal care and reduces the risk of other dangers to her pregnancy from smoking, drinking, sexually transmitted diseases, violence, and abuse. [2,3]
During pregnancy, the dose of the opioid is carefully monitored to prevent withdrawal symptoms in mom and baby. Withdrawal symptoms in mom may include craving, anxiety, insomnia, and nausea. During delivery, pain is treated as needed, with the knowledge that pain medication may need to be given at higher doses. 
After delivery, counselling and maintenance should continue. Breastfeeding is encouraged, as neither methadone nor buprenorphine move into breast milk in any significant amounts.  In the best-case scenario, the experience of a safe pregnancy, good prenatal care, a healthy baby, and addiction counselling can lead to continued addiction treatment and eventual recovery from addiction after pregnancy. [2,3]
Treatment of NAS
NAS is common and can be anticipated when a mother is maintained on an opioid. The baby may start to have symptoms of opioid withdrawal from methadone in about 72 hours. Symptoms may last for days or weeks. Buprenorphine withdrawal starts in about 48 hours and may last for about a week. Common symptoms of both include irritability, poor feeding, tremor, sweating, and diarrhea. Symptoms can range from mild to more severe. Some babies may need to be given an opioid drug that is slowly reduced and stopped over time. This may increase hospital stay. Managed properly, NAS should have no long-term effects on a child. 
If you or someone you know is pregnant and taking an opioid, a safe pregnancy is a must. The worst thing to do is to avoid prenatal care and keep drug use secret. Obstetricians and addiction specialists can keep mom and baby safe, avoid withdrawal symptoms, and reduce other dangers of addiction. Managing addiction along with pregnancy is the best way to a healthy baby and eventual recovery from addiction. [2,3]
- NIH, What are the effects of maternal cocaine use?
- American Congress of Obstetricians and Gynecologists, ACOG Statement on Opioid Use During Pregnancy.
- American Congress of Obstetricians and Gynecologists, Opioid Abuse, Dependence, and Addiction in Pregnancy.