Increase in NAS and Drug-Related Newborn and Mother Hospitalizations


The miracle of life is supposed to be beautiful. A mother and her newborn baby should be bonding in the moments following birth, not battling tremors, uncontrollable vomiting and other painful addiction withdrawal symptoms. But this is the reality that more and more mothers and newborns are facing every day in America. The problem of NAS and drug-related hospitalizations among mothers and newborns has grown alongside the opioid abuse epidemic and unfortunately shows no signs of slowing down.

A Horrifying Nationwide Trend

America’s opioid addiction crisis has been well documented for the better part of the 21st century. Opioid overdose deaths have quadrupled since 1999. From 2000 – 2015, more than 500,000 Americans lost their lives to a drug overdose, including an astonishing rate of 91 per day involving heroin and prescription opioids.[1] Newborn babies are the youngest and most helpless victims of this epidemic.

Infographic about the rise neonatal abstinence syndrome in the U.S.

 

Rates of neonatal abstinence syndrome (NAS) have exploded in recent years, running parallel to the growth of the drug abuse trend. Admissions for NAS (which is primarily a result of maternal opioid abuse) grew from seven per 1,000 admissions to 27 per 1,000 from 2004 – 2013.[2] In 2012, a Vanderbilt University study found that a baby is affected by NAS every 25 minutes.[3] The problem is even worse in Southern states like Tennessee, Mississippi, Alabama and Kentucky. In Kentucky in particular, hospitalizations of drug-dependent newborn babies increased 48 percent from 2013 (955) to 2014 (1,409).[4]

For these unfortunate newborns, their first experience in life is withdrawal.

Immediate Symptoms of NAS

High-pitched crying
Vomiting
Diarrhea
Feeding difficulty
Fevers
Seizures
Respiratory distress
Premature birth
Extra sensitivity to light and sound
Fetal death

These symptoms can begin within 24 hours of birth or as late as 10 days. The severity of symptoms will vary based on the type of drug used, how recently it was used and whether the baby was born premature. In most cases, symptoms cease after five days. Very little information is available about the long-term impact of NAS. This is because isolating all of the independent factors – environment, parenting, exposure to other substances – is nearly impossible. However, treatment for NAS includes declining doses of morphine or methadone, which have been shown through maternal reports and clinical observations to limit motor functioning, reduce attention span and negatively impact social skills.[5]

Maternal Substance Abuse is Root of Problem

Over 27,000 babies are born addicted to opioids every year – a number that has increased throughout every part of the U.S.[6] This is an unfortunate and terrible byproduct of an even larger problem – maternal substance abuse. Drug use and abuse in America are at all-time highs, particularly when it comes to prescription opioids and heroin.[7]

Mothers have not been immune to this trend:[8],[9]

A graphic detailing the increase in opioid use by pregnant women.

Between 2000 and 2009, opioid use among women who gave birth increased in the U.S. from 1.19 to 5.63 per 1,000 hospital births.

Combined data from the 2007 – 2012 National Surveys on Drug Use and Health indicated that an average of 21,000 women per year from ages 15-44 misused opioids within the previous month of being surveyed.
According to the 2012 Treatment Episode Data Set, of the 21,553 females between ages 15-44 who were pregnant at the time of treatment entry, over 50 percent reported heroin or a non-heroin opioid as their substance of misuse.
Drug and alcohol use during any stage of pregnancy – even before a woman realizes she is pregnant – is extremely dangerous. The first three months of pregnancy are the most vulnerable for leading to negative neonatal and maternal outcomes.[10] These outcomes are typically less favorable when expectant mothers are impoverished.

Alcohol and Other Drugs Are Also Harmful

The most common drugs abused by pregnant women include alcohol, stimulants and opioids (tobacco and marijuana are included as well but are not relevant to this article). While each drug is extremely dangerous, each also potentially creates a unique set of developmental and behavioral problems.

Cocaine:

Because of the crack/cocaine epidemic that plagued the U.S. in the 80s and 90s, there are nearly 2 million Americans living today who were prenatally exposed to cocaine. Currently, an estimated 50,000 infants are born each year in America having been prenatally exposed to cocaine.[11]

“Cocaine-exposed infants display deficits in orientation, habituation, reflexes, motor function, alertness, excitability, autonomic stability and irritability.”

Most studies have reported that infants exposed to cocaine in utero are likely to have reduced weight and head size at birth. Cocaine-exposed infants display deficits in orientation, habituation, reflexes, motor function, alertness, excitability, autonomic stability and irritability. The impact of cocaine exposure as newborns advance through early childhood, adolescence and adulthood is unclear. Findings have been inconsistent, though some evidence suggests that prenatal cocaine exposure can negatively affect growth, perceptual reasoning, attention span, behavior and academic achievement.[12] Other studies have found evidence of subtle brain changes as children age.[13]

A mother hugging her childMethamphetamine and Prescription Stimulants:

There is limited research about the long-term impact of prenatal exposure to methamphetamine or prescription stimulant medications. One of the more well-regarded studies, the Infant Development, Environment, and Lifestyle Study, indicated that exposed infants were 3.5 times more likely than unexposed infants to have a lower average birth weight and size. It has also been associated with a lack of energy and sleep difficulties, though it is not linked to behavioral or academic problems.

No data exists showing any long-term impact on the fetus when pregnant women take prescription stimulants for attention deficit hyperactivity disorder (ADHD) as directed by a physician. However, many industry experts recommend that pregnant women avoid all stimulants during the length of their pregnancies.[14],[15]

Opioids:

Prenatal heroin exposure leads to decreased birth weight, length and head circumference. It is also linked to significant impact on a newborn’s central nervous system and autonomic nervous system. The effects include high-pitched crying, high muscle tone, inconsolability, stuffiness, excessive sucking, poor sucking ability, sneezing and irritability.[16]

There is also the issue of expectant mothers suddenly ceasing heroin or opiate abuse. Fluctuations in daily heroin use by pregnant women will affect the fetus. Abrupt changes in heroin use can lead to the development of fetal abstinence syndrome, premature delivery, low birth weight, still births and sudden infant death syndrome (SIDS).[17]

Alcohol:

Over 3 million U.S. women are at risk of exposing their baby to alcohol every year. When a pregnant woman drinks, her baby does as well.[18] There is no safe amount of alcohol for an expectant mother to consume – this includes wine, beer and hard liquor. Fetal alcohol spectrum disorders (FASDs) are a group of conditions that can occur in a person whose mother drank alcohol during pregnancy. The potential effects associated with FASDs include physical, behavioral and learning problems. Many times, a person with FASD suffers from a mixture of all three.[19]

“Over 3 million U.S. women are at risk of exposing their baby to alcohol every year.”

Three Types of FASDs:

  1. Fetal Alcohol Syndrome (FAS): The most severe end of the FASD spectrum, FAS may lead to fetal death in the most extreme cases. People with FAS may suffer from central nervous system problems and difficulties with memory, learning, attention span, vision, hearing and communication.
  2. Alcohol-Related Neurodevelopmental Disorder (ARND): People with ARND may struggle with intellectual disabilities and behavioral problems. This can lead to poor performance in school.
  3. Alcohol-Related Birth Defects (ARBD): This condition relates to problems with the heart, kidneys, bones or a mixture of all of the above.

Infants born with any type of FASD are in danger of having speech or language delays, poor coordination, learning disabilities, low IQ, poor judgment and a host of many other cognitive, physical and emotional developmental difficulties.

How to Help Drug Addicted Mothers and Newborns

An infographic showing how many states in the U.S. consider substance abuse during pregnancy child abuse. While there’s no shortage of outrage and dismay at the rising rates of drug-related hospitalizations of mothers and newborns, determining what to do about the problem raises questions of ethics and morals. Should women who knowingly abuse drugs and/or alcohol while they are pregnant face legal ramifications? Should they have their babies taken away? Does it put unfair onus on women to cease drug abuse but leave men free to do whatever they please? What’s best for the baby? Opinions about each of these questions and many others range greatly.

One stance is that a woman who cannot contain her substance abuse enough to keep her child safe may not be fit to be a parent. Tennessee is currently the only state in the U.S. that has criminalized drug use during pregnancy. However, 23 states and the District of Columbia classify substance abuse during pregnancy as child abuse and require healthcare professionals to report suspected prenatal drug use.[20]

One of the criticisms of this punitive approach is that it discourages pregnant women from coming forward about their addictions. Rather than seek treatment and try to overcome a substance use disorder, women may be so frightened at the prospect of being imprisoned or losing their child that they hide the problem. Addiction rarely improves without treatment.

On the other hand, the impact of substance abuse and addiction on children is undeniable:[21],[22]

  • Between one-third and two-thirds of child maltreatment cases involve some form of substance abuse
  • Parental substance abuse and addiction are linked to children suffering cognitive, social and behavioral difficulties
  • A parent with an SUD is three times more likely to physically or sexually abuse their child. These children are more than 50 percent more likely to be arrested as juveniles and 40 percent more likely to commit a violent crime.

“A parent with an SUD is three times more likely to physically or sexually abuse their child.”

Ultimately, the onus lies with women who are pregnant or plan on becoming pregnant. It’s never too late to stop abusing drugs or alcohol. If you’ve just found out that you’re pregnant, the sooner you cease substance abuse, the better chance you’ll have of avoiding any of the complications associated with prenatal drug or alcohol use. The same applies to women who plan on trying to become pregnant in the near future. The sooner you remove substance abuse from your life, the better.

Substance Abuse and Addiction Help is Available

Whether you’re pregnant, thinking of trying to get pregnant or already have children, there’s no room for drug or alcohol abuse in your life. Not only are drugs and alcohol detrimental to your health, but they also put your child’s life and well-being at risk. There’s never a bad time to start trying to turn your life around.

But it’s important to understand that wanting to overcome your substance use disorder and actually doing it are two separate things. No matter how motivated they are, very few people are able to defeat addiction without the help of trained professionals in an inpatient facility.

If you’re ready to change your life, Unity Behavioral Health is ready to help. We have aided countless individuals and families in fighting back against addiction – we’re ready for you to be our next success story. Contact us today at 561-708-5295 to find out how you can get started.

  1. https://www.cdc.gov/drugoverdose/epidemic/
  2. http://www.nejm.org/doi/full/10.1056/NEJMsa1500439?af=R&rss=currentIssue&#t=article
  3. https://news.vanderbilt.edu/2015/04/30/babies-born-with-drug-withdrawal-symptoms-on-rise/
  4. https://www.usatoday.com/story/news/nation/2015/07/08/babies-born-dependent-on-drugs-continue-to-rise/29212565/
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3589586/
  6. https://www.livescience.com/56267-opioid-dependent-babies-united-states.html
  7. https://www.cdc.gov/mmwr/volumes/65/wr/mm655051e1.htm?s_cid=mm655051e1_w
  8. https://www.samhsa.gov/data/sites/default/files/TEDS2012N_Web.pdf
  9. https://nsduhwebesn.rti.org/respweb/homepage.cfm
  10. https://www.samhsa.gov/data/sites/default/files/report_2724/ShortReport-2724.html
  11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3188826/
  12. https://www.ncbi.nlm.nih.gov/pubmed/11792524
  13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2704485/
  14. https://www.ncbi.nlm.nih.gov/pubmed/17872810/
  15. Goodman MD, Quinn PO. Medication use during pregnancy: A concern for women with AD/HD. In: Nadeau K, Quinn PO, editors. Understanding Women with AD/HD. Silver Spring, MD: Advantage Books; 2002. pp. 69–85
  16. https://www.ncbi.nlm.nih.gov/pubmed/12456917
  17. https://www.ncbi.nlm.nih.gov/pubmed/11064485/
  18. https://www.cdc.gov/vitalsigns/fasd/index.html
  19. https://www.cdc.gov/ncbddd/fasd/facts.html
  20. https://www.guttmacher.org/state-policy/explore/substance-use-during-pregnancy
  21. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3725219/
  22. U.S. Department of Health and Human Services. Administration on Children, Youth, and Families. Child maltreatment 2005. U.S. Government Printing Office; Washington, DC: 2007