Addicted At Birth
Background: Addiction in pregnant women causes complications such as abortion, asphyxia and cerebral and physical problems. APGAR score assesses vital signs and birth weight and represents the physical and brain growth of newborns. In this study, the effects of opium addiction in mothers on birth weight and APGAR scores of neonates were discussed.
Addicted at Birth
Methods: This study analytic, descriptive study was conducted on 49 pregnant women addicted to oral consumption of opium (0.5-0.8 grams daily) and 49 non-addicted women who referred to Afzalipour Hospital associated with Kerman University of Medical Sciences. Information including various personal characteristics, history of addiction and drug consumption, and the possibility of taking other drugs was collected by a researcher and recorded confidentially in a checklist. Birth weight and APGAR score t first, fifth and tenth minutes were also recorded. Statistical analysis was performed using Pearson correlation test, independent t-test, and repeated measure to evaluate the APGAR scores and other characteristics of the two groups of infants.
Findings: Average birth weight of infants with addicted mothers was 2255 grams which had a significant difference with infants born by non-addicted mothers (P
Most women who are addicted to cocaine are of childbearing age. Estimates suggest that about 5 percent of pregnant women use one or more addictive substances,25 and there are around 750,000 cocaine-exposed pregnancies every year.26 Although women may be reluctant to report substance use patterns because of social stigma and fear of losing custody of their children, they should be aware that drug use while pregnant is associated with specific risks that may be reduced with appropriate care.
Babies born to mothers who use cocaine during pregnancy are often prematurely delivered, have low birth weights and smaller head circumferences, and are shorter in length than babies born to mothers who do not use cocaine.26,29,30 Dire predictions of reduced intelligence and social skills in babies born to mothers who used crack cocaine while pregnant during the 1980s were grossly exaggerated. However, the fact that most of these children do not show serious overt deficits should not be overinterpreted to indicate that there is no cause for concern.
But as those lawsuits play out in distant courtrooms, stories of human suffering continue to accumulate here at home. As the number of overdoses has increased, so has the number of babies born suffering from withdrawal, the pain of addiction cascading from one generation to the next. Nationwide, the number of women giving birth while on some sort of opioid more than quadrupled between 1999 and 2014, hitting a rate of 6.5 per every 1,000 hospital deliveries. (In comparison, the rate of children born with fetal alcohol syndrome in America ranges from 0.5 to 2 per 1,000 births.) The number of NAS cases in America increased nearly fourfold between 2000 and 2012.
Medical practitioners have treatments to ease the syndrome. When the baby is born, morphine typically lessens NAS symptoms and the child is slowly weaned from the drug over the course of three to four weeks. But addressing NAS also starts well before birth. A mother quitting opiates cold turkey while pregnant can lead to miscarriages and fetal distress, so pregnant addicts are usually prescribed either methadone or buprenorphine, two other opioids. Those drugs alleviate the pain caused by withdrawal without delivering euphoria.
The nonprofit Operation PAR runs nine methadone clinics between Spring Hill and Fort Myers. Its Sarasota and Bradenton locations have more than 1,000 active patients. Between them, those two clinics treated 53 women who gave birth last year.
In the past, according to Hill, there was little communication between maternal physicians, Operation PAR and the many nonprofits and agencies that interact with addicted women, like Healthy Start, First Step and Planned Parenthood. Hill helped spearhead the creation of Addiction Support and Pregnancy (known as ASAP), a task force that tries to coordinate care for pregnant addicts and babies with NAS and other risky conditions. Steps as simple as inviting pregnant addicts to tour the labor and delivery and newborn intensive care units at Sarasota Memorial help put the women at ease and keep them on track, he says. The hospital also offers a support group for pregnant women struggling with addiction that brings in around six people every Wednesday.
Study design: We performed a retrospective cohort study of opiate-addicted gravid women treated with methadone who delivered a single neonate between 2000 and 2006. Variables evaluated as potential risk factors for PTB less than 37 weeks included medical and infectious comorbidities and "supplements to methadone" (illicit drugs and/or alcohol).
"I could have gone [to] a baby doctor at first, but I was scared because of the new law," Crowe tells the group. When she was pregnant with her youngest son, she was addicted to prescription drugs and knew that if she went to a doctor, a drug test would come back positive. So she stayed away. She had no prenatal care through her entire pregnancy. She was so afraid of going to jail and losing custody of her children that she considered giving birth at home.
Crowe finally went to the hospital 10 minutes before she gave birth. Her son was born with neonatal abstinence syndrome. The Department of Children's Services took him and her older children away and put them in foster care. Crowe enrolled in the MIST program to get clean.
Opioid use during pregnancy can lead to neonatal abstinence syndrome (NAS) in some newborns. NAS is a group of conditions that can occur when newborns withdraw from certain substances, including opioids, that they were exposed to before birth. Signs of withdrawal usually begin within 72 hours after birth and may include the following:
The signs a newborn might experience, and how severe the signs will be, depend on different factors. Some factors include the type and amount of substance the newborn was exposed to before birth, the last time a substance was used, whether the baby is born full-term or premature, and if the newborn was exposed to other substances (e.g., alcohol,5 tobacco,5,7 other medications5-8) before birth.
In November, a California woman who gave birth to a stillborn baby and admitted to using methamphetamine while she was pregnant was charged with murder. The case touched a nerve, igniting a debate over whether mothers should be held accountable for their drug use or treated with compassion for their addictions.
There are no clear rules that always apply to navigate relationships with people who are actively addicted because it depends on so many factors, but Kate Cleary, Executive Director of Consortium for Children, who has negotiated many post-adoption openness agreements and is an adoptee whose birth mother was addicted, suggests the following guiding principles for helping to navigate a relationship when the birth parent is addicted.
A year later, in 1993, Lynda Jones was charged with murder in Siskiyou County after she suffered a placental abruption and gave birth prematurely. The infant died 22 hours later, and authorities blamed methamphetamine use. A judge dismissed the case.
On August 9, Hutchison signed an order August 9 referring cases involving about 600 NAS children to the MLP. Those lawsuits are filed on behalf of children born addicted to opioids against various drug manufacturers and distributors.
She got through pregnancy and drug treatment without a hitch and delivered a healthy baby boy with no complications. But at exactly six weeks after childbirth, Raftery said she started feeling lonely, empty and disengaged.
Raftery had insurance coverage, as nearly everyone in Massachusetts does. She quickly got help from a doctor and avoided a relapse. But in states that have not expanded Medicaid, low-income women lose health care coverage two months after childbirth, which addiction experts say increases the risk that postpartum blues and drug cravings will result in an overdose.
Since the study only included Massachusetts residents, lack of insurance following childbirth was not a contributing factor. Even so, postpartum gaps in opioid treatment, such as the discontinuation of addiction medications, may have contributed to some overdose deaths, according to the study.
And Missouri, which has not expanded Medicaid to low-income adults, enacted legislation in June, extending traditional Medicaid coverage for a year after childbirth for women who are engaged in addiction treatment.
In a June advisory to states, the Centers for Medicare and Medicaid Services recommended that for mothers in non-expansion states who are no longer eligible for Medicaid coverage after childbirth, states may include screening for maternal depression and other behavioral health conditions under traditional Medicaid coverage for routine infant checkups.
The condition, which typically causes irritability, trembling, vomiting and diarrhea in newborns for about four weeks following birth, affects nearly six in 1,000 newborns in the U.S., and its prevalence is growing, according to the National Institute on Drug Abuse.
Knox County, about 50?miles northeast of Columbus, was among the first in Ohio to charge women this way. The charge comes only after a woman has given birth; Springer said the law does not consider fetuses people.
Springer brought the charge for the first time in 2009, against a mother who gave birth to a baby addicted to cocaine. That mother agreed to a plea deal that sent her to a rehabilitation facility for a year. Since then, three other women, including two in the past four months, have been charged with corrupting.