Can your baby suffer from withdrawal symptoms due to substance abuse?

Drinking alcohol, smoking or taking illicit drugs or medication in pregnancy may put your baby at risk for serious withdrawal symptoms after birth. These substances can affect the baby’s growth and development in the womb, and many of them cause long-term physical, emotional and learning difficulties for the child.

If you are struggling with substance abuse, especially in pregnancy, it can be frightening to tell someone. The first step to seeking treatment for addiction is asking for help and it’s a decision you can make to put your baby’s health first. Your healthcare provider will support your decision.

Safety in pregnancy

No amount or number of illicit drugs nor alcohol or a number of cigarettes smoked per day are considered safe in pregnancy. Even medicines that you may take for a health condition, both over-the-counter (OTC) and on prescription, can be harmful to your baby.

It is essential to tell your healthcare provider or pharmacist that you are pregnant before any medication is prescribed or dispensed. If you currently use prescription medication for pain management or any chronic condition and haven’t yet told your healthcare provider that you are pregnant, do so immediately. Your doctor will determine the safety of the medication and change your prescription if necessary. Never stop taking your chronic medication without first speaking to your doctor.

Mother addiction and withdrawal

‘Abuse’ can be defined as using a substance outside of its intended usage or more than the recommended or prescribed amount or dose.

Addiction is the compulsive need to use a substance. It is a complex disease caused by changes in the brain that occur when a substance is repeatedly used. Addiction can develop regardless of why the person started using the substance, whether for recreational, social or medical reasons. As usage continues, the body builds up a tolerance to the substance and the user begins to take more to create the same physical effect (a high, pain relief etc.) initially experienced. If an individual becomes dependent on a substance, they may find it difficult to function properly without it.

Withdrawal is the term used to describe the physical and mental effects experienced by a user when they stop taking the substance.

Newborn addiction

Quitting drugs, alcohol and smoking may seem overwhelming for a user, however, if you are pregnant, it is the best thing you can do for your baby. Substance abuse can cause several risks and complications in pregnancy. These include miscarriage, premature birth, stillbirth, birth defects, and other complications. With substances like nicotine, cocaine and alcohol, the effects on the baby can be long-term, extending beyond infancy, into child and adulthood.

Maternal addiction can also lead to withdrawal in the newborn. The placenta supports your baby’s growth with nutrients and oxygen, through your bloodstream. Some substances are able to cross the placenta, to the baby’s blood. The baby’s body gets used to the substance and when it leaves the baby’s system after birth, he or she may go through withdrawal.

Addictive substances that can lead to newborn withdrawal include:

• Alcohol
• Tobacco
• Heroin
• Opium
• Cocaine
• Amphetamines (a stimulant drug to treat ADHD, narcolepsy, and weight loss)
• Methamphetamines/ Crystal Meth/Tik
• PCP & LSD
• Ecstasy/MDMA/Molly
• Dagga/Marijuana
• Opioid pain killers like codeine, oxycodone etc.
• Antidepressants
• Sedatives (sleeping tablets and minor tranquilisers prescribed for anxiety)

Newborn withdrawal and treatment

Withdrawal symptoms can begin 24 hours to 10 days after the birth and can last up to six months. Newborn addiction symptoms range from mild to severe, depending on the substance and how long or often the mother used.

Neonatal abstinence syndrome (NAS) refers to a collection of withdrawal symptoms seen in babies who were exposed to various drugs in utero. Alcohol can cause withdrawal in the newborn, as well as foetal alcohol spectrum disorders (FASD). This is an umbrella term used to describe a wide range of physical, developmental and learning difficulties noted in babies and children who were exposed to alcohol in the womb.

Foetal Alcohol Syndrome (FAS), one of conditions that falls under FASD, is caused when a mother drinks alcohol in pregnancy, causing permanent physical and mental disabilities for the baby. South Africa has the highest reported prevalence of FAS in the world, with the Department of Health estimating an overall average of 6%. FAS is 100% preventable.

Smoking and using drugs and alcohol also increases the risk for Sudden Infant Death Syndrome (SIDS), where a baby under one year of age dies suddenly and unexpectantly.

Symptoms of withdrawal in babies include:

• Crying – a high-pitched cry; periods of incessant crying
• Difficulty feeding – sucking may be poor, frantic or the baby may have a constant need to suck
• Vomiting and diarrhoea
• Difficulty sleeping and unsettled – baby is difficult to sooth; naps are short
• Breathing difficulties – fast breathing or breaks between breaths
• Sweating
• Nasal congestion or sneezing
• Excessive yawning
• Stiffness – the limbs and/or back feel rigid
• Twitching or shaking – baby seems jittery and trembles
• Failure to thrive – in the first week baby gains little or no weight
• Skin irritation – rough patches, often on the face and in the nappy area
• Seizures

The healthcare provider will prescribe treatment for the newborn, based on the type of substance used. Babies are provided with supportive treatment and may need intravenous (IV) fluids to prevent dehydration and medication to help ease symptoms of withdrawal. Some babies need special care in the neonatal intensive care unit (NICU).

Support for mom

Your healthcare provider is dedicated to the health and wellbeing of you and your baby and will assist without prejudice. If you are struggling with substance abuse or feel unable to control your usage of alcohol, drugs or medications, or stop smoking, take a step towards recovery by reaching out to your GP or gynaecologist.

Professional help and support to stop the use  of drugs is best in pregnancy as stopping certain drugs suddenly can be harmful. Your healthcare provider will advise you on a treatment plan that provides a safe detox for you and your baby.  You can also reach out to your dedicated midwife on the Maternity Programme for counselling and advice.

No matter where you are in your pregnancy, it is never too late to stop using unhealthy, and or dangerous substances. The sooner you stop, the less chance of permanent harm to your baby, yourself.

Contact your treating doctor, midwife or counsellor for support.

Resources:  https://www.verywellmind.com/; https://www.healthline.com/; https://www.arcare.net/;

https://americanaddictioncenters.org/; https://www.healthlinkbc.ca/; https://www.detox.com/; https://kidshealth.org/; https://www.stanfordchildrens.org/; https://health.clevelandclinic.org/; https://www.mottchildren.org/; https://www.drugabuse.gov/; https://www.webmd.com/; https://recoverycentersofamerica.com/; https://intermountainhealthcare.org/; https://www.mind.org.uk/; https://www.westerncape.gov.za/; http://www.fasfacts.org.za/;