Opioid Use & Pregnancy

How Long Do Opiates Stay in Your System While Pregnant?

Opiate drugs—including illicit substances like heroin and prescription opioids like morphine, codeine,  oxycodone, and hydrocodone—have a range of half-lives, meaning the time that it takes the body to process them out of the system. The length of time that an opiate can stay in someone’s system depends on type of opiate used, how much was used, and the way it was used.

Certain physiological changes throughout pregnancy may influence the pharmacokinetics and pharmacodynamics of particular drugs; in the case of medications, this means that a doctor will take into account the potential changes and adjust your dosing schedule accordingly during a pregnancy. Not knowing this information can make it that much more dangerous to use any drug without medical supervision.

What are the Risks of Opioids While Pregnant?

Opioids have the ability to cross the placenta, and exposure to these drugs can cause serious problems for your developing baby. Women who take opioids should be aware of the risks and possible negative birth outcomes associated with opioid use during pregnancy.

Birth Defects

Several long-term studies have shown an association between maternal opioid use during pregnancy and certain birth defects. Findings from the National Birth Defects Prevention Study, one of the largest studies on birth defects ever undertaken in the United States, show an association between opioid use during pregnancy and birth defects that include:¹

• Congenital heart defects
• Neural tube defects (serious problems in the development or formation of the brain, spine, and spinal cord)
• Gastroschisis (a defect of the abdominal wall, where the intestines stick outside of the body through a hole beside the belly button)
• Glaucoma (an eye disorder associated with increased eye pressure, optic nerve damage, and blindness if left untreated)
• Hydrocephaly (build-up of fluid in the brain)

Other studies have suggested that opioid use during pregnancy increases the risk for birth defects such as cleft lip, cleft palate, and clubfoot.²

Neonatal Abstinence Syndrome (NAS)

Opioids can cross the placenta and directly interact with the fetal central nervous system. This prenatal exposure to opioids can cause an unborn baby to develop a dependence on opioids, and it is possible for newborns to experience withdrawal from opioids that they were exposed to before birth. Withdrawal symptoms associated with this condition, which is referred to as neonatal abstinence syndrome (NAS), usually occur 2-3 days after birth and can include:³

• Excessive crying
• Irritability
• Jitteriness
• Tremors
• Poor feeding
• Vomiting
• Diarrhea
• Weight loss
• Fever
• Sweating
• Rapid heartbeat
• Seizures

Placental Abruption

A previous study showed that opioid use during pregnancy increases the risk of placental abruption by 2.6 times.⁴ This serious condition is characterized by the premature separation of the placenta from the uterine wall. As a result, the baby may not receive adequate oxygen and nutrients while in the womb.

Other complications that have been associated with opioid dependency during pregnancy include:^5-6

• Preterm labor and premature birth
• Preeclampsia (high blood pressure in pregnant women that can lead to serious, even fatal, complications for both mother and baby)
• Premature rupture of membranes (breaking open of the amniotic sac before labor begins)
• Miscarriage or stillbirth
• Problems with growth of baby (fetal growth restriction and low birthweight)
• Sudden infant death syndrome
• Maternal cardiac arrest
• Cesarean delivery

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Opioid Abuse

Opioids have a high potential for abuse, and their prolonged use can lead to physical dependence.⁷ This can result in the user experiencing dangerous withdrawal symptoms upon discontinuation of opioids. Opioid abuse also leads to tolerance, which causes the need for increasingly higher doses to achieve the same desired effect.

Because of the effects that these drugs have on the part of the brain that regulates breathing, high doses of opioids can cause respiratory depression and death.⁸ Opioid abuse can lead to addiction and an increased risk of overdose and death. According to the Centers for Disease Control and Prevention (CDC), there were 47,600 drug overdose deaths involving opioids that occurred in the United States in 2017. ⁹

The opioid epidemic ravaging our country is not only a reflection of the highly addictive and dangerous properties of this drug, but also a consequence of our rampant use of prescription opioids. During the last year nearly 1 in 5 people in the United States were prescribed at least one opioid medication.10 More than 191 million opioid prescriptions were dispensed to American patients in 2017, with the average person receiving 3.4 prescriptions.¹⁰

Unfortunately, the harmful effects of opioids go beyond the individual user. In the case of pregnant women, opioid abuse can have serious adverse consequences for both the mother and developing fetus.

How to Quit Opiates Cold Turkey While Pregnant?

Quitting any kind of substance cold turkey can be dangerous, especially if you are pregnant. Unmanaged opioid withdrawal can be painful and can introduce added risks to you and stresses to the fetal environment, thereby increasing the risks of both obstetrical and fetal complications.

Some of the uncomfortable symptoms of opioid withdrawal may include:¹¹

• Abdominal cramps.
• Nausea.
• Vomiting.
• Diarrhea.
• Flu-like symptoms.
• Chills.
• Muscle aches.
• Sweating.

If you are someone you know is concerned about their use of opioid drugs during pregnancy, or already showing signs of withdrawal symptoms during pregnancy, seek medical help. At an addiction treatment facility, medical professionals can help stabilize you for recovery, provide medical care, and treatment to best help their patient’s needs.

At American Addiction Centers (AAC), we offer specialized and unique treatment options for all our patients. At our treatment facilities medical professionals will assist during withdrawal and will continue care through evidence-based therapies. We have facilities all across the U.S.

If you or a loved one is worried about pregnancy and opioid withdrawal give us a call today at . We can answer your questions about addiction, share information about our facilities and treatment programs, and start the admissions process.

What are Opioid Treatment Options?

If you suffer from an opioid addiction and are pregnant or planning to become pregnant, the first thing you should do is talk with your doctor or other healthcare provider. You should not abruptly stop taking opioids during pregnancy, as this can have serious consequences for both you and your baby.

The current clinical recommendation for pregnant women is medication-assisted treatment.¹² This form of treatment uses a combination of medications, counseling, and behavioral therapies to treat opioid addiction, and studies have shown that this approach has a higher likelihood of success in pregnant women compared to other strategies like supervised withdrawal.

Sources

1. Broussard, C.S., Rasmussen, S.A., Reefhuis, J., Friedman, J.M., Jann, M.W., Riehle-Colarusso, T., & Honein, M.A. (2011). Maternal treatment with opioid analgesics and risk for birth defects. American Journal of Obstetrics and Gynecology, 204(4), 314.e1–314.e11.
2. Lind, J.N., Interrante, J.D., Ailes, E.C., Gilboa, S.M., Khan, S., Frey, M.T. …& Broussard, C.S. (2017). Maternal Use of Opioids During Pregnancy and Congenital Malformations: A Systematic Review. Pediatrics, 139(6), e20164131.
3. Jansson, L.M., Velez, M., & Harrow, C. (2009). The opioid-exposed newborn: assessment and pharmacologic management. Journal of Opioid Management, 5(1), 47-55.
4. Salari, Z., Mirzaie, F., & Mehran, M. (2008). Evaluation of relationship between opioid addiction and placental abruption. Scientific Journal of Hamadan University of Medical Sciences and Health Services,14(1), 39–43.
5. Kellogg, A., Rose, C.H., Harms, R.H., & Watson, W.J. (2011). Current trends in narcotic use in pregnancy and neonatal outcomes. American Journal of Obstetrics and Gynecology, 204(3), 259.e1-259.e4.
6. Substance Abuse and Mental Health Services Administration. (2009). Substance Abuse Treatment: Addressing the Specific Needs of Women. Treatment Improvement Protocol (TIP) Series, No. 51. HHS Publication No. (SMA) 13-4426. Rockville, MD: Substance Abuse and Mental Health Services Administration.
7. Centers for Disease Control and Prevention. (2019). Basics About Opioid Use During Pregnancy.
8. Centers for Disease Control and Prevention. (2016). Prescription Opioids: What You Need to Know.
9. World Health Organization. (2018). Information sheet on opioid overdose.
10. Scholl, L., Seth, P., Kariisa, M., Wilson, N., & Baldwin, G. (2018). Drug and Opioid-Involved Overdose Deaths – United States, 2013-2017. Morbidity and Mortality Weekly Report, 67(5152), 1419-1427.
11. MedlinePlus. (2018). Opiate and opioid withdrawal.
12. Centers for Disease Control and Prevention. (2018). 2018 Annual Surveillance Report of Drug-Related Risks and Outcomes.