Opioids During Pregnancy—Key Risks for Mom and Baby

What are opioids?

• Opioids are medicines that can relax the body and relieve pain. Doctors may prescribe them after an injury, dental work, or to treat other conditions.
• Some common opioids are: fentanyl, codeine, hydrocodone, morphine, oxycodone, tramadol, and many others. There are also many different brand names for opioids. If you’re unsure whether a medicine you’re taking is an opioid, talk to a medical professional.
• Some illegal drugs are also opioids, such as heroin. Other times, pills like fentanyl are made and sold illegally, and could be mixed with other dangerous drugs. Getting opioids outside of a pharmacy is risky, since they may be contaminated or too strong, increasing the chance of an overdose.
• Taking opioids regularly can make your body depend on them. Over time, you may need more for the same effect. If you stop suddenly, you may experience withdrawal, which can make you feel very sick, depressed, and in more pain.
• Using kratom regularly can also cause withdrawal that is very similar to opioid withdrawal.
• When withdrawal happens, people often look for ways to get more opioids to avoid feeling bad. This can lead people to seek more opioids just to feel normal.
• Addiction means strong cravings and difficulty stopping, even when it causes harm.

Risks of non-prescribed opioid use during pregnancy

Taking non-prescribed opioids during pregnancy can create health risks for mothers and their babies.

Impact on Mother’s Health

• When a pregnant woman is taking non-prescribed opioids, there is a higher risk of complications like C-section, infection, heavy bleeding, or even death.
• When a pregnant woman is taking any opioids regularly, pain during childbirth can be harder to control.
• After delivery, the combination of pain, hormone changes, lack of sleep, and caring for a newborn can make cravings for opioids and mental health symptoms worse. 
• It is also important to know that pregnant women who are taking opioids regularly (even if prescribed) should not try to quit “cold turkey” without medical guidance.
• If a pregnant person who is dependent on opioids stops taking them suddenly, it can cause withdrawal.
• Withdrawal is stressful on the body and may lead to miscarriage and early labor.
• The greatest risk to coming off opioids during pregnancy is the temptation to start using them again. A person’s body may not be able to handle them as well, so the risk for overdosing is much higher. An overdose can be harmful or even fatal for a mother and her baby.

Risks for Babies

• The most serious consequence of having withdrawal during pregnancy can be losing the baby. Withdrawal can cause miscarriage, stillbirth, or premature delivery requiring critical care.
•  A fatal overdose for a mother will also be fatal for the baby. 
• Exposure to opioids in the womb also increases the risk of poor growth, birth defects, longer hospital stays, and needing care in a neonatal intensive care unit.
•  Babies can be born dependent on opioids, which may result in Neonatal Abstinence Syndrome/Neonatal Opioid Withdrawal Syndrome (NAS/NOWS). Babies with NAS/NOWS experience withdrawal symptoms like problems with feeding, sleeping, crying, and seizures.

What if I become pregnant while I am taking opioids?

• Whether or not opioids were given to you by a doctor, it is extremely important to talk to a medical professional as quickly as possible once you know that you are pregnant.
• You should NOT stop taking opioids “cold turkey,” or by yourself. This can be dangerous. Withdrawal from opioids during pregnancy is stressful for you and your baby and can lead to stillbirth or premature birth.
• Instead, pregnant women who use opioids should seek medical advice to help them have the healthiest pregnancy possible.

Exploring Safer Alternatives and Supportive Approaches

If you are taking opioids during pregnancy, you should see a medical professional as soon as possible. They can help you develop a plan to have a healthy pregnancy. Treatment plans should be specific for your unique needs. However, common types of support that a health care provider could offer include:

Pain management

• If you are taking opioids to manage chronic pain, a health care professional may connect you with a pain management specialist.
• This type of specialist focuses on diagnosing, treating, and helping people live better with pain, especially when it is hard to control.
• Pain management specialists use a mix of approaches that are customized to each person’s needs.
• Some examples include medications, procedures like injections or nerve blocks, physical therapy, exercise plans, and counseling.
• The goal is to reduce pain, improve your ability to move and perform everyday tasks, and to improve quality of life.

Medication-Assisted Treatment (MAT)

• One treatment option could include medication given to you by a doctor. You might hear them called Medications for Opioid Use Disorder (MOUD for short) or Medication Assisted Treatment (or MAT). Common examples are methadone and buprenorphine.
• During pregnancy especially, these medications are safer than opioids. They can help reduce your cravings and withdrawal symptoms.
• Withdrawal makes you feel sick, anxious, sweaty, nauseated, achy, restless, and you may have vomiting, diarrhea, or trouble sleeping.  During pregnancy, it’s important to avoid withdrawal, which can be uncomfortable or harmful to you and your baby. MOUD/MAT can prevent or greatly reduce withdrawal and cravings.
• You don’t have to stop opioids on your own before starting treatment. An opioid treatment provider can help you safely transition to MOUD/MAT. The timing and amount of medication are carefully chosen to prevent or minimize cravings, and your dose can be adjusted until you feel comfortable and stable.
• Many people using opioids find that medications can help them get back to their lives. Doctors approve of these medications, and you won’t face legal consequences for taking them as prescribed.

Other treatment options

• Treatment options could include treating addiction to other substances that could harm your baby, like nicotine or alcohol.
• Using nicotine and alcohol during pregnancy can cause poor growth in the womb, early birth, miscarriage, birth defects, and developmental problems.
• Completely quitting alcohol and nicotine is safest.
• Treatment to help you quit alcohol and nicotine could include medications, counseling, and quit programs.
• If you live in South Carolina, the SC QUIT Line is a free resource to help. You can learn more at https://www.quitnowsc.org/ or by calling 1-800-QUIT-NOW.
• Treatment options may also focus on helping you with your mental health.
• Untreated mental health issues can lead to preterm birth, poor self-care, and a higher risk for severe postpartum depression.
• If you have anxiety of depression, a variety of medications can safely be used to help, like antidepressants, antihistamines, and others.
• Counseling or therapy can also be helpful for mental health.

What are signs that I should speak to a health care professional?

•  Early signs of pregnancy can include a missed period, nausea or vomiting (any time of day), breast tenderness or swelling, feeling tired, a heightened sense of smell, food cravings, mild cramping, and changes in your mood.
•  The most reliable way to know is to take a home pregnancy test, or see a healthcare provider for confirmation.
•  If you have been taking opioids every day for more than two weeks, you may be at risk for dependence and withdrawal.
•  It is important to tell your health care professional exactly how much you are taking, and for how long.

Support & Resources

• Pickens & Anderson Counties (SC): The MAiN Program (Managing Abstinence in Newborns) offers non-judgmental pregnancy support, hospital delivery care, postpartum nurse or social worker visits, and newborn supplies.
• Statewide (South Carolina): Access county-level care programs through the SC Resource Directory.
• Tobacco / Nicotine Cessation: Call 1-800-QUIT-NOW or visit quitnowsc.org for free state support.